Original Medicare does not generally cover vasectomies or other elective surgeries unless considered medically necessary. Medicare Advantage plans may cover the procedure.
This article discusses vasectomy and Medicare coverage. It also looks at elective surgeries and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
A person can get a vasectomy at various places, including a doctor’s office, hospital, health clinics, or Planned Parenthood health centers.
A vasectomy stops sperm entering semen and thereby prevents pregnancy, and is a form of permanent sterilization. More than half a million men undergo the procedure every year, according to the Urology Care Foundation.
The surgical procedure involves cutting the
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 get to one of the vas deferens. The tube is then cut, with the ends either sutured or seared. The procedure is repeated on the other tube.
The no-scalpel vasectomy involves the urologist making a small hole in the scrotum skin, and stretching it to enable the vas deferens to be lifted and cut. The ends are then seared or sutured, and replaced in the testicle area.
Although a surgeon can, in some cases, reverse a vasectomy, they cannot guarantee success.
Are there alternatives to a vasectomy?
Medicare is a federal health insurance program. Original Medicare (Part A and Part B) provides coverage for hospital and medical insurance.
Medicare Part A provides coverage for care as an inpatient in a hospital or a skilled nursing facility. It may also cover nursing home, hospice, and home healthcare. Because urologists often do vasectomies on an outpatient basis, Part A does not cover the cost.
Medicare Part B is medical insurance covering medically necessary services as an outpatient, including doctor’s visits and diagnostic services. It also covers ambulance services and durable medical equipment. If a person chooses to have a vasectomy for non-medical reasons, Part B will not cover the cost.
Part C (Medicare Advantage) is considered 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, it may cover a vasectomy as part of the benefits package.
In addition, if a person has a Medicare savings account (MSA), they may use the funds to pay out-of-pocket costs. In general, an MSA is linked to a private insurance plan with a high deductible.
Medicare Part D helps with the cost of both generic and brand-name drugs. The plans are offered by Medicare-approved private insurance companies, and some Medicare Advantage plans offer coverage for prescription drugs.
Part D plans all offer a standardized level of coverage including a list of the covered drugs, called a formulary. Within the formulary, a company will list drugs in various tiers, plus a specialty tier. Copay amounts vary and generally depend on the tier in which a drug is categorized.
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– $1,000, depending on various factors:
- where the vasectomy is done
- the kind of surgery
- whether or not a person has health insurance
- if a person has Medicaid or any other government program
Many Planned Parenthood health centers accept health insurance, including Medicaid. Costs are often based on a person’s income. A person can use this online tool to find a health center in their area.
If a person has a Medicare Advantage plan, they can check to see if the plan offers coverage. A person may have related out-of-pocket costs such as deductibles, copays, and coinsurance.
Medicare does not consider a vasectomy a medically necessary procedure, so original Medicare will not cover the cost. Medicare Advantage plans may offer coverage. A person can check with their plan provider to find out if coverage extends to vasectomies.