ED treatment cost and insurance: what to know in Louisiana

What goes into the cost of ED care

ED care usually has a few parts, and each one can be billed on its own:

• The visit: a talk about your health, medicines and symptoms, and often a physical exam
• Lab tests: blood work to look for causes like diabetes, low testosterone or thyroid problems
• The treatment: pills, a vacuum device, injections, medicine placed in the urethra, or in some cases surgery for an implant
• Follow-up: return visits to see how treatment is working and adjust it if needed

Why costs vary so much

Two men with ED can pay very different amounts. The type of treatment matters most. A daily habit change costs little, while surgery costs much more. Your insurance plan, your deductible, where you go for care, and how many visits you need all play a part too.

Prices for ED medicines also vary widely from one place to the next. Since there’s no single price, the best move is to ask.

Medicare and ED care

Federal law keeps Medicare drug plans (Part D) from covering drugs when they are used to treat erectile dysfunction. Some plans may offer this as an extra benefit, so check your plan’s details.

Medicare Part B covers medically necessary doctor services, including outpatient visits. That means the visit to find out what’s causing your ED may be covered, even if the medicine is not. Coverage for devices and procedures depends on your situation, so ask your doctor and your plan before treatment.

Medicaid and private insurance

Federal law also bars federal Medicaid funding for drugs used to treat erectile dysfunction. In practice, that means Medicaid generally does not pay for ED medicines. That rule is about the drugs, so ask your Medicaid plan what it covers for visits and tests to look for the cause.

Private insurance and employer plans differ, and coverage for ED medicines and treatments varies from plan to plan. Call the number on your insurance card and ask what is covered and what you will owe.

How to protect yourself from surprise costs

You don’t have to guess. Before you agree to treatment, ask these questions:

• What will the first visit cost, and do you take my insurance?
• Can I get the full cost of treatment in writing before I start?
• Which parts will my insurance cover, and which will I pay?
• Do you offer payment plans?
• Are there lower-cost options that could work for me?

Lower-cost places to get care

If cost is a worry, these options can help:

• Community health centers: they offer primary care, and how much you pay depends on your income. They are an option even if you don’t have insurance.
• VA health care: if you are a veteran enrolled in VA care, your costs depend on your priority group, disability rating and income. Some veterans pay nothing for care.
• Your regular doctor: a primary care visit is often a lower-cost first step, and it can check for causes like heart disease and diabetes.

Don’t let cost stop you

ED can be a sign of another health problem, like clogged blood vessels or diabetes. That makes a checkup worth it, even before you decide on treatment. Talk to a doctor about what’s going on and ask about costs at the same time. Many men find a treatment that fits their health and their budget, and pills work well for many men.

Common questions

Does Medicare cover ED pills?

No. Federal law keeps Medicare Part D drug plans from covering drugs when they are used to treat erectile dysfunction, though some plans may offer them as an extra benefit. Medicare Part B may still cover medically necessary doctor visits to find the cause.

Does Louisiana Medicaid cover ED medicine?

Federal law bars federal Medicaid funding for drugs used to treat erectile dysfunction, so Medicaid generally does not cover them. Ask your Medicaid plan what it covers for visits and tests to find the cause.

Does private insurance cover erectile dysfunction treatment?

It depends on your plan, and coverage varies widely. Call the number on your insurance card and ask what is covered before you start treatment.

How can I get ED care if I don’t have insurance?

Community health centers offer care where what you pay depends on your income. Veterans can check whether they qualify for VA health care.

Ready for next steps? Read how to find ED care in New Orleans and Metairie, including what a good first visit looks like and the questions worth asking.

Not sure where to start? We list trusted places to get checked in Louisiana, from community health centers to men’s health clinics. See where to get care.

Sources

• CMS: Medicare Prescription Drug Benefit Manual, Chapter 6 (Part D Drugs and Formulary Requirements)
• CMS: State Medicaid Director Letter on Drugs for Erectile Dysfunction (SMDL #05-006)
• Medicare.gov: Doctor and Other Health Care Provider Services
• HealthCare.gov: Community Health Centers
• VA: VA Health Care Costs