Over half a million vasectomies were performed in the United States in 2015. Vasectomies are an extremely effective birth control procedure with very few risks involved.
Because theyâ€™re not used to treat a medical condition, vasectomies are considered an elective procedure by Medicare â€” and Medicare doesnâ€™t pay for elective procedures.
However, you might be able to get coverage with some Medicare Advantage plans.
What parts of Medicare might cover vasectomy?
A vasectomy is generally considered elective surgery. That means itâ€™s a surgery youâ€™re choosing 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 isnâ€™t covered.
Other surgical procedures might be covered under Part A and Part B, together called original Medicare, but vasectomies arenâ€™t covered.
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 that original Medicare does, and many include additional coverage for services that Medicare doesnâ€™t cover.
Depending on your Medicare Advantage plan, itâ€™s possible that this could include vasectomies.
Part D and Medigap
You wonâ€™t have any additional vasectomy coverage with a Part D or Medigap plan.
Medicare Part D plans cover only prescription drugs, and Medigap plans cover only the services that original Medicare does.
What are my best steps for getting coverage?
Youâ€™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. A great first step is to talk with your doctor or a billing representative at your doctorâ€™s office. They might be able to point you to a list of insurance companies they accept, then you can contact the companies to determine which ones cover a vasectomy.
- Contact local Medicare Advantage companies. You can also contact Medicare Advantage plan providers in your area 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. Another option is contacting 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.
Costs and ways to save
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 doctorâ€™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 youâ€™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
Itâ€™s a good idea to confirm that your doctor is part of your planâ€™s network before you have your vasectomy.
Youâ€™ll pay a lot less by staying in your planâ€™s network. Going outside the network could lead to surprise costs.
You might also have a few payment options if youâ€™re paying out of pocket.
Some doctorâ€™s offices and medical centers will let you enter a payment plan. Youâ€™ll be able to split the cost of surgery into smaller payments over several months. Generally, youâ€™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 you can use to pay for elective procedures, like a vasectomy. Your doctorâ€™s office will be able to tell you if they accept this type of payment and how they work.
What should I expect from the vasectomy procedure?
Vasectomies are an extremely effective form of birth control that can prevent pregnancy nearly 100 percent of the time, according to Planned Parenthood.
A vasectomy works by disconnecting the tubes that allow sperm to join with semen in the body. The procedure is low risk and can normally be done in an outpatient setting under only local anesthesia.
Preparing for a vasectomy
Before you or a partner have a vasectomy, youâ€™ll discuss with your doctor whether a vasectomy is the right option.
They might want to verify that youâ€™re sure you donâ€™t want to have biological children, since vasectomies are intended to be permanent. Theyâ€™ll also walk you through the procedure to make sure youâ€™re prepared.
How the procedure is performed
Vasectomies can often be performed in a doctorâ€™s office or outpatient medical center. Your doctor will start by giving you a small injection to numb the skin around your scrotum.
Once your skin is numb, the doctor will make an incision or surgical hole in the area. Theyâ€™ll then locate the tube that allows sperm to join semen and pull it through the incision or hole.
The tube is then cut and sealed by tying it, using surgical clips, or heating it. When the tube is sealed, it will gently be placed back inside your body. The area will then be cleaned and stitched.
Recovery after a vasectomy
You can go home after the procedure. Youâ€™ll probably be sore for several days afterward and might have bruising and swelling in the affected area.
Your doctor will give you recovery instructions, but generally, youâ€™ll be advised to:
- Watch your incision site for any signs of infection.
- Keep a bandage on your incision site for at least 48 hours.
- Evaluate the area as much as possible for the first 48 hours.
- Use ice packs to keep swelling down.
- Rest for several days.
- Avoid sexual activity for about a week.
What to expect after recovery
Your vasectomy wonâ€™t be effective right away. Even after you heal, itâ€™ll take a few months and between 15 to 20 ejaculations before there is no longer any sperm in your semen.
Your doctor will schedule a follow-up exam in 2 to 3 months to analyze your semen. Youâ€™ll need to use other methods of birth control until your doctor tells you that your semen is clear of sperm.
Sex and orgasms wonâ€™t feel any different after a vasectomy. The only difference will be that there is no longer sperm in your semen.
If you do have any pain, discomfort, or changes to your sexual function once your vasectomy has healed, talk with your doctor right away.
Vasectomies are one of the most effective forms of birth control. Unlike condoms or birth control pills, you donâ€™t have to remember to do anything or make sure youâ€™re doing something correctly for it to be effective.
However, a vasectomy doesnâ€™t prevent you from getting or giving a sexually transmitted infection. That means safe sex should continue to be an important consideration.
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