Medicare and Sexual Health
Maintaining a healthy sex life as you age is an important part of overall health and wellness. Although it does not cover everything, Medicare does cover some tests and services that can help improve your sexual health.
What Medicare Covers
STI Screenings and Counseling
Sometimes overlooked by older adults, getting screened for sexually transmitted infections is very important for this demographic. In fact, cases of syphilis among seniors spiked nearly 29 percent between 2017 and 2018, the highest increase among any age group.
Thankfully, Medicare recipients can get screened for certain STIs and pay nothing out of pocket. Medicare Part B covers the full cost of STI screenings for chlamydia, gonorrhea, syphilis and Hepatitis B every 12 months.
If you are at increased risk for contracting an STI, you may also be eligible for up to two 20- to 30-minute behavioral counseling sessions a year to discuss safe sexual practices and help you curb risky behaviors.
Some factors that could put you at increased risk for contracting an STI include:
Using condoms inconsistently
Having multiple sexual partners
Having sex under the influence of drugs or alcohol
Having contracted an STI within the past year
Having used IV drugs
Having sex with other men if you are also a man
In order for Medicare to cover these counseling sessions, they must take place in person and in a primary care setting (such as a doctor’s office).
Female Hormone Therapy
Decreased estrogen levels after menopause can have some uncomfortable consequences for women’s sexual health, including decreased libido and vaginal dryness.
Thankfully, many Medicare prescription drug plans (stand-alone Medicare Part D plans or Medicare Advantage plans that offer drug coverage) cover hormone replacement drugs and suppositories used to treat vaginal dryness caused by menopause.
Original Medicare (Medicare Part A and Part B) does not typically cover prescription drugs, so if you need help covering hormone replacement drugs, you may want to consider purchasing a separate prescription drug plan.
You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.
Penile Implant Surgery
Medicare does not cover erectile dysfunction drugs such as Viagra and Cialis, but you may not be entirely out of options.
Medicare does cover penile implant surgery, which can help men with ED achieve an erection through the insertion of a small device into the penis.
There are a few different types of penile implant options, depending on your personal medical needs. Typically, doctors may recommend penile implant surgery when the cause for ED is clear and unlikely to resolve through other less invasive medical treatments.
Besides penile implant surgery, therapy from a mental health professional is the only other possible treatment for ED covered by Medicare.
Although psychotherapy can take time, it can be an effective remedy when the reasons for dysfunction stem from a mental illness or other psychological factors.
Stress and mental health concerns are some of the most common causes for erectile dysfunction, which might not be successfully treated by simply taking a Viagra.
Psychotherapy can also be effective for women with trouble achieving arousal when the problems are caused by similar mental factors.
What Medicare Doesn’t Cover
Viagra and Other Pills
Beyond implant surgery and psychotherapy, Medicare does not cover treatment for erectile dysfunction.
Viagra is not typically considered medically necessary, which means it does not meet the standard for Medicare coverage.
Because Viagra is not covered by Medicare, Medicare beneficiaries must pay 100% of the prescription costs if they choose to use the drug. The same is true for Cialis, Levitra and other popular drugs used to treat erectile dysfunction (ED).
Medicare Part D prescription drug plans and some Medicare Advantage (Medicare Part C) plans may cover other prescription drugs used to help treat men's sexual health. However, these plans do not typically cover Viagra.
Pills prescribed for women to help improve libido and sexual function are also not covered by Medicare.
Vacuum Erection Devices
In 2015, Congress voted to stop funding coverage for a lesser-known ED treatment informally referred to as “penis pumps.”
These pumps work by using a vacuum and constriction ring to help the penis stay erect and are considered a safe and effective alternative to traditional pills. However, if you choose this treatment while on Medicare, you will be responsible for paying the full cost.
Learn more about common procedures that medicare covers.
Medicare Supplement Insurance Helps Cover Out-of-Pocket Costs
Medicare Supplement Insurance (Medigap) can help cover some of your out-of-pocket costs for Medicare-approved sexual health treatment.
If you have questions about Medicare Supplement Insurance or want to learn more about how you can spend less at the doctor, call to speak with a licensed insurance agent today.
Find Medigap plans in your area.Compare Plans
Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.