Does Health Insurance Cover Vasectomy Costs?
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A vasectomy is a reversible form of birth control for men. According to the Association of Reproductive Health Professionals, vasectomies are covered by 70% of insurance companies. Since vasectomies are not essential federal health benefits under the Affordable Care Act (ACA), private insurance plans may not always cover them. If your insurer covers this procedure, you may have to use an in-network doctor and/or pay a copay, coinsurance or deductible costs. Each insurance plan is different, so you must check with your insurer. Vasectomies are not covered by Original Medicare, but they may be covered by the Medicare Advantage plan.
How Much Is a Vasectomy Without Insurance?
The typical cost for a vasectomy without insurance can cost anywhere from $250 to $1,000. Aftercare, including semen analysis, can increase the cost of your vasectomy. How much you pay out-of-pocket really depends on whether you have insurance and what your policy covers. If you decide to reverse your vasectomy, which is typically not supported by insurers, it could cost around $6,000 to $15,000.
What Factors Affect the Cost of a Vasectomy?
Many factors can affect the cost of your vasectomy; for example, whether you have a no-cut procedure or an incision. Many vasectomies are done in doctor’s offices with local anesthesia. You may have to pay more if you have the procedure done at an ambulatory surgical center.
Total costs for a vasectomy often include:
- Follow-up visits
- Semen analysis
The cost of a vasectomy is typically less than $1,000, but several factors can affect cost including:
- The facility where the vasectomy is performed: Depending on if you go to a doctor’s office, clinic, hospital, surgical center or health center, you may be charged a facility fee that could increase your costs.
- Doctor’s cost: Some doctors may charge more or less for a vasectomy, or they may work on a sliding scale.
- Anesthesia: Some doctors use local anesthesia to minimize pain before the procedure, while others prefer full sedation, which would be more costly.
- Type of vasectomy: No-scalpel and incision are the two main forms of vasectomy. Surgical procedures are more costly.
- Follow-up visits: You will have to make an appointment with a urologist after your vasectomy to analyze your semen to determine if the procedure was effective.
Will Medicare or Medicaid Cover a Vasectomy?
In many states traditional Medicaid covers vasectomies. Hawaii and the District of Columbia do not offer this benefit in their ACA Medicaid expansion programs.
Medicare parts A and B, Part D and Medigap won’t cover vasectomies or other elective procedures, but Medicare Advantage (Part C) plans may include vasectomy coverage. Policyholders should check with their plan provider to see if vasectomies are included in their coverage.
Why Don’t Some Insurance Companies Cover Vasectomies?
Since vasectomies are not a preventive service under the Affordable Care Act, federal law does not require health plans to cover vasectomies. Each insurer’s coverage varies from policy to policy. If you don’t live in one of the five states that mandate which vasectomies should be at no cost to patients (Illinois, Maryland, Vermont, Oregon, and Washington) and you have a private insurance policy instead of Medicaid, you’ll need to look at your specific insurance policy terms.
If your current policy doesn’t cover vasectomy, you may be able to buy supplementary coverage that does. Or, during the next open enrollment period for insurance, you could look for an insurer that includes vasectomy as one of its covered services.
Will Insurance Cover the Costs of Medications for Vasectomy Recovery?
For most patients, acetaminophen or ibuprofen — along with ice packs — is sufficient enough to address any pain or soreness for the next two or three days. If necessary, your doctor can prescribe pain medication, which will likely be covered by your insurance company.
Most insurance plans cover a portion or all of your vasectomy cost once your deductible is paid. If your insurance does not cover a vasectomy, it may be time to shop around for a new health insurance plan that will. SmartFinancial can help you find the perfect plan that fits your budget and lifestyle. By entering your zip code below and answering a few questions, you will receive free health insurance quotes.