Does Medicare Cover Viagra for Erectile Dysfunction: How Does Insurance Cover Viagra and does Medicaid Cover Viagra if Medicare Won't
The Medicare Part A and Medicare Part B program provides coverage for a wide range of medical services and treatments, but there are some limits to what they will pay for.
This can be frustrating for Medicare Beneficiaries who are dealing with specific health issues that aren’t always covered by traditional Medicare plans.
In this post, we’ll take a look at whether or not Medicare covers Viagra and other similar medications. You may be surprised to learn that there are some circumstances in which Medicare will cover the cost of these drugs.
Let’s dive in:
Table of Contents
Does Original Medicare Cover Viagra?
Original Medicare coverage does not help cover Viagra. However, some Medicare Advantage plans may cover Viagra or other drugs for erectile dysfunction. If you have Original Medicare, you can still get Viagra by paying for it out of pocket.
If you are paying for ED prescription drugs out of pocket, we recommend looking for insurance companies that cover generic versions of ED prescription drugs.
What is Viagra Used For?
Viagra is a drug that is recommended for the management of erectile dysfunctions. Viagra works by relaxing the muscles in the walls of the blood vessels of the penis, which leads to a greater amount of blood entering the penis and an erection.
How effective is Viagra?
Viagra is a highly effective drug that works by a variety of different mechanisms. This may include the following:
- Relaxing the muscles in the walls of blood vessels in the penis
- Increasing blood flow to the penis
- Facilitating an erection by increasing levels of a chemical called cyclic guanosine monophosphate (cGMP)
What are the Side Effects of Viagra?
The side effects of ED medication like Viagra are usually mild and temporary. The most common side effects include:
- Flushing
- Headache
- Nausea
- Dizziness
- Stomach upset
If you experience any of these side effects, they should go away within a few hours. If they persist or become severe, you should contact your healthcare provider. Medicare Beneficiaries with high blood pressure and other medical conditions should talk with their treating physician before taking viagra.
What is Erectile Dysfunction?
Erectile dysfunction (ED) is a health condition in which the penis cannot obtain or sustain an erection. ED drugs are used to treat ED. Viagra is one of the most commonly used ED drugs.
Who Should Not take Viagra for Erectile Dysfunction?
There are some individuals who should not take medication for ED which include
- People with certain medical conditions.
- People with a history of medical conditions.
- People who are taking certain medications.
- People with a history of drug use.
Your doctor may not recommend taking ED prescription medications for other reasons as well. Always consult your doctor before taking any medications.
What is Medicare Part D Drug Coverage?
Medicare Part D prescription drug coverage is a government-sponsored health insurance program that covers prescription drugs for people with qualifying medical conditions.
Your Medicare prescription drug plan may not cover Viagra but it could include prescription drug coverage for a generic drug like Tadalafil.
Does Medicare Part D Prescription Drug Plan Provide Viagra Insurance Coverage?
Viagra is not currently covered by Medicare Part D.
Private insurance companies eligible to offer Medicare Part C plans may help cover generic prescription drugs similar to the Viagra brand name drug.
Generic ED prescription drugs offered by private insurance companies offer a more affordable option to brand name drugs.
Medicare prescription drug coverage offered by Medicare Advantage plans includes a list of covered drugs and may provide medication dealing with sexual dysfunction.
Do Medicare Advantage Plans Cover Erectile Dysfunction Drug Costs?
Many Medicare Advantage plans will cover the costs of erectile dysfunction drugs, as long as they are prescribed by a doctor. However, some plans may have a higher co-pay for these drugs, so it is important to check with your plan before you fill your prescription.
We have seen many Medicare Advantage companies create a standalone drug Tier for these types of prescriptions. They may limit the amount of prescribed ED prescription drugs to 4 to 6 a month.
Will My Medicare Supplement Insurance Plan Cover ED Medications?
Medicare supplement insurance plans usually do not cover the cost of ED medications.
