Original Medicare does not generally cover vasectomies or other elective surgeries unless doctors consider them medically necessary. Medicare Advantage plans may cover the procedure.
Medicare is a federal health insurance program in the United States for people ages 65 or older and some younger individuals with certain disabilities. A vasectomy is a surgical procedure and a form of permanent male birth control.
Generally, Medicare will not cover a vasectomy as health experts do not consider it to be medically necessary. Instead, a doctor will categorize the vasectomy procedure as an elective surgery, as it is a procedure that a urologist will schedule in advance due to it not being a medical emergency.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
A vasectomy is a type of permanent male contraception. It is a surgical procedure that
The two types of vasectomy procedures include conventional and no-scalpel.
During a conventional vasectomy, the urologist makes small cuts in the scrotum skin to access one of the vas deferens. They then cut the tube, sear or suture the ends, and repeat the procedure on the other tube.
The no-scalpel vasectomy involves the urologist making a small hole in the scrotum skin and stretching it to enable lifting and cutting the vas deferens. They sear the ends, suture them, and replace them in the testicle area.
Although a surgeon can sometimes reverse a vasectomy, they cannot guarantee its effectiveness.
A person can get a vasectomy at various places, including a doctor’s office, hospital, health clinics, or Planned Parenthood health centers.
Are there alternatives to a vasectomy?
Temporary birth control methods include barrier methods such as condoms and diaphragms and hormone methods such as the contraceptive pill, patch, and implantable devices.
Medicare is a federal health insurance program. Original Medicare (Part A and Part B) provides coverage for hospital and medical insurance. However, Medicare will only cover medically necessary inpatient and outpatient surgical procedures. Therefore, Original Medicare will not typically cover a vasectomy, as it is an
Part A
Medicare Part A provides coverage for care as an inpatient in the hospital or skilled nursing facility. It may also cover nursing homes, hospices, and home healthcare. Additionally, urologists often perform vasectomies on an outpatient basis, so Part A will not cover the cost.
Part B
Medicare Part B is medical insurance that covers medically necessary outpatient services, including doctor’s visits and diagnostic services. It also covers ambulance services and durable medical equipment. However, if a person chooses to have a vasectomy for non-medical reasons, Part B will not cover the cost.
Part C (Medicare Advantage) is an alternative to Original Medicare, with plans offered by private companies. All plans must provide at least the same coverage as Original Medicare and may offer additional benefits.
Depending on the plan, a vasectomy may be part of the benefits package. For example, the
In addition, if a person has a Medicare savings account (MSA), they may use the funds to pay out-of-pocket costs. An MSA generally relates to a private insurance plan with a high deductible.
Medicare Part D helps with the cost of both generic and brand-name drugs. Medicare-approved private insurance companies offer the plans, and some Medicare Advantage plans offer coverage for prescription drugs. As such, Part D will not cover the vasectomy procedure.
Part D plans all offer a standardized level of coverage, including a list of the covered drugs, called a formulary. A company lists drugs in various tiers, including a specialty tier within the formulary. Copay amounts vary and generally depend on the drug’s category tier.
Medicaid is a federal program that helps people with low incomes and resources, although criteria vary between different states.
If a person does not have private health plan insurance, they may get assistance from a federally qualified health center (FQHC). As with Medicaid, the coverage is means-tested and depends on a person’s income.
According to Planned Parenthood, the cost of a vasectomy ranges from $0 to $1,000, depending on various factors:
- where a person has the procedure
- the kind of surgery
- whether or not the individual has health insurance
- if a person has Medicaid or any other government program
Many Planned Parenthood health centers accept health insurance, including Medicaid. Costs can vary depending on income. The organization’s online tool allows people to find a health center in their area.
A person with a Medicare Advantage plan can check to see if it offers coverage. Related out-of-pocket costs may include deductibles, copays, and coinsurance.
Generally, Medicare does not consider a vasectomy a medically necessary procedure, so Original Medicare will not cover the cost. However, Medicare Advantage plans may offer coverage. A person can check with their plan provider to determine if coverage extends to vasectomies.
