What Does Medicare Cover for Erectile Dysfunction (ED)?

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Millions of men suffer from symptoms of erectile dysfunction (ED) in the United States. Roughly 15-25 percent of those men are at least 65 years old. 

What is erectile dysfunction?

Erectile dysfunction (ED) is when a male cannot get or keep an erection firm enough to have sexual intercourse. It is sometimes referred to as impotence, although that term has become less common.

It is not uncommon for men to experience occasional ED, but if ED is experienced frequently, it could be a sign of health problems such as diabetes or high blood pressure. Men may experience symptoms of sexual dysfunction from certain physical or psychological conditions that may include:

  • Medical conditions
  • Substance abuse
  • Psychological conditions
  • Medications used to treat many medical conditions or surgeries that involve the prostate or spinal cord may also contribute to sexual or erectile dysfunction in men. 

Treating erectile dysfunction

Treating erectile dysfunction may be done through many different outlets. Some of the common options are psychological therapy, prescription drugs, surgery, or certain kinds of medical equipment, such as a penile pump. Corrective surgery is also an option that involves implants that are surgically placed and may be inflatable or bendable to help control erections.

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What does Medicare cover?

ED drugs are not deemed medically necessary by Medicare, which is why they don’t offer coverage for these drug costs in most cases. If you have a Medicare Part D plan, it may cover the drug Cialis, if prescribed for bladder outlet obstruction or signs of benign prostatic hyperplasia (BPH). Your doctor must diagnose the problem before coverage begins.

Viagra is the most popular drug for ED treatment, but Medicare will not pay for this brand-name medication. However, Medicare Part D may offer coverage for generic versions of Viagra.

Some Medicare Advantage plans offer coverage for drugs like Viagra. Even if your plan covers the drug, it could still be expensive for you. Your cost varies based on your plan.

Another ED treatment option is penile implant surgery. Both Medicare and Medicare Advantage coverage will cover the costs of a penile implant surgery as long as it is deemed medically necessary by your doctor.

Since a penile implant surgery is considered an outpatient procedure, Medicare Part B will cover 80 percent of the Medicare-approved costs. You will be responsible for the remaining 20 percent.

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