Does Medicare Pay for Viagra? - Medicare Consumer - Medicare Consumer

Does Medicare Pay for Viagra?

Original Medicare, which is Medicare Part A and Part B, provides very limited coverage for prescription medications. Therefore, this part of Medicare does not offer coverage for Viagra. Currently, the stand-alone prescription drug plans – Medicare Part D – also do not provide coverage for this particular drug, as well as for similar drugs such as Cialis.

However, it has been proposed that as of January 1, 2016, there may be some Medicare Part D prescription drug plans that will start covering Viagra on their formulary. A formulary is the list of drugs that a Medicare Part D plan will cover. In doing so, this could add up to big savings for Medicare Part D enrollees, as even just a monthly supply of 10 pills can cost in excess of $200.

Similar to with Medicare Part D plans, it is also possible that some Medicare Advantage plans – also referred to as Medicare Part C – may being offering coverage for Viagra in early 2016. Because Medicare Advantage plans are offered by private, individual insurance carriers and not directly through Medicare, each of these plans can differ in terms of what it offers, as well as in what each costs. With that in mind, it is important to check out the options of several different Medicare Advantage plans prior to moving forward with a purchase, if this is the route that you choose to receive your Medicare benefits.

 

Viagra Alternatives That Are Covered By Medicare

Although Medicare does not presently cover the cost of Viagra, there are possible alternatives for Medicare enrollees. For example, durable medical equipment, or DME, is covered under Medicare Part B (Medical Insurance) – and erectile dysfunction pumps are considered to be durable medical equipment.

In this case, the Medicare enrollee would need to pay 20 percent of the Medicare-approved amount. In addition, the annual Medicare Part B deductible would also apply. In 2015, the amount of this deductible is $147.

It is important to note that your doctor and medical equipment supplier would need to be enrolled in Medicare and they would also need to accept Medicare assignment. Otherwise, Medicare will not pay for the claims that these entities submit. With this in mind, it is important that you inquire of your doctor and your medical equipment supplier whether or not they are enrolled in Medicare and whether they accept Medicare assignment prior to making a durable medical equipment purchase.

 

Covering Additional Expenses

Just like Original Medicare and Medicare Advantage, Medicare Supplement insurance plans do not cover the cost of Viagra. However, these plans may cover your out-of-pocket expenses for the erectile dysfunction pump, as this is considered to be durable medical equipment (DME).

In order to determine more accurately how much your equipment will actually cost, you should check with your doctor and / or your medical equipment supplier. This is because the cost is factored by a number of criteria, such as any other insurance that you may have, and where you purchase your equipment from.

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