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Is Viagra covered by health insurance?

To sum it up...
  • Coverage for Viagra varies depending on your insurance company
  • Medicare typically does not cover Viagra
  • Some Medicare Advantage plans will cover Viagra
  • Many insurance companies consider Viagra non-essential and will either not be covered or billed at a higher rate
  • Aetna insurance company does cover Viagra if it is deemed medically necessary based on their diagnosis criteria

What is Viagra?

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Viagra is a certain type of drug that is used to treat erectile dysfunction by increasing blood flow towards certain parts of the body, particularly the penis. You usually need a prescription for Viagra and it is important to speak to your doctor about the other medications you are taking and any possible side effects that may occur after taking Viagra.

In some circumstances, Viagra can decrease blood flow to the eyes and cause unexpected problems with vision and blindness.

It is important to take Viagra exactly how it says to on the label or how your doctor told you to. You should take it thirty minutes to an hour before engaging in any sexual activity. However, you can take it up to four hours before sex. You should not take Viagra more than once a day.

How do I know if my health insurance plan covers Viagra?

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You can check if your health insurance plan covers Viagra by reading through the benefits summary affiliated with your plan. If you are purchasing a plan on the Healthcare Marketplace, you can look through what a plan offers before choosing one and enrolling in it.

If you get your insurance plan through your employer, you can speak to a human resources representative about enrolling in a plan that might cover erectile dysfunction treatments. Coverage for Viagra will vary depending on the plan. Private insurance plans might cover Viagra if it is considered medically necessary. However, this coverage might come with a higher co-pay than many other drugs.

If your insurance plan does not cover Viagra or if you do not have any health insurance at all, you might have to pay $20 or more per pill out of pocket to acquire Viagra. Some doctors may offer their patients free Viagra samples if their insurance does not cover it.

Does Medicare cover Viagra?

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Medicare Part D is the Medicare program that covers prescription drugs. However, it does not cover Viagra. Medicare Part B, which covers medical equipment, does cover pumps that might assist in erectile dysfunction treatment. Medicare Part B only covers 80 percent of costs, so you will be responsible for paying the other 20 percent out-of-pocket if you choose to use the erectile dysfunction pump instead of Viagra.

Some Medicare Part D plans will cover Cialis, which is another erectile dysfunction drug that can also be used to treat an enlarged prostate.

Medigap also does not cover Viagra because it does not cover prescription drugs. You can purchase Medigap to help cover your other out of pocket costs. Some Medicare Advantage plans do cover Viagra. These are typically private insurance plans you purchase in addition to original Medicare. You will still most likely have to pay a high percentage or co-payment for Viagra even if your insurance covers it.

Does Aetna cover Viagra?

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Some private insurance plans will cover Viagra but it can vary. For example, some Aetna plans will not cover pharmaceutical drugs that are considered lifestyle enhancements, which can include Viagra. These plans will cover Viagra if it is required by the state or if the insured has purchased additional pharmacy benefits.

Aetna will cover erectile dysfunction treatment if it is deemed medically necessary. However, that does not always mean Viagra. These plans can cover injectable medications, pharmaceutical pills, transdermal medications, external devices, and implantable devices. It will depend on the plan exactly what is covered under these categories. Under certain circumstances, some Aetna plans might even cover surgical re-vascularization.

Is Viagra covered by health insurance?

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Coverage for Viagra varies depending on the plan but many plans do not cover the drug at all. Some plans will provide coverage at a higher co-pay cost than other medications. Most Medicare plans do not cover Viagra.

Speak to a representative at your health insurance company to find out exactly what your plan covers and what options you have for erectile dysfunction treatment.

If you know that you will need coverage for ED treatment, look for a plan that includes Viagra in their benefits summary. However, continue to look for a plan that meets as much of your healthcare needs and costs as possible, not just one that covers Viagra.

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