Does Medicare Cover a Vasectomy?

Medicare Benefits Solutions
Oct 20, 2020

Many men consider a vasectomy when they’re weighing their family planning options. While the procedure does not prevent anyone from getting or giving sexually transmitted illnesses, it is considered a very effective form of birth control.

Medicare Coverage for a Vasectomy

A vasectomy serves no medically necessary purpose, and so it’s considered an elective procedure. Original Medicare coverage, known as Part A (hospital insurance) and Part B (medical insurance), does not cover elective procedures like this. 

If you have Medicare insurance with a Part C plan (also known as a Medicare Advantage plan), you may have some options available. These plans contract with Medicare insurance to provide Part A and Part B benefits bundled together with certain extra benefits, like routine dental and vision care. However, since these plans are provided by private insurers, these enhanced benefits are at their discretion to provide — which means some insurers could offer reproductive health benefits like vasectomies.

Beyond that, there may still be ways to cut your out-of-pocket costs. If you have a prescription drug plan, the medications your doctor may prescribe following a vasectomy could be covered by that PDP. Your plan’s representative can help you determine which medications would be included in that coverage and which aren’t.

What is a Vasectomy?

Tubes known as the vas deferens connect a man’s testes to his urethra, which allows for the transportation of sperm via semen during climax. A vasectomy is a surgical procedure that disconnects those tubes so that sperm cannot then enter the semen, leaving the man infertile but still sexually functional.

The procedure is done as an outpatient service that typically takes a couple of hours and involves local anesthetic unless general anesthesia is recommended or requested. You can expect offices that offer more advanced, less invasive procedures and more conveniences like general anesthesia to charge more than providers that use conventional scalpel procedures and local-only anesthesia.

Men who have undergone a vasectomy do report a moderate level of postoperative pain, but the procedure is considered a safe and tolerable one by most patients and healthcare professionals. Common medications used after the surgery include pain-relieving and antibiotic creams, as well and oral pain relievers and anti-inflammatory medication. Practical pain remedies, like an ice pack, may also be recommended for postoperative care.

Depending on the type of vasectomy performed, it may be possible to reverse the procedure if a man decides he would like to explore his reproductive options again. Even in surgeries where reversals are possible, it’s not a guaranteed result — and the longer it is between the vasectomy and a reversal, the less likely it is that the reversal will be successful. A reversal requires a more invasive procedure, however, so it may require general anesthesia instead of local-only anesthesia.

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