Medicare Coverage for Erectile Dysfunction (ED)

Medicare doesn’t typically cover erectile dysfunction oral medications or injections.

However, penile implant surgery is partially covered by Medicare for those who qualify.

Diagnosing erectile dysfunction, or ED, typically requires you to answer a few questions and undergo a physical exam from your doctor.

Besides penile implant surgery, therapy from a mental health professional is generally the only other treatment covered by Medicare for erectile dysfunction.

Your out-of-pocket Medicare costs to treat erectile dysfunction may be high, since prescription drugs to treat the condition aren’t covered.

Oral medications are often the first line of treatment for erectile dysfunction.

Unfortunately, Medicare generally does not cover brand-name prescription drugs used to treat erectile dysfunction, such as Viagra and Cialis.

Since 2006, Congress has banned Medicare Part D coverage of medications for erectile dysfunction.

In addition, most private Medicare Advantage plans with prescription drug coverage don’t cover oral or injectable ED medications.

These medications can be expensive without insurance. Drugs.com estimates that just two 100 milligram Viagra pills cost about $164.

However, generic versions of these drugs are now on the market for a fraction of the price.

It’s nearly always more affordable to purchase generic erectile dysfunction medications — such as sildenafil citrate, tadalafil and vardenafil — without insurance than to buy Viagra or Cialis.

For example, the average cash pharmacy price for sildenafil, the generic version of Viagra, costs about $197 for a 30-day supply, according to GoodRx.

Prescription coupons from GoodRx and similar companies can substantially reduce your out-of-pocket cost to as little as $12 to $25 a month.

Note that Medicare may cover sildenafil and another branded drug called Revatio when the drugs are used to treat pulmonary arterial hypertension, a serious high blood pressure condition in the lungs.

However, Medicare won’t cover these same drugs if prescribed for erectile dysfunction.

In 2015, CMS discontinued coverage for male vacuum erection systems and related accessories.

According to legislation at the time, vacuum erection devices — more commonly known as penis pumps — were excluded from Medicare coverage “in the same manner that erectile dysfunction drugs are treated in Part D.”

Medicare Advantage plans must comply with such federal decisions, so private Medicare plans likely won’t cover erectile pumps either.

Your urologist might know of pharmacies in your area where FDA-approved penis pumps are sold.

Medicare covers penile implant surgery for those who qualify.

A penile implant prosthesis is considered a medically necessary treatment for erectile dysfunction if noninvasive treatments — such as prescription drugs and injections — have been ineffective.

Your erectile dysfunction must also be the result of an organic rather than psychological cause.

You can expect to pay between $2,500 and $3,000 out-of-pocket for penile implant surgery, according to Coloplast, a company that develops and produces medical devices related to ostomy, urology and continence.

You may owe less for this surgery if you have supplemental insurance, such as Medicaid or a Medigap policy.

If you’re enrolled in a Medicare Advantage plan, your doctor may need prior authorization before scheduling your surgery.

Penile implant procedures typically take place on an outpatient basis and are covered under Medicare Part B.

After meeting your annual Part B deductible, you will owe 20% for doctor services and 20% for any separately billed items you receive during surgery. Hospital facility fees also apply.

Mayo Clinic defines erectile dysfunction, also known as impotence, as “the inability to get and keep an erection firm enough for sex.”

Symptoms of ED include trouble getting an erection, trouble keeping an erection and reduced sexual desire.

Underlying health conditions often contribute to erectile dysfunction. Other times, medications and other treatments may be necessary.

Some medications make it more difficult to keep or maintain an erection.

Other risk factors that may contribute to or worsen erectile dysfunction include alcohol and tobacco use, obesity, certain injuries and psychological conditions.

While ED is most common in older men, it can affect men at any age.