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Does Medicare Cover Penile Implants

Does Medicare Cover Penile Implants?

Erectile dysfunction is a common issue that affects many men. Especially senior men.

There are a number of treatment options for ED. We have articles about Medicare coverage for some of them in the articles here and here.

Sometimes those treatment options work. But sometimes they don’t. When they fail and the ED is clearly due to a medical issue that will not go away on its own, penile implants are an option.

These implants are basically a device that goes in the erection chambers of the penis. They are a few different types of penile implants that you can choose from. 

If your doctor thinks you are a candidate for these devices, a common question many people have is, “does Medicare cover penile implants?” In this article, we answer that question in clear, plain English. You will also find the average costs of penile implant surgery and other helpful info.

Does Medicare Cover Penile Implants?

The short answer is yes; Medicare will cover the cost of penile implants. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for them.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for penile implants. Because the procedure usually takes place in an outpatient setting, coverage often falls under Medicare Part B.

In order to get coverage, your doctor has to determine that the implants are medically necessary. However, Original Medicare does not need an official authorization (though Advantage plans may).

Medicare will usually consider the procedure medically necessary if you have tried other treatment options but they have not worked. These options include drugs, injections and/or vacuum devices.

The cause of the ED must not be psychological in nature in order to get coverage.

Also, you will need to have the surgery at a Medicare-approved facility in order to get your costs covered. 

If it goes through Medicare Part B, it will probably cover 80% of the costs. You will be responsible for the other 20% as well as the Part B deductible.

Part C Coverage

Just like with Original Medicare, Medicare Advantage plans (Medicare Part C) will generally cover the cost of penile implants. These supplemental plans cover everything Original Medicare covers and typically include some additional benefits as well. Exactly what the coverage is and how much your out-of-pocket costs are will vary depending on the specifics of your plan.

Part D Coverage 

After surgery your doctor may prescribe pain medications for you. If that is the case, you’ll need to rely on a Medicare Part D plan to help cover prescription drug costs. Or, if you have an Advantage plan, you may have drug coverage as part of your Part C plan.

How Much Does Penile Implant Surgery Cost?

Penile implant surgery is fairly pricey. The average cost for the procedure is around $17,500 for those who do not have insurance. 

For those with Medicare (either Original or Medicare Advantage) the average patient will pay around $2,750 for penile implant surgery.

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 in-home care?

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