Thomas Walsh, MD
University of Washington Men's Health Center
In an ever-changing health care environment, many patients are frustrated by the financial aspects of medical care and surgical treatment. This frustration is particularly pronounced when it comes to the treatment of erectile dysfunction, which is often not covered by insurance carriers.
Some men are shocked by the cost of ED treatment options, and many patients do not know what the average cost for a penile implant is. For men whose doctors recommend penile prosthetic surgery as the best treatment option for erectile dysfunction, concerns over “how to pay” for the surgery can be distressing.
Fortunately, unlike pills and injections, the placement of a penile implant is covered by Medicare. Bottom line, penis surgery cost is a common concern and question. And the answer is that there are solutions to covering the cost of penile implant surgery.
Because Medicare sets the standards for health care coverage in the United States, some private insurers follow suit and provide insurance coverage for penile implants.
Insurance coverage for erectile dysfunction treatments
ED pills and injections are not covered by Medicare. Does Medicare pay for penile implants? Yes.
For individuals who have Medicare benefits, the cost of oral or injectable medications will usually run between $400 to $500 per month. The costs of other treatment options for ED depend upon frequency of use and the dose needed. While these treatments need to be re-dosed with each episode of sexual activity, the penile implant is a one-time treatment with no associated fees for Medicare recipients.
Because Medicare sets the standards for health care coverage in the United States, some private insurers follow suit and provide insurance coverage for penile implants. However, many insurers do not provide coverage for penile implants, or they assess co-pay fees that are cost-prohibitive, leaving their subscribers with uncertainty about how to pay for the most effective treatment for erectile dysfunction.
Inquire if the penile implant manufacturer offers a co-pay assistance program or other financial assistance.
Paying for penile implant surgery
For men without insurance coverage for penile prosthesis procedures or are not of the age where their ED pumps are covered by Medicare, several options should be considered:
Some penile prosthetic surgeons offer “package pricing.” This is a low-cost option for penile implant surgery that bills the cost of surgery, facility fees, and any penile implant directly to the patient. The “package price” is heavily discounted. Penile implant cost with package pricing typically runs between $16,000 and $19,000 and includes all associated fees. Penile implant cost will vary slightly, but package priced treatment is particularly attractive for men who are not eligible for Medicare or who are unable to change their current insurance for any reason.
Some penile implant manufacturers offer help to navigate insurance coverage with providers. Inquire if the manufacturer of your device offers a co-pay assistance program or other financial assistance program in the form of a loan for those who qualify. Such programs may be beneficial to individuals for whom the out-of-pocket expense of penile implant surgery has made moving forward impossible. Penile implant costs are not insignificant, but financial assistance programs may be a viable option for men considering this surgery for erectile function restoration.
Consider switching to Medicare once eligible or investigating other plans that may offer more inclusive erectile restoration benefits. When looking at plan options, you can research whether the insurance covers penile implants or not.
This physician is a Boston Scientific consultant but was not compensated for the creation of this article.
Thomas Walsh, MD
University of Washington Men's Health Center
4245 Roosevelt Way NE
Seattle, WA 98105
(206) 598-0937
http://www.uwmedicine.org/bios/thomas-walsh