Does Medicare Cover Sexual Dysfunction?

Last Updated : 09/10/20183 min read

The Cleveland Clinic defines sexual dysfunction as a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction with sexual activity. Certain health phenomenon more common for older people may result in sexual dysfunction.

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What causes erectile dysfunction?

Erectile dysfunction is a common type of male sexual dysfunction, according to the U.S. National Library of Medicine. Erectile dysfunction is when a man has trouble getting or maintaining an erection. According to the Cleveland Clinic, erectile dysfunction is increasingly prevalent with age. At age 70, nearly 70% of men experience erectile dysfunction. Erectile dysfunction can be a sign of other health problems. According to the Mayo Clinic, common causes of male sexual dysfunction could include:

  • Heart disease
  • High cholesterol and high blood pressure
  • Obesity
  • Diabetes
  • Alcoholism and substance abuse
  • Tobacco use
  • Sleep disorders
  • And more

Getting more exercise, losing weight and stopping smoking may help with sexual dysfunction in men according to the U.S. National Library of Medicine.

What causes female sexual dysfunction?

Female sexual dysfunction could involve low sexual desire, sexual arousal disorder, orgasmic disorder, and sexual pain disorder, according to the Mayo Clinic. Female sexual dysfunction could be caused by:

  • Cancer
  • Kidney failure
  • Heart disease
  • Bladder problems
  • Medications, such as antidepressants or chemotherapy drugs
  • Lower estrogen levels after menopause

According to the Mayo Clinic, the average age of menopause is 51. At menopause women may experience vaginal dryness and loss of elasticity which can cause discomfort and bleeding during sexual intercourse. This may result in reduced sexual libido.

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Does Medicare cover sexual dysfunction?

Medicare may cover services that help diagnose and treat the underlying causes of sexual dysfunction.

Medicare may cover:

  • Smoking and tobacco use cessation counseling (you may pay nothing)
  • Obesity screening and counseling (you may pay nothing)
  • Cardiovascular disease screenings (you generally pay nothing)
  • Diabetes screenings (You generally pay nothing)
  • Pelvic exams for women (you generally pay nothing)
  • Sleep studies (you generally pay 20% of the Medicare-approved amount)

Does Medicare Part D cover sexual dysfunction prescription drugs?

Medicare Part D covers many types of prescription drugs with some exceptions. You can get Part D coverage through a stand-alone Part D Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage. Unfortunately, agents used in the treatment of sexual dysfunction (including Viagra, Cialis, Levitra and Stendra) are on the list of prescription drugs excluded from Part D coverage.

Medicare Part D may cover prescription drugs to treat the underlying cause of your sexual dysfunction, such as heart disease or diabetes. Medicare may also cover hormone therapy for women experiencing menopause. To find out exactly what prescription drugs your Medicare Part D plan covers, check the formulary or list of covered medications. The formulary may change at any time and you will be notified when necessary.

Do you have questions about Medicare coverage of sexual dysfunction?

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