Does Medicare cover penile implants?
This article was updated on: 09/10/2018
A study published by the U.S. National Library of Medicine suggested that 67% of men age 65 and over had some level of erectile dysfunction (ED), and in nearly half (48%) the condition was severe. If your doctor has ruled out other treatments for ED such as medication or a penile pump, you may be a candidate for penile implant surgery.
This article will explain what penile implants surgery is, discuss the risks, help you estimate penile implant cost, and explain your benefits if you are covered under Medicare.
What is penile implants surgery?
The Mayo Clinic describes penile implants surgery as a procedure in which inflatable implants or semi-rigid rods are placed inside the penis to help you achieve an erection.
Penile implants surgery is usually performed on an outpatient basis; it’s a fairly short procedure, typically lasting about 45 minutes. You may get general anesthesia for penile implants surgery, or your doctor may recommend spinal anesthesia to block all sensation below the waist.
After the surgery, your doctor may recommend pain medication for a period of time; you may also need to take antibiotics to prevent infection. Most men return to full physical and sexual activity after about four to six weeks following penile implant surgery.
The Mayo Clinic calls penile implant surgery the most invasive and expensive treatment for ED, but notes that most men are satisfied with the results.
Are there risks involved with penile implants surgery?
All surgical procedures carry risk, but the Mayo Clinic lists the following risks specifically associated with penile implants surgery:
- Infection, especially if you have diabetes or a spinal cord injury.
- Malfunctioning penile implants that may require removal and replacement.
- Erosions or adhesions around the penile implants themselves.
How much does a penile implant cost?
Your penile implant cost could vary considerably depending on a number of factors, including where the surgery is performed, the type of anesthesia used, and even where you live.
You will generally have to pay anesthesia costs, which include both the services of the anesthesiologist and any anesthesia medications, surgeon fees, hospital or outpatient surgery center fees, the costs of the penile implants, any laboratory and diagnostic tests performed before and during the penile implants surgery itself, plus costs for miscellaneous medications and surgical supplies. This is by no means an exhaustive list, but it does cover most of the main expenses in penile implants surgery.
Does Medicare cover the penile implant cost?
Medicare coverage of sexual dysfunction in men and women is very limited. Generally speaking, it may cover doctor visits and diagnostic tests to identify the cause of any sexual dysfunction, and Medicare may also cover certain medical treatments that focus on underlying causes of sexual dysfunction such as obesity, heart disease, and diabetes.
However, prosthetic devices such as a penile pump are excluded from coverage under Medicare, which suggests that the penile implant cost would also be excluded from coverage.
If you have Medicare Part D coverage for prescription drugs, medications that treat underlying medical causes of erectile dysfunction should be covered under your plan. However, drugs specifically targeted at ED such as Viagra, Cialis, and Levitra are currently excluded from coverage under Medicare Part D.
Your Part D prescription drug coverage may cover costs for medication associated with your penile implant surgery, such as pain medications and antibiotics, if prescribed by your doctor.
Need more information about Medicare and penile implant surgery?
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