Does Medicare Cover Penile Implants?

If you are required to undergo surgery to receive a penile implant, you will want to know how to cover the costs associated with the procedure. In addition to the cost of the surgery itself, you will need to pay for testing and follow-up doctor’s visits.

Does Medicare Cover Penile Implants?

The good news is that Medicare Part B and Medicare Advantage (Part C) plans offer coverage for the operation as long as your doctor can prove that it is medically necessary.  

You need to review the details of your plan to determine how much coverage you qualify for, as this can be different depending on where you live. Since Medicare Part B covers this procedure, the Medicare Advantage Plan is also required to, but there may be additional requirements to meet in order to receive coverage. Make sure that all of the doctors and facilities that you visit are approved by your plan to avoid being denied coverage. 

Your financial responsibility for treatment will depend on whether you receive treatment at an outpatient facility or ambulatory surgery center. Medicare Part B typically covers 80% of the costs if you have met your deductible for the year. You may need to cover the remaining 20% unless you have a Medicare Supplement plan. Medicare Advantage plans are required to cover any procedure covered by Medicare Part B, but each plan differs in its coverage amount and qualification requirements. 

Make sure that you inform your doctor that you have a Medicare Advantage plan so that you can work together to ensure all of these requirements are met and that you know how much it will cost you out of pocket.  

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Who Requires a Penile Implant Operation? 

Penile implants are considered a final treatment option for those who have tried other erectile dysfunction treatments and seen little or no results. You may be prescribed medications first and advised to use devices that are meant to help you achieve an erection. Only after these alternatives fail will you be advised to undergo surgery. 

Penile implants are also used to treat a condition called Peyronie’s Disease. This condition can make it painful to achieve an erection due to a buildup of scar tissue in your penis. This can cause an unnatural degree of curvature in your penis and make it painful to have sex. Surgery is one of the most effective ways to treat the condition. 

Talk to Your Doctor About Coverage Options 

Even though surgery for penile implants is covered under both Medicare Part B and the Medicare Advantage plans, you do need to work with your doctor to get the procedure and all related care approved. This may require sending in paperwork and getting approvals prior to undergoing the operation. The mistake many people make is not following the guidelines for receiving coverage.  

Medicare may not provide upfront coverage, meaning that you will receive reimbursement instead of a direct payment to your doctor. Keep this in mind when planning for your procedure. Most penile implant surgeries can cost over $16,000, which means you will be responsible for up to $3,200 and 20% of the cost of postoperative care if you don't have supplemental insurance.