For men on Medicare, there may be questions about coverage options for a vasectomy. A vasectomy is almost 100 percent effective in preventing pregnancy but is not usually deemed medically necessary for other purposes.
What is a vasectomy?
A vasectomy is considered to be a simple outpatient surgery. The surgery can be done with an incision or a non-scalpel method. During the procedure, the tubes that carry sperm through the body are either blocked or cut.
It is common for people to confuse what the procedure is, but it is not an operation on the penis. In an incision vasectomy, the doctor will make small cuts to the scrotum, and a non-scalpel procedure is when the doctor makes very small punctures to reach the tubes in the scrotum. Both methods are effective at blocking sperm from leaving the body. A vasectomy procedure usually causes minor temporary pain, and will not affect sexual performance in the long term.
The costs of a vasectomy usually range from around $300 to $3,000. Your cost will depend on where your procedure is done, what kind of vasectomy you get, and what kind of health coverage you have.
Medicare Advantage coverage of vasectomy
Medicare Parts A and B will not cover a vasectomy because it is not usually ruled as medically necessary but as a form of birth control. However, if you have a Medicare Advantage plan, you may have options.
While Medicare Advantage is required to offer the same coverage as Medicare Part A and Part B, some plans may have additional benefits. Check with your Medicare Advantage plan to see if it will cover a vasectomy.
A Medicare supplement plan (Medigap) may also cover some out-of-pocket Medicare costs, including copays and deductibles, but these plans generally will not cover the costs of a vasectomy either.
Other coverage
If you feel like you need a vasectomy, it may be in your best interest to ask your doctor if there are any other options for you to prevent pregnancy. Your healthcare provider may be able to point you in the direction of less expensive options.
Talk to your doctor about your options before moving forward with any type of surgery or procedure.
Vasectomy reversal
A vasectomy reversal procedure is possible, but is not covered by most insurance providers and can be very costly. The average costs of a vasectomy reversal are between $3,000 and $15,000. The procedure is not always successful, but it is a possibility. Vasectomy reversal can be done even up to 15 years after the vasectomy was completed. Medicare will not cover the costs of a vasectomy reversal.
