Does Medicare Cover Viagra and Cialis Erectile Dysfunction Medication? (2024)

Seniors eligible for Original Medicare (Part A and Part B) managing erectile dysfunction must understand how their coverage works. Does Medicare cover Viagra? Or are seniors left to pay for this medication on their own? Depending on which erectile dysfunction (ED) medication you use, your Medicare Part D plan may provide coverage.

Additionally, your Medicare Advantage plan may include additional coverage in which you can enroll for erectile dysfunction medication. Explore your options among both name-brand and generic ED meds when it comes to your Medicare coverage.

What Erectile Dysfunction Drugs are Covered by Medicare?

Most brand-name medications for erectile dysfunction, such as Viagra and Cialis, are not covered under Medicare Part D. However, generic versions are available that may receive coverage from a Medicare Part D prescription drug plan. This came to be after the government banned payment for ED medication by Medicare and Medicaid.

The key to understanding your drug coverage is understanding your plan’s formulary. Formularies provide seniors with the list of prescription drugs their Medicare Part D plan includes. Each policy has its own formulary, and considering there are 800+ Medicare Part D stand-alone prescription drug plans, it’s important to understand what is included with yours.

Medicare Part D plans vary from state to state, meaning formularies can too. For example, this means that while generic Viagra may be included in a Part D plan in New York, the same cannot be said for any other state without checking to confirm.

All things considered, the healthcare benefits of each senior will vary, as will the plans available. But there are still some important overarching trends to explore involving Medicare and ED medication. Let’s break down the most popular brands and explore your options.

Does Medicare Cover Viagra?

Medicare Part D plans do not cover Viagra as it is a name-brand drug. But seniors with a Medicare Part D drug plan may find coverage for some generic versions. This can be an issue for seniors looking to cut costs on name-brand prescriptions, as the retail cost of Viagra can be very expensive.

Is Generic Viagra Covered by Medicare Part D?

Sildenafil, which is the generic version of Viagra or Revatio, receives coverage from some Medicare Part D plans. Again, you’ll need to look closely at your Medicare Part D drug plan’s formulary. Then, you can determine whether or not sildenafil is included and the amount you’ll have to pay out of pocket.

Is Viagra Covered by Medicare Advantage?

Seniors enrolled in certain Medicare Advantage Prescription Drug Plans (MAPD) may receive coverage for both Viagra and its generic versions. The drug class is a PDE-5 inhibitor, and depending on your Medicare Advantage plan, could receive coverage.

Medicare Advantage plans provide coverage through private insurance companies. These plans can vary, meaning your benefits will also vary. The best way to understand whether your Medicare Advantage benefits cover Viagra is to speak with a licensed Medicare agent.

Does Medicare Cover Cialis?

As with Viagra, Medicare Part D plans also won’t cover Cialis – however, some generic versions, such as tadalafil, may have coverage under either Medicare Part D or a Medicare Advantage Prescription Drug Plan. This drug class is also a PDE-5 inhibitor.

Does Medicare Cover Cialis for BPH?

There are situations in which your Medicare prescription drug plan may cover Cialis when prescribed for BPH. Benign prostatic hyperplasia (BPH), which is also known as prostate gland enlargement, is a chronic disease that can affect the health of men as they age. If a senior is diagnosed with BPH, a doctor may prescribe Cialis.

But while Original Medicare doesn’t have coverage for prescription medications, Medicare Part D does. The same goes for seniors with Medicare Advantage Prescription Drug Plan coverage.

The majority of Medicare Part D drug plans include coverage for Cialis when used for BPH, and some Medicare Advantage plans may also include coverage. Again, these benefits will vary by where you live and the plan you choose.

Does Medicare Cover Levitra?

Medicare Part D plans do not cover Levitra, but it’s a bit of a moot point as the drug is discontinued in the United States. However, there are a few generic versions that do have coverage, such as vardenafil.

Some Medicare Advantage Prescription Drug plans may also cover vardenafil. Once again, this drug class is a PDE-5 inhibitor.

How Much Do Erectile Dysfunction Drugs Cost with Medicare?

When choosing which medication is right for you, the price you’ll pay is an important factor. Not all erectile dysfunction drugs are the same, nor are everyone’s bodies or needs. All seniors seek medication that works right for their bodies, as what works for one person may not work for another.

Unfortunately, health insurance restrictions are usually the final determining factor. Many insurance plans restrict the number of pills a patient may receive each month. After reaching the limit amount, out-of-pocket costs for one tablet can be $20-$50.

Erectile dysfunction drug costs depend on the co-payment amount, health insurance coverage, plan type, and pharmacy price. The national out-of-pocket cost per pill is generally $15-$20.

Does Medicare Cover Erectile Dysfunction?

Healthcare for erectile dysfunction, as with many other conditions, is a complex subject. There are procedures, medications, and treatments to consider, some of which Medicare may cover and others that it may not.

We’ve already covered a wealth of information on Medicare coverage for Viagra, Cialis, and other ED medications. Let’s tackle some of the other considerations Medicare seniors might have involving their ED below.

Does Medicare Cover Penile Implant Surgery?

Medicare covers penile implant surgeries. If it’s medically necessary, coverage includes all other Coloplast devices. Unless supplemental insurance is in place, patients can expect to make payments of $2,500 – $3,000 for the procedure.

Generally, this is an outpatient service, so Medicare Part B covers 80% of the allowable costs. Seniors are responsible for the remaining 20%, unless they have a Medicare Supplement (Medigap) plan.

Does Medicare Cover ED Injections?

Medicare does not cover ED injections, nor does it cover penis pumps. Unlike penile implant surgery, which can be medically necessary, you’ll have to pay for these treatments out of your own pocket.

Mental Health Coverage and ED

Seniors suffering from mental health issues due to ED may be able to receive treatment covered by Medicare. This includes a range of mental health services, including counseling. Medicare Part D will also include coverage for antipsychotic and antidepressant medications.