However, there are some limited circumstances in which a Medicare supplement plan may offer coverage for a medically necessary surgery or procedure to treat erectile dysfunction.
The surgery would be required to be approved by Medicare before your Medigap plan would provide the needed secondary insurance coverage.
What is the Extra Help Program and Does it help pay for Viagra Costs?
The Extra Help Program is a government-sponsored program that helps low-income seniors pay for their prescription drug costs. It does not cover the cost of Viagra specifically, but it can help with the overall costs of other prescription drugs.
My Medicare Coverage Does not Cover the Cost of Viagra Do I have Other Options?
If your Medicare plan does not cover the cost of Viagra, there are other options available to you. You can talk to your doctor about other prescription medications that may be covered by your plan, or you can purchase Viagra over the counter at a pharmacy.
You may also be able to get Viagra through a mail-order pharmacy, or you can buy it online. Due to the high costs of Viagra, seeking an alternative may be a better option and could be covered by your Part D plan.
When Can I Switch to a New Medicare Plan that Covers ED Medications?
If you are enrolled in a Medicare Advantage plan that does not cover Viagra or other ED medications, you can switch to a new plan during the annual open enrollment period.
If you have Original Medicare, you can enroll in a stand-alone prescription drug plan that covers Viagra during the annual open enrollment period.
You may also be able to switch to a new Medicare Advantage plan or prescription drug plan if you experience a qualifying life event, such as losing your job-based health insurance.
Does Medicaid Cover Viagra?
Medicaid is a state and federal program that provides health insurance to low-income individuals and families. Medicaid coverage varies from state to state, so you will need to check with your state Medicaid office to see if Viagra is covered.
In some states, Medicaid covers Viagra for men with certain medical conditions. In other states, Medicaid covers generic ED medications but not brand-name drugs like Viagra.
If you are enrolled in Medicaid and have questions about your coverage, you can contact your state Medicaid office or call the Medicare hotline at 1-800-MEDICARE (1-800-633-4227).
Do Prescription Discount Cards Cover Medications for Erectile Dysfunction?
There are many prescription discount cards available, and some of them may offer discounts on Viagra or other ED medications. However, it is important to compare the costs of different cards before you choose one.
Some prescription discount cards are sponsored by pharmaceutical companies and only offer discounts on their products. Others are sponsored by organizations like AARP and offer discounts on a wide range of drugs, including Viagra.
You can also check with your local pharmacist to see if they know of any discount programs that could help you save money on your prescriptions.
What is the Cost of Viagra with and without Medicare Coverage?
The cost of Viagra with Medicare will vary depending on the type of plan you have, the pharmacy you use, and whether you use a generic or brand-name medication.
If you have Original Medicare, you can expect to pay for Viagra out of pocket. The retail price for a 100-mg dose of Viagra is $166 for two tablets. However, we found Viagra for $7.55 on GoodRX which offers discounts towards local pharmacy stores.
If you have a Medicare Advantage plan that covers Viagra, your costs will depend on the terms of your specific plan. You may pay nothing, or you may have a copayment or coinsurance.
If you have a stand-alone prescription drug plan, your costs will also depend on the terms of your specific plan. You may pay the full retail price for Viagra, or you may have a copayment or coinsurance.
The best way to find out how much Viagra will cost with Medicare is to contact your plan directly. Remember to always check pricing with and without insurance as you may be able to save a bundle.
Also, compare the price of the brand version to the generic prescription medication. Most often you can save hundreds if not thousands of dollars with the generic brand.
Do you need Help Finding the Best Medicare Plan that Offers Erectile Dysfunction Drugs like Sildenafil and Tadalafil?
If you need help finding the best Medicare plan that offers erectile dysfunction drugs like Viagra, contact one of our licensed insurance agents.
A qualified Medicare agent can help you compare Medicare plans and find one that meets your needs and budget.
Integrity Now Insurance Brokers has helped many wives and men find a Medicare plan that offers benefits for ED prescription drugs.
You can either fill out our online quote form or give us a call at 562-735-3553.
