Living with erectile dysfunction can be embarrassing and can be trying for a couple’s intimate life. Fortunately, there are options for men who experience this condition to revive intimacy with their partners.
The medication and treatment options for this condition can be expensive, though. There are varying levels of erectile dysfunction and different types of treatment, depending on what someone responds best to.
If you are on Medicare to pay for your other medical costs you may be wondering if Medicare will also pay for the treatment for living with this condition.
Here’s what you need to know.
Does Medicare Cover Treatment For Erectile Dysfunction?
The short answer to this question is that it depends on the type of treatment being prescribed. There are a few different types of treatment a doctor can choose from when treating a patient for erectile dysfunction and the Medicare coverage will vary depending on what it is.
Erectile Dysfunction Pumps
Some men will prefer to use a pump which alleviate the symptoms of erectile dysfunction, and allows them to achieve and maintain an erection.
The pump works by using suction to pull blood into the penis, causing an erection. A ring is then placed at the base of the penis to allow the penis to stay erect.
Using a pump helps to alleviate the symptoms of erectile dysfunction (IE not being able to achieve or maintain an erection) rather than looking to treat the causes of it in an individual.
Medicare does provide coverage for a variety of medical equipment, but at this time it does not cover this type of treatment for lifestyle concerns. So treatment to enhance sexual activity would fall under a lifestyle concern, and therefore is not covered.
The benefits of Medicare are supposed to be reserved for medically necessary and lifesaving treatments, as ordered by a physician.
Knowing this, Medicare does not cover an ED pump unless using this device is a critical part of a treatment plan that is in place to treat a serious medical concern or condition.
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Treatment For Erectile Dysfunction While Hospitalized
If you are in a hospital of skilled nursing facility, Medicare benefits will generally cover you for all the care required during your stay. However, erectile dysfunction treatment would not, generally, be considered required or medically necessary care.
However, if the treatment was given out for testing in direct relation to the cause for hospitalization then there is a chance Medicare would continue to cover the cost of erectile dysfunction treatment while in the hospital.
Coverage For Off-Label Erectile Dysfunction Medications
Medicare does not cover the cost of vacuum pump treatments for erectile dysfunction, there may be a way to get coverage for other types of treatment and medications.
Since they cannot cover the prescription when it’s prescribed as a sexual aide or for sexually-related activities, some men get prescriptions for erectile dysfunction medications for reasons other than sexual needs.
There are many medications out there used for erectile dysfunction that have other uses to treat different medical conditions. For example, these types of medications often dilate vessels which can help improve blood flow.
Knowing this, some of these medications can be prescribed to treat cardiovascular conditions that are not in direct relation to any type of erectile dysfunction condition.
However, in order to get coverage for these specific medications it may be required that other medications and types of treatment have been tried for the condition that is not erectile dysfunction. Your doctor may also have to make a note that a certain medication is not being used specifically to treat erectile dysfunction.
So if this is the first attempt to get it covered by circumventing the process, you may not be able to get your doctor to prescribe for another reason.
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Ways To Save On Purchasing Erectile Dysfunction Medication
Since Medicare will not cover prescription medication when prescribed to treat erectile dysfunction, many men will be looking for other options as to how to purchase this medication within their budget.
Purchase The Generic Version
Many people will know the name brands, like Viagra or Cialis, but there are now generic versions on the market of these medications.
Drugs like sildenafil, which is a generic version of Viagra, can be almost a third of the price of a prescription for the brand name versions.
Additionally, the generic versions can also be covered under Medicare Part A when prescribed by a doctor for pulmonary hypertension and not for erectile dysfunction.
You will need to discuss these options with your doctor, though, and determine what is the best course of action for you. Your doctor cannot prescribe something for a condition you don’t have because this could jeopardize their license, but they may have some options for how to get these medications on a budget.
There could be a difference in price from pharmacy to pharmacy, so it could be in your best interest to shop around a little bit. There are also a couple web-based tools and smart phone apps that will allow you check prices and compare quickly.
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For some types of erectile dysfunction medication, you may be able to purchase pills in a higher dose. By buying them at a higher dose, and then splitting them to only take half at a time it could save you money in the long run.
Some pharmaceutical companies will offer free trials or help in purchasing these medications. Your doctor will be aware of any special offers or free samples that are being offered right now.
There are ways to make it affordable to purchase erectile dysfunction medications, and to help enhance your sexual life.
Medicare Coverage And Penile Implants
While Medicare will not cover a penis pump or a prescription for medication for erectile dysfunction, they do cover the surgery for penile implant for those patients who qualify under their conditions.
Why Is A Penile Implant Necessary?
This is a treatment that involves a prothesis and is considered medically necessary when non-invasive treatments, like medications and a penis pump, have not worked.
In these types of cases, the cause of the erectile dysfunction may be organic and not due to any type of lifestyle or psychological factors.
How Much Does Penile Implant Surgery Cost?
If you are paying out of pocket for this surgery, most patients can expect to pay somewhere around $3,000.
However, you may end up paying less if you have supplemental insurance like Medicaid or a Medigap policy.
For patients who have a Medicare Advantage plan, they may need to get prior authorization from insurance before even scheduling the surgery to be done.
When you’ve met your required deductible, you will still be responsible for 20% of the services and 20% of any treatment or items that are billed separately during surgery.
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What Causes Erectile Dysfunction?
The exact cause of erectile dysfunction is different for everyone. In some cases, it’s a psychological cause or something due to lifestyle – like a poor diet or smoking. For other men, it’s organic and could be a biological factor.
Symptoms Of Erectile Dysfunction
Erectile dysfunction is defined as the inability to get and keep an erection firm enough for penetrative sex.
In most cases, the symptoms of erectile dysfunction include difficulty getting an erection, keeping an erection and reduced sexual drive.
For many men, underlying health conditions will contribute to erectile dysfunction for men or can make the symptoms much worse.
Additionally, there are some medications taken for other conditions that can make getting an erection difficult for men. These can included
- High blood pressure drugs (antihypertensives)
- Parkinson’s disease drugs
- Medications for an irregular heart beat
- Muscle relaxants
- Chemotherapy drugs
- Prostate cancer medications
- Antiseizure medications
Lifestyle Factors For Erectile Dysfunction
Men who consume a lot of alcohol or smoke excessively may also have difficulties with erectile dysfunction as they age, or it may become an issue for them quicker than it would for other men.
It’s A Natural Thing
As men age, erectile dysfunction is a natural thing that happens. It can happen to men at any age, and it doesn’t necessarily relate to a lack of wanting to be sexually intimate.
It can be difficult on a relationship as one partner may feel rejected when the other is not able to participate in sexual activities. When this happens, reaching out to your doctor can help to look at different options for reliving the symptoms one is experiencing.
This could include medication or it could include a penile implant surgery if medications don’t work.
There will likely be some cost associated with it and it will not be completely free to the person needing help, but Medicare can sometimes cover some of the costs associated.
If you have questions about your specific coverage, it’s best to talk to your doctor to determine what your options are and how to best go about getting the right treatment for your specific cause of erectile dysfunction.
The majority of treatments out there will treat the symptoms of erectile dysfunction but not the cause, so it will allow men to participate in sexual activity but it will not fix the reason a man experiences it.