Is Viagra Covered by Medicare?

Most Medicare Part D prescription drug plans offer scant coverage, if any, for brand-name erectile dysfunction drugs, although a small but growing number offer reimbursement for generic equivalents of those drugs. Check your Part D insurer’s drug formulary to see if it offers any coverage for ED medications.

Viagra is made to treat erectile dysfunction, which becomes progressively more common as men get older.

In fact, the age group of men most in need of Viagra is the same age group that is eligible for Medicare. However, Medicare, except in specific situations, does not cover any of the cost of Viagra, and that’s too bad, because Viagra is expensive and many men over age 65 are on fixed incomes.

But it’s not all bad news. There are some ways to get help paying for Viagra. These include the increasing availability of generic alternatives to Viagra and Cialis, another very popular ED drug, which are being sold at significantly lower prices than the brand-name drugs. A generic formulation of Levitra may soon debut on the U.S. market.

Original Medicare Coverage

The traditional Medicare consists of Part A, which is hospital coverage, and Part B, which covers nonhospital medical care. Neither Part A nor part B covers prescription drugs, so by definition original Medicare doesn’t cover Viagra. Medicare Part B once covered vacuum pumps used to treat erectile dysfunction, considering them Durable Medical Equipment (DME), but that is no longer the case.

In December 2014, lawmakers in Washington passed the Achieving Better Life Experience (ABLE) Act, which allows disabled people to set up tax-advantaged savings accounts to pay for educational and healthcare expenses. They came up with the money to cover ABLE act expenses by disallowing Social Security benefits for suspected Nazi war criminals and by no longer allowing Medicare Part B to cover vacuum penis pumps.

There wasn’t much outcry over the discontinuance of Medicare Part B coverage for vacuum pumps, since Medicare never covered other erectile dysfunction treatments, and since Medicare was found to be paying significantly more for the pumps than the prices an ordinary person could get buying them from Amazon or from another source.

Medicare Advantage Plans

Some senior citizens choose to have Medicare Advantage plans rather than traditional Medicare. Medicare Advantage plans are sold by private insurers under contract with Medicare. These plans must provide at least the same level of coverage as traditional Medicare, but are allowed to provide other benefits as well, including coverage for some prescription drugs.

Therefore, it’s possible to forgo enrolling in traditional Medicare in order to enroll in a Medicare Advantage plan, and some of these offer some coverage for Viagra, but that alone may not be enough to make a Medicare Advantage plan worthwhile.

Part D Drug Coverage

An alternative to enrolling in a Medicare Advantage plan is sticking with traditional Medicare and then enrolling in a standalone Medicare Part D plan for prescription drug coverage. These plans are sold through private insurers as well. Medicare Part D standalone prescription plans each has its own formulary, which is a list of drugs the plan covers. Naturally, if you’re considering Medicare Part D plans, you’ll want to see which drugs are on a plan’s formulary and how well the formulary matches up to the prescription drugs that you take.

Medicare Part D, though offered by private insurers, is approved and regulated by Medicare. That means you can use Medicare Part D to get significant discounts on prescription medications. It also means that choosing the best Medicare Part D plan hinges on the drugs that you take regularly.

Part D Plans Vary Widely

Medicare Part D plans vary in terms of premium and which drugs are covered, but for 2018, the average monthly premium for Part D plans is roughly $35. Age, income, and the plan selected all influence how much the premium is. Since it’s unlikely that you’ll find a Part D plan that covers all the drugs you take, you’re probably better off considering Part D as more of a “discount drug program” that helps keep a lid on costs in case you need expensive medications. Even if a Part D plan doesn’t cover Viagra, it could save you enough on other drugs to help you afford Viagra.

Part D plans may cover brand-name and generic prescription drugs, and some plans cover “bonus” drugs that include multivitamins, Levitra, and Viagra. Bear in mind that payments for bonus drugs (whether made by your plan or out of your pocket) may be considered differently from other drug payments. For example, they may not count toward your true out-of-pocket costs, in which case they won’t affect whether you fall into (or can get out of) the coverage gap known as the “donut hole.”

The ‘Donut Hole’ and Drug Coverage

To understand the so-called “donut hole” coverage gap, you have to understand that with Part D coverage, you still have deductibles and will pay a percentage of total costs. Under 2018 regulations, once you’ve spent $3,750 on prescriptions, you will reach the donut hole and will have to pay 100 percent of your additional prescription costs but with a discount. But then, if your total prescription bills reach a higher threshold, roughly $6,500, then your Part D plan pays approximately 95 percent of your additional costs for the rest of the year.

For many men, the best strategy for making Viagra and other erectile dysfunction drugs affordable is to use insurance benefits to cover other prescription drug costs and free up money that can go toward Viagra. There are Medicare Advantage plans and Medicare Part D plans that offer some coverage for Viagra or its generic equivalent, but you have to weigh their costs with how much they cover.

Conclusion

Men over age 65 are more likely to need Viagra or similar drugs for erectile dysfunction than are younger men. Unfortunately, many men in this age group are on fixed incomes and rely on Medicare to cover medical expenses, so being able to afford Viagra can be a challenge. Men on Medicare do, however, have some options, in terms of choosing Medicare Advantage plans and Medicare Part D prescription coverage. Even if Medicare Part D doesn’t cover Viagra, it could bring down the cost of other drugs a man takes regularly to free up funds that can then be used on Viagra.

You might also find that you can save time and money by ordering your ED drugs from a trustworthy online facilitator such as eDrugstore. In business since the late 1990s, eDrugstore is based in Tempe, Arizona, and supplies only FDA-approved medications that are sourced exclusively from licensed U.S. pharmacies. The website can even arrange a complimentary online consultation with a licensed U.S. physician who can authorize a prescription for Viagra or another ED drug if appropriate. To learn more, visit eDrugstore’s Erection Problems page.