Medicare Coverage for Erectile Dysfunction
- Read about diagnostics and treatments for erectile dysfunction, and learn which services are covered by Medicare. Get tips for finding affordable medications.
Erectile dysfunction affects around 30 million men in the United States and is especially prevalent among older men. While there are effective treatments available for the condition, Medicare coverage for erectile dysfunction is limited.
What Is Erectile Dysfunction?
Men with erectile dysfunction (ED) may have problems getting an erection, or they may be unable to keep an erection long enough to enjoy sex. Some men with ED can occasionally get an erection while others have lost the ability altogether. In the past, ED was also called impotence, but that term is less common now.
There are many causes of ED, and the condition can sometimes indicate a more serious health problem. Speaking with a doctor can help determine the cause of ED, which can include:
- Heart disease
- Medications, including blood pressure medications and antidepressants
- Depression and other psychological causes
- Alcohol or drug use
Although ED is more common in older men, it can occur at any age and isn't necessarily a part of normal aging.
Does Medicare Cover Erectile Dysfunction Doctor's Visits?
There is Medicare coverage for medical appointments related to erectile dysfunction. Medicare may cover:
- A visit with a general practitioner
- An appointment with a specialist such as a urologist
- Urine and blood testing
- Other diagnostic lab work
- Mental health appointments
You may wish to use this coverage to speak with a doctor because ED can impact your quality of life and sometimes indicate another health condition.
Does Medicare Cover Viagra or Cialis?
Medicare doesn't cover Viagra, Cialis or any other prescription drug to treat ED. Congress stopped allowing Medicare plans to cover drugs for erectile dysfunction in 2006. Neither Medicare Part D nor Medicare Advantage plans cover ED medications. Even though private insurance companies offer these plans, they must comply with federal Medicare rules.
Medicare does cover some drugs like sildenafil, the generic version of Viagra, but only if a doctor prescribes the medication for another condition such as severe high blood pressure. Generic versions of these medications are not covered if prescribed to treat ED.
Is There Medicare Coverage for Erectile Dysfunction Treatments?
Medicare doesn't cover injections that are sometimes used to treat ED. The FDA has approved some male vacuum erection systems, also known as penis pumps, to treat ED. Unfortunately, these aren't covered by Medicare either.
One ED treatment that Medicare does sometimes cover is a penile implant. A penile implant is a prosthesis that requires outpatient surgery and is considered medically necessary if medications and injections haven't worked. Medicare Part B may at least partially cover a penile implant for beneficiaries who qualify. To qualify:
- A beneficiary must have tried medications or injections without success
- The cause of the beneficiary's ED must be physical, not psychological
Qualifying beneficiaries still face some out-of-pocket costs. They usually must pay their Medicare Part B deductible and 20% of the Medicare-approved amount of the medical services.
Finally, Medicare covers treatment for many conditions that can cause ED, including diabetes and depression. Some men may have success treating their ED by dealing with the underlying medical problem.
Is There a Way to Get More Affordable Treatment for ED?
Treatments like Viagra, Cialis and penis pumps can be expensive without insurance coverage. Because there is little Medicare coverage for erectile dysfunction treatment, beneficiaries may look for other ways to afford doctor-prescribed ED medication. Some options include:
- Paying out of pocket for generic versions of medications, which are often significantly cheaper than the brand name drug
- Using pharmacy discount programs or coupons
- Purchasing medications from a reputable mail-order pharmacy
A doctor can also recommend a vacuum erection system, but the Medicare beneficiary will have to pay for the device's total cost out of pocket.