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Medicare does cover penile implants if your physician determines that a penile implant is deemed medically necessary.
If Medicare does pay for your penile implant surgery, a Medicare Supplement (Medigap) plan can help cover your out-of-pocket Medicare costs like deductibles and copays.
Medicare covers penile implants if considered medically necessary by your doctor.If Medicare Part B covers outpatient surgery or other care services associated with your penile implant, you should be prepared to pay a number of out-of-pocket costs:
Medicare Part B Deductible
Before Medicare will pay its share of the procedure, you must meet your Medicare Part B deductible. In 2024, the standard Part B deductible is $240 per year.
Medicare Part B coinsurance
Under Part B, Medicare recipients must pay 20% of all Medicare-approved costs of services.
Many men over 60 years old suffer from erectile dysfunction, or ED, an affliction that makes it hard to achieve or sustain an erection.
Well-known ED treatments include prescription medications, such as Viagra. But Viagra, despite its name recognition, isn’t covered by most Medicare Part D prescription drug plans.
That means seniors have to pay out of pocket for Viagra or seek another option.
One of those options is a penile implant. This is a medical prosthesis that is custom fit and placed, via surgery, in one’s penis in order to produce a natural-feeling erection.
Deciding between a penile implant and other options is a personal decision. Work together with your doctor to decide if a penile implant is the best option for you.
If you have a penile implant that is covered by Medicare, you may likely face out-of-pocket Medicare costs such as deductibles, coinsurance and copayments.
A Medicare Supplement Insurance (Medigap) plan can help cover some of these costs.
For example, each of the 10 standardized Medigap plans that are available in most states provide at least partial coverage for the Medicare Part B coinsurance or copayments you might face when you receive covered outpatient penile implant surgery.
Learn more about Medicare coverage of common procedures
A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.
Or call 1-800-995-4219 to speak with a licensed insurance agent.
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.
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareSupplement.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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