Does Medicare Cover Viagra?
Learn about Medicare’s coverage for Viagra and how you can potentially get it covered by your health insurance.
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Since it first became available back in 1998, Viagra has become one of the best-selling drugs in the world.
While it was intended to treat high blood pressure, its other approved use has made it a popular choice for older men. But, will Medicare cover Viagra prescriptions and how much will it cost?
This article will discuss Medicare coverage for Viagra and help you find out how to save on prescription drug costs.
What Is Viagra?
Viagra is the brand name of Sildenafil, a medicine originally developed to treat hypertension, but it was later found to treat erectile dysfunction (ED), too.
It is just one of many different drugs out there that can treat erectile dysfunction in men. Some other medications that are also prescribed to treat erectile dysfunction include Cialis and Levitra.
While Viagra has proven benefits in the treatment of erectile dysfunction, certain people can experience side effects from taking this drug.
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Common side effects of Sildenafil include:
Flushing (warmth, redness, or a tingly feeling).
Headaches, dizziness.
Abnormal vision (blurred vision, changes in color).
Runny or stuffy nose, nosebleeds.
Sleep problems (insomnia).
Muscle pain.
Back pain.
Upset stomach.
Until 2017, Viagra was exclusively made by Pfizer; however, there are other manufacturers of the drug in the U.S. Remember that it's a prescription medication in the U.S., which means you must see a doctor in order to get it.
What Are the Common Causes of Erectile Dysfunction?
There are multiple causes for erectile dysfunction, including:
Age.
High blood sugar (diabetes).
High blood pressure.
Cardiovascular disease.
High cholesterol.
Smoking or the use of tobacco products.
Using drugs or drinking excessive amounts of alcohol.
Obesity.
A lack of exercise or physical activity.
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What Is Medicare?
Medicare is a federal health program aimed at people over the age of 65. However, it also covers certain disabled individuals and people who suffer from ESRD (End-stage Renal Disease) and ALS (Lou Gehrig’s).
The Medicare program has four parts - Part A, B, C, and D.
Part A: This is hospital insurance or in-patient coverage for Medicare beneficiaries. It pays for treatments, tests, and services that people receive while they are admitted patients in a hospital.
Part B: This is general medical coverage for outpatient costs, such as visiting your doctor. It also covers preventive treatments, screenings, and tests.
Part C: This is now known as Medicare Advantage and is made up of private health care plans that Medicare beneficiaries can join.
Part D: This relates to private prescription drug coverage plans that people can buy to cover the cost of certain prescription drugs.
Any Medicare beneficiary can either join Original Medicare, Medicare Advantage, a Part D Prescription Drug Plan, or get Medicare Supplement Insurance (Medigap).
| Original Medicare | Medicare Advantage |
|---|---|
| Original Medicare covers Part A (in-patient) and Part B (outpatient) costs. | Medicare Advantage can cover Part A and Part B expenses. In some cases, it can cover Part D expenses too. |
| Original Medicare beneficiaries can also join a Part D PDP or get Medigap Coverage to help pay for out-of-pocket costs. | Medicare Advantage members cannot join a Part D (Medicare Prescription Drug Plan) and cannot get Medigap. |
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Will Original Medicare Cover Viagra?
In general, Original Medicare will not cover Viagra for erectile dysfunction as it is not medically necessary.
Medicare only covers medicines, procedures, screenings, tests, and services that will treat or relieve the symptoms of one of their covered conditions.
For example, if you have mobility issues, you can claim certain costs back from the CMS (Centers for Medicare and Medicaid Services), including a wheelchair, pain medication, and physiotherapy.
How Do I Find Out What Is Covered by Medicare?
There are several ways to check whether or not a treatment, service, test, or item is covered by Medicare.
✅ You can Google the term and see whether or not there are articles that mention if your specific test, treatment, service, or item is covered.
✅ You can call the Centers for Medicare and Medicaid Services (CMS) and ask them.
✅ You can speak to your local SHIP (State Health Insurance Program) and find out from them.
✅ You can call PolicyScout’s team of experienced Medicare agents with your questions and they’ll happily answer them.
The one exception is if your doctor prescribes Viagra for high blood pressure in your lungs. However, you’ll need to check with your doctor before you take this route as it may not be the best or only course of treatment if you suffer from pulmonary hypertension.
What about Cialis and Levitra?
Medicare doesn’t cover other erectile dysfunction drugs, such as Cialis and Levitra. However, you may be able to get generics of these drugs covered under a Part D Prescription Drug Plan.
If you’re interested in finding out what plans are available in your area, reach out to one of our agents today at 1-888-912-2132 or send an email to help@policyscout.com to get help.
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Does Medicare Part D Cover Viagra?
In general, Medicare Prescription Drug plans won’t cover erectile dysfunction medication such as Viagra. Unfortunately, the cost of most medications to treat ED will have to be funded out-of-pocket.
