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A vasectomy is a type of procedure that can prevent pregnancy in an effective way. It has a near 100 percent success rate. This procedure disconnects the tubes that allow the sperm to join with the semen in the body.
If this is a procedure you are thinking about getting, a common question you likely have is “does Medicare cover a vasectomy?” In this article, we answer that question in clear, plain English. You will also find the average costs of the vasectomy and other helpful info.
Does Medicare Cover a Vasectomy?
The short answer is no. In almost all cases, Medicare will not cover the cost of a vasectomy procedure. Though there are some related procedures that Medicare may cover is certain situations. Below find out about why Medicare does not cover vasectomies and what other similar procedures it might cover.
Original Medicare
Original Medicare (Medicare Part A and Part B) does not provide coverage for a vasectomy procedure. So that means you will have to pay 100 percent for your vasectomy procedure. The reason as to why Original Medicare does not provide coverage for a vasectomy procedure is that because they are not considered medically necessary.
Original Medicare does not provide coverage for a vasectomy procedure because they are considered as an elective procedure rather than a medically necessary one.
An elective procedure is a type of procedure that you chose to have rather than a medical procedure that you need to treat a certain illness or medical condition. And because the nature of a vasectomy procedure is elective rather than a medically necessary one, Original Medicare does not provide coverage for it.
According to the Centers of Medicare and Medicaid Services also known as CMS, Original Medicare does not provide coverage for the following procedures:
- Elective hysterectomy
- Tubal ligation
- Vasectomy
But in some cases, Original Medicare provides coverage for a hysterectomy procedure as long as it is medically necessary and it is not elective. Original Medicare provides coverage for a hysterectomy treatment if it is for treating endometriosis.
Part C Coverage for Vasectomy
However, Medicare Advantage plans (Medicare Part C) provide coverage for a vasectomy procedure. Medicare Advantage plans cover everything Original Medicare covers and some additional benefits. However, coverage and out-of-pocket costs will vary depending on the specifics of your plan.
How Much Does A Vasectomy Cost?
The average cost of a vasectomy ranges from $300 to $3,000. This cost depends on the type of vasectomy and the healthcare provider.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover DBT therapy?
