Does Medicare Cover Cialis? 

Men’s sexual health is a topic that has earned more public discussion since the introduction of the little blue pill, Viagra (sildenafil). Viagra became one of the most popular treatments for erectile dysfunction after being given FDA approval in 1998. It was the first oral medication that could be taken to treat erectile dysfunction as needed.

Despite the popularity of Viagra in the senior community and elsewhere, the medication does have its drawbacks. Viagra must be taken a few hours prior to engaging in sexual activity, meaning you must plan in advance for sexual activity. Additionally, since Viagra is a vasodilator, it can interfere with certain heart conditions. 

Due to these challenging aspects of Viagra, medical scientists set to work to find alternatives. One of the solutions they came up with was Cialis. If you’re experiencing erectile dysfunction and have Medicare, you may be wondering if your benefits will help cover the cost. 

What is Cialis?

Cialis (tadalafil) is a medication designed to treat erectile dysfunction. Unlike Viagra which was designed to treat cardiovascular conditions, Cialis is meant to be used exclusively for concerns surrounding erectile dysfunction.

Also unlike Viagra, Cialis is an oral medication that lasts for up to 36 hours. Instead of taking a pill a few hours prior to engaging in sexual activity, Cialis can be taken up to once daily and continues to provide functionality for days. Seniors taking Cialis are advised to consult with their physicians due to the potential for cardiovascular reactions and side effects.

Does Medicare cover Cialis?

Seniors who have dealt with erectile dysfunction understand the frustrations and challenges that come along with the condition. Many would like to know if Medicare benefits cover Cialis since Medicare insurance covers over 60 million seniors