Erectile dysfunction affects a man’s genital parts, which prevents them from either having or maintaining an erection. One type of erectile dysfunction is known as Peyronie’s disease. The good thing about this medical condition is that it is treatable.
If you are looking for treatment for this condition, a common question many people have is, “does Medicare cover treatment for Peyronie’s disease?” In this article, we answer the question in clear, plain English.
Does Medicare Cover Treatment For Peyronie’s Disease?
The short answer is yes. Medicare will cover the cost of treatment for Peyronie’s disease. 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 your treatment for Peyronie’s disease. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for treatment for Peyronie’s disease. Medicare Parts A and B provide coverage for certain treatments for Peyronie’s disease such as surgery and injectable medications.
Original Medicare provides coverage for your treatment for Peyronie’s disease if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
Original Medicare provides coverage for visits to the doctor, certain injectable medications, and surgical treatment such as penile prosthesis and penile plication.
Part B Coverage
Most of the time, coverage for penile implant surgery is provided by Medicare Part B. That is because most of the time, penile implant surgery takes place in an outpatient setting.
However, for Medicare Part B to provide coverage for penile implant surgery, you must meet certain conditions. Medicare Part B provides coverage for penile implant surgery if it is medically necessary to treat erectile dysfunction as well as Peyronie’s disease.
Once approved, Medicare Part B covers 80 percent of the costs of bypass surgery. You will pay for the remaining 20 percent.
Part A Coverage
If you need an inpatient stay after your penile implant surgery, Medicare Part A will provide coverage for the cost. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days. For days 61 to 90, Medicare Part A will still provide coverage. However, you will pay a copayment each day your are in the hospital. After 90 days, Medicare Part A will no longer provide coverage.
However, Medicare Part A provides 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days but, again, you will have a sizeable copayment each day.
Medicare Part B also provides coverage for Xiaflex. Xiaflex is an injectable medication for treating Peyronie’s disease. Medicare Part B will provide coverage for your Xiaflex if it will be administered by your healthcare provider.
Part C Coverage for Treatment for Peyronie’s Disease
Medicare Advantage plans (Medicare Part C) also provide coverage for treatment for Peyronie’s disease. They cover everything Original Medicare covers, as well as offer coverage for some things that Original Medicare does not cover. However, the coverage and costs will vary from plan to plan.
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 Testopel?