Erectile dysfunction (ED) can be caused by a number of issues, including chronic high blood pressure, atherosclerotic heart disease, diabetes mellitus, metabolic syndrome, or testosterone deficiency. It can be brought on by pelvic surgery or can be a side effect of vascular or neuroendocrine conditions. Lifestyle choices, including smoking, can also contribute to ED. The risk of erectile dysfunction increases with age and affects senior men more commonly than any other age group.

There are a number of treatments that may restore erectile function, but when all other options have failed and there is a clear medical indication that the condition will not resolve naturally, penile implants can provide a solution to erectile dysfunction. If you qualify for Medicare insurance, your coverage may help cover the costs of your surgery.

What is a Penile Implant?

A penile prosthesis is a device that is implanted into the erection chambers of the penis. There are different types of implants that may be used including semi-rigid and inflatable devices. You and your physician can discuss your personal needs and preferences, and based on your overall health and any underlying health issues you may have, you can choose the penile implant that will be right for you.

There are inherent risks associated with any type of invasive surgery, so discuss any concerns you may have with your doctor. Penile implant surgery is usually performed in an outpatient setting, and generally takes no more than an hour. The post-op success rate is high, but you may require medication following the surgery to ease the pain.

Medicare Can Help Cover Your Penile Implant Surgery

As long as your physician determines penile implant surgery to be medically necessary, Medicare can help cover the costs of the procedure. Since this surgery is usually performed in an outpatient setting, Medicare Part B (Medical Insurance) may cover the care and services you need as long as you visit a Medicare-approved facility that accepts assignment. If you have Original Medicare, you will likely pay 20% of the Medicare–approved amount, and the Part B deductible will apply.

Many Medicare recipients with Original Medicare choose to purchase supplemental insurance to help cover the out-of-pocket costs that Original Medicare does not pay for, including copayments, coinsurance, and deductibles. If you have a Medigap (Medicare Supplement) policy, check with your plan for more details.

If you are enrolled in a Medicare Advantage (MA) plan, you will have at least the same coverage as Original Medicare Part A and Part B, but many MA plans offer additional benefits. Check with your plan to find out the exact costs of your penile implant surgery.

If your physician prescribes medications to help relieve pain after your penile implant surgery, you will need Medicare Part D prescription drug coverage to help cover the costs. If you have Original Medicare, you can enroll in a stand-alone Prescription Drug Plan (PDP). Many Medicare Advantage plans include prescription drug coverage in their package of benefits, and are referred to as MA-PDs. Each PDP or MA-PD will have its own formulary, or list of covered drugs, and unique tiers of pricing, based on whether you purchase generic, brand-name drugs and whether you use a mail order pharmacy or a pharmacy within the plan’s network.

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