Is Viagra Covered By Medicare? What You’ll End Up Paying

By: Edward Neeman
Published: Tuesday, November 20 2018
Last Updated: 9 days ago

Sildenafil and Revatio are names associated with the drug Viagra. These particular agents are used to treat pulmonary arterial hypertension and erectile dysfunction (ED) in men. This problem is usually caused by some sort of physical disability and some examples may be an injury (such as being struck by lightning), a disease of some kind, or even result as a side effect of certain drugs.

People with cardiovascular disease should be cautioned when taking this medication, and should first consult their physician. Others who may be taking nitrates (such as nitroglycerin) should not take this erectile disorder drug because it may cause a potentially fatal blood pressure drop. Contingent upon a person's diagnosis and doctor recommendation, Viagra is not a cheap prescription. The question running through most minds is will Medicare pay for your Viagra prescription?

Does Original Medicare Cover Viagra?

Unfortunately, neither Original Medicare Part A or Part B will cover Viagra, however, there are other options through Medicare you can leverage for coverage. Original Medicare only pays for certain limited drugs covered by prescriptions, and Viagra doesn’t fall into that category. However, there are other benefits covered by Part A and B that could help you with your erectile dysfunction.

Although it’s not considered medication, Original Medicare will cover pumps that help with ED. These specially designed pumps are considered Durable Medicare Equipment, and you would only have to pay the 20% coinsurance, which significantly reduces the price. If you have a Medigap plan that covers your Part B deductible, then you may get away without paying a dime. You can shop for a Medicare Supplement plan today with FirstQuote Medicare here.

What About Part D Prescription Coverage?

Most people that are Medicare beneficiaries generally enroll in a Medicare Part D prescription drug plan so that they can get the help they need to pay for their prescriptions. Medicare Part D will typically cover your Viagra prescriptions, but there is also a secondary option known as Medicare Advantage that may cover your Viagra as well.

It’s important to keep in mind when choosing a Prescription Drug Plan, you need to review the formulary in order to make sure Viagra is actually covered under your plan. If a person's physician actually says that the erectile disorder drug is for the hypertension problem, then this drug could be covered under the Part D plan as well, since it will be deemed medically necessary.

Medicare Supplements (Medigap) Policy Plans

Medigap plans are no longer available with prescription drug coverage if they have been sold to a person after the year of 2006. The Medigap plans that were sold to a person before January 1st, 2006, may provide limited coverage for the prescription drugs.

Currently, Medicare Supplemental plans are only available to help cover the out-of-pocket costs from Original Medicare. That means they will not cover your Viagra prescription. Although, it’s still a good idea to look into supplemental coverage for your Medicare, which you can learn more about here.

What Does Viagra Cost Without Medicare?

Without Medicare or any other type of health insurance, Viagra may cost you between $30-$61.54 per pill. Luckily, that cost can be reduced if you opt for an insurance plan that covers your prescriptions. For example, if a person has Aetna Medicare Insurance, they could pay $30, whereas if they have AARP Medicare Preferred they could end up paying $41.

Viagra covered by Medicare will only be covered by the person's diagnosis and what the erectile disorder drug may be prescribed for. Viagra covered by Medicare may cost less if a person gets the generic versions.

The Arrival Of Generic Viagra

The erectile drug used to not have an alternative generic option, but that has changed. There are now two new generic versions of this erectile drug that costs less as of 2017. Levitra (also known as vardenafil) and Cialis (also known as tadalafil) are both viable options for treating erectile dysfunction. According to GoodRx, the generic version of this erectile drug costs roughly about $0.70 per pill. This is contingent upon where a person actually gets their prescriptions filled though, and costs may vary.

Is it covered by Medicare?

The same rules apply to the generic or alternative versions of Viagra, Levitra and Cialis included. Original Medicare still won’t pay for your prescriptions, however, depending on your Medicare Part D or Medicare Advantage plan, these options may fall under your benefits. Your best bet is to begin searching for a plan that covers your needs, which you can do through FirstQuote Health.