Key takeaways
- Original Medicare (Parts A and B) plans do not cover vasectomies because they are considered elective procedures.
- Some Medicare Advantage (Part C) plans may offer coverage for vasectomies, as these plans often include extra benefits not covered by Original Medicare.
- To save money on a vasectomy, confirm that your doctor is in-network with your Medicare Advantage plan and explore payment options, such as payment plans or medical credit products.
Vasectomies are a highly effective birth control procedure with very few risks involved.
Because vasectomies are not used to treat a medical condition, Medicare considers them elective procedures and doesn’t pay for them.
However, you might be able to get coverage with some Medicare Advantage plans.
A vasectomy is generally considered elective surgery. That means it’s a surgery you choose to have and not one you need to treat a medical condition.
Medicare only pays for services it considers to be medically necessary, however. It never pays for elective procedures, including both vasectomies and vasectomy reversals.
This rule applies to all sterilization procedures unless the procedure is being used to treat an underlying medical condition. For example, hysterectomies can be used to treat endometriosis.
However, a vasectomy is always done as a form of birth control and isn’t covered.
Other surgical procedures might be covered under Part A and Part B, together called Original Medicare, but vasectomies aren’t covered.
Medicare Advantage
The only time you might find vasectomy coverage with Medicare is if you have a Medicare Advantage (Part C) plan.
Medicare Advantage plans are required to cover everything Original Medicare does, and many include additional coverage for services that Medicare doesn’t cover.
Depending on your Medicare Advantage plan, coverage may include vasectomies.
Medicare Part D plans cover only prescription drugs, and Medigap plans cover only the services that original Medicare does.
Medicare Part D plans cover only prescription drugs, and Medigap plans cover only the services that original Medicare does.
You’ll need to find a Medicare Advantage plan that offers vasectomy coverage. There are a few ways you can do this:
- Talk with your doctor: Talk with your doctor or a billing representative at your doctor’s office about the insurance companies they accept. You can then contact the companies to determine which ones cover vasectomies.
- Contact local Medicare Advantage companies: You can also contact Medicare Advantage plan providers directly. Use the Medicare website to find the plans offered in your ZIP code. You can narrow your search to plans that fit your budget and include your doctor in the network. From there, you can call those plans and ask a representative if they cover vasectomies.
- Find additional help: Contact your local State Health Insurance Assistance Program (SHIP) center. A SHIP counselor can give you information about the Medicare plans offered in your area, including details about what they cover. They can also answer any other questions you might have about Medicare. SHIP counselors are trained to provide unbiased and locally based advice.
The cost of a vasectomy is affected by many factors. While Planned Parenthood reports that vasectomies cost between $0 and $1,000, your costs will depend on your individual circumstances.
These may include:
- where you live
- what kind of facility is performing the procedure
- the type of vasectomy procedure the doctor performs
- how many doctor’s visits you need before your vasectomy
- how much follow-up care you need
Your costs will also depend on the insurance coverage you have. All Medicare Advantage plans set their own prices for things like deductibles and copayments, so your price will depend on the specifics of your plan.
When you’re using a Medicare Advantage plan, your price could be affected by:
- your deductible
- your copayments
- your coinsurance
- whether your doctor and the surgery facility are in-network or out-of-network
You can check with your plan to get this information ahead of time. Many plans will let you pull this information up in your online member portal. You can also call and ask a representative what your costs will be.
Tips for cost savings
Confirm that your doctor is part of your plan’s network before you have your vasectomy.
Staying in your plan’s network will cost you much less, but going outside the network could result in surprise costs.
You might also have a few payment options if you’re paying out of pocket.
Some doctor’s offices and medical centers will let you enter a payment plan. You can split the surgery cost into smaller payments over several months. Generally, you’ll need to make these payments before you have the procedure.
Other practices might accept payment through credit products that are just for medical care.
These products allow you to get a loan or credit card to pay for elective procedures, like a vasectomy. Your doctor’s office can tell you if they accept this payment type and how they work.
Original Medicare won’t pay for a vasectomy, but a Medicare Advantage plan might. You can contact a local SHIP center for recommendations on Medicare Advantage plans in your area that cover the procedure.
Your doctor’s office might have other ways to help you pay the cost, such as payment plans or credit products. Vasectomies are generally low risk and very effective.