What Does Out-of-Pocket Mean?
Typically when an expense is covered by Medicare, there are still some charges that beneficiaries need to cover. These are deductibles, coinsurance, and co-payments.
Out-of-pocket means that you won’t be covered at all by your health insurance for an expense and you will need to fund it on your own.
For example, let’s say you go to the doctor and he prescribes you medication.
If the medication is covered by Medicare and you have Part D coverage, you’d be able to claim this expense and would need to pay a small co-pay when you collect your medication.
However, if the medication isn’t covered by Medicare, you would need to pay for the entire cost of the drugs.
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Will Medicare Advantage Cover Viagra?
While Medicare Advantage Plans offer the same minimum level of coverage as Original Medicare, some plans do offer additional benefits to their members.
Some Medicare Advantage Plans may cover Viagra; however, it will depend on the plan you’re on and how much you pay each month in premiums.
For example, if you are part of a top-end MA-PD Plan, Viagra may be covered by your health plan. However, if you are on a basic MA Plan, you probably won’t be able to get the cost of erectile dysfunction medication covered by your health insurance.
MA-PD vs. MA Plans
MA-PD Plans are Medicare Advantage Prescription Drug Plans that also offer coverage for Part A and Part B expenses, as well as Part D (Prescription Drug Coverage) costs.
MA Plans don’t cover Medicare Part D expenses and will only cover Part A and B costs.
There are also other types of Medicare Advantage Plans that beneficiaries can join, including Special Needs Plans and Medical Savings Account Plans. To learn more about these, check out our article on Medicare Advantage.
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It’s important that you read through the terms of your Medicare Advantage contract to understand what is covered and what you’ll need to pay for out-of-pocket.
If you don’t have a Medicare Advantage Plan and would like to look at some options in your area, check out our plan finder to see which companies offer MA and MA-PD plans.
You can also reach out to one of our agents at 1-888-912-2132 or help@policyscout.com to speak with someone about finding coverage that will suit your needs.
Will Medigap Cover Viagra?
Medicare Supplement Insurance Plans are designed to help pay for out of pocket costs that Original Medicare (Part A and B) doesn’t cover.
Unfortunately, Medicare Supplement Insurance Plans don’t cover viagra or other prescription medications that fall under Part D.
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Other Treatment Options to Look into for Erectile Dysfunction
Erectile dysfunction is more common than you might think. In fact, the NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) estimates that around 30 million men suffer from some form of ED.
However, there are treatments that can help. Viagra and other oral drugs are a convenient way to address the symptoms of ED, but you can also talk to your doctor about nondrug interventions that may help.
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Some general lifestyle changes that you can make, include:
Reducing your stress levels.
Exercising regularly.
Losing weight.
Staying sexually active.
Eating a healthy diet.
Besides oral medication, there are other treatments for erectile dysfunction that might be beneficial, these include:
Testosterone therapy.
Vacuum erection device.
Intracavernosal (ICI) and urethra (IU) therapies.
Surgical treatment.
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Top Tip: Generic Versions Like Sildenafil Might Be Covered by Your Part D Plan
One route to look at is to see whether your Medicare Part D plan will cover generic versions of Viagra. In the U.S., Viagra is sold as a generic under the name Sildenafil in pharmacies.
Generic medicines are versions of a drug that provide the same effects as the original formulation.
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Medicare and Viagra FAQs
Is Viagra covered by Medicare?
No, Viagra (Sildenafil) for the treatment of erectile dysfunction is not covered by Medicare. Medicare will also generally not cover other ED treatments such as Cialis or Levitra. However, if you have Medicare Part D, you may be able to get certain generics covered.
Does Medicare Part D pay for Sildenafil?
Depending on your Medicare Part D plan, you might be able to get your Sildenafil covered if you purchase this generic version of Viagra. However, you’ll need to check with your health insurance plan provider to make sure that they pay for it.
Does Medicare cover generic Viagra?
Original Medicare won’t cover Viagra, but it may cover a generic version if it is medically necessary. In some cases, your Medicare Part D plan may cover a generic version of Viagra (Sildenafil). You should speak with your doctor and health insurance provider to learn more.
Source: Pexels
Where Can I Learn More about Medicare?
While Viagra has proven efficacy in treating erectile dysfunction, Medicare beneficiaries aren’t generally covered by the federal Medicare program for these prescription drugs.
Our advice is to speak to your doctor about alternative treatments and to look into generic versions like Sildenafil that may be covered by your Prescription Drug Coverage Plan (If you have one).
If you’d like to learn more about Medicare coverage, costs, and enrollments, be sure to visit our Medicare hub to read our latest articles and guides.
If you need assistance with finding a Part D plan provider in your area and want to compare your options, reach out to one of our agents today at 1-888-912-2132 or help@policyscout.com.