Does Insurance Cover Vasectomy and How Much Does It Cost?
Last updated 07/16/2022 byOssiana Tepfenhart
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If you or someone in your life is considering a vasectomy, you will want to factor in the cost and how much of that cost is covered by your health insurance. Fortunately, vasectomies are usually covered, at least in part, by insurance. Some states even mandate that insurance companies cover the cost of vasectomies.
If you have to pay the full cost of the procedure, you have some options, including using a health savings account, buying supplemental insurance coverage, paying in installments, or getting a personal loan. Below, we’ll go over some common questions about vasectomies and your options for paying the bill, with or without insurance.
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What is a vasectomy?
A vasectomy is a form of male sterilization. This procedure is usually done in a urologist’s office, surgical center, or hospital and involves cutting the vas deferens. This allows men to ejaculate, but eliminates the sperm from the seminal fluid.
Patients need to do a semen analysis after the procedure to ensure their sperm count is zero. Once the analysis is performed and they are cleared, they are officially sterilized. This could be considered a “get and forget” method of family planning.
It’s important to realize that a vasectomy does not protect against sexually transmitted diseases. Moreover, vasectomies can fail, although it is rare. It’s often best to have other forms of birth control as a backup.
Can vasectomies get reversed?
Vasectomy reversal is possible, but it is not guaranteed to work. It can also be expensive, and your insurance might not cover it.
How much does a vasectomy cost?
The price of a vasectomy can vary greatly. The average cost is around $1,000, but it could be as much as $4,000, depending on what the doctor and medical center charge. Many men can get a vasectomy for free through insurance policies or government programs. Others will have to pay for part of the procedure as a copay or to meet a deductible while insurance covers the rest. Check with your insurance company to find out your specific coverage for vasectomy.
If you do not have insurance coverage, check out local government programs or Planned Parenthood health centers to determine if you qualify for an income-based discounted procedure.
Does insurance cover vasectomies?
The Affordable Care Act doesn’t mandate vasectomy coverage. Rather, the law requires coverage for women’s birth control methods, including tubal ligation. But many insurance companies cover at least part of a vasectomy, as it is a relatively affordable one-time birth control method.
If you live in certain states, you’re in luck — insurance companies are mandated to cover vasectomies there. So in Washington, Vermont, New Jersey, New Mexico, New York, Maryland, Oregon, and Illinois, you should have at least some, if not all, of your vasectomy covered.
How can you find out if your vasectomy is covered?
Every health insurance plan has a section that shows covered services. You may be able to access this through your insurance company’s website or call them (look for a number on the back of your insurance card).
Even if you have a health insurance policy that covers part or all of a vasectomy, you still have to meet your deductible for the policy to kick in. Thankfully, most visits to the doctor’s office will chip away at your deductible.
Does Medicaid cover vasectomy costs?
Most state programs that utilize Medicaid and health insurance supplements tend to cover vasectomy costs. This is because a vasectomy is more affordable compared to a tubal ligation, or, worse, an unplanned pregnancy.
Can you use an FSA or HSA to cover vasectomy costs?
If your insurance coverage doesn’t cover all of your vasectomy costs, there is some good news for you. You can use a flexible spending account or health savings account to cover the out-of-pocket costs. Depending on your savings, this can cover the whole surgery or a sizable portion of it.
Explore a variety of savings accounts that can help you save money for your procedure.
If you have an FSA or an HSA, make sure to budget for this potential cost ahead of time. Your FSA or HSA is there to cover what your insurance doesn’t. This can also include aftercare, such as pain relievers for post-surgery soreness.
How much do vasectomy reversals cost?
Vasectomy reversal costs can vary even more wildly than the cost of a vasectomy itself. A typical vasectomy reversal costs approximately $8,000-$15,000. However, if the reversal is complicated, then you could have to pay as much as $80,000. Reversals may also be considered elective and therefore not covered by insurance.
Is a vasectomy cheaper than female sterilization?
If you are debating between getting a vasectomy and getting your partner’s tubes tied, a vasectomy is going to be far cheaper. On average, female sterilization will be six times more expensive than a vasectomy. It’s also more invasive and riskier.
What can you do if your insurance coverage doesn’t include vasectomy costs?
Unfortunately, this means you will need to come up with an alternate plan. These are your options:
- Pay the out-of-pocket costs for a vasectomy. This can get pricey since you need to visit a board-certified urologist, get local anesthesia, and also have the traditional vasectomy performed. Some urologists may be able to do a VasClip implant procedure instead at a lower cost. Either way, ask your doctor about a payment plan or use your health savings account to pay the bill.
- Buy supplementary coverage. If your health insurance plan does not cover vasectomy, then you can look into buying supplementary coverage. It may cost extra, but it could save you hundreds of dollars.
- Check out other programs that can help with funding. It is in the government’s best interest to prevent unwanted pregnancy, so many areas have government-funded programs that help cover vasectomy costs. Check with your local health department. Some Planned Parenthood health centers also offer vasectomies with reduced costs on a sliding scale.
- Get a loan for your vasectomy. Medical bills can be sky-high, which is why it shouldn’t surprise anyone that there are now loans designed to help with medical bills. Also, check out SuperMoney’s Ultimate Guide to Medical Financing for more ideas on how to pay your medical bills.
If you have to pay the full cost of a vasectomy, don’t panic. Many urologists will have a payment plan option that divides the whole cost into installments.
Are vasectomies generally covered by insurance?
For the most part, health insurance policies will have some kind of coverage for vasectomy, even if they just cover the initial consultation. However, each insurance plan is different, so you should always check your coverage document.
How long is a vasectomy procedure?
A vasectomy is an outpatient procedure that only takes about 15-20 minutes in the office, plus a little monitoring time. Recovery time is short as well, with most people taking about two days to recover before they can return to typical daily activity.
Is a vasectomy considered preventive care?
The Affordable Care Act only requires insurance coverage for birth control methods used by women, so a vasectomy doesn’t count as preventative care.
How effective is a vasectomy?
It depends on the type of vasectomy you get. A “no-scalpel vasectomy” has different efficacy rates than a traditional vasectomy. But most vasectomies have an efficacy rate of over 99 percent — fewer than 2 of every 1000 women will get pregnant within a year after their partner has a vasectomy.
Is a vasectomy tax deductible?
Yes. Vasectomy is one of the items you can include in your medical expense deduction. However, you should consult with a tax preparer to make sure you can take the deduction.
- A vasectomy can be free of charge or cost as much as $4,000, depending on your situation. The average cost is around $1,000.
- Most insurance plans will offer some coverage for vasectomies, but you should always double-check your own policy for coverage details.
- Vasectomies should be treated as a form of permanent birth control. A vasectomy reversal often costs more than a vasectomy, may not be covered by insurance, and is not guaranteed to work.
- If your insurance plan doesn’t cover vasectomies, you can get a supplemental insurance plan to help cover the costs.
- You can also cover your medical bills with an HSA or FSA, or a personal loan.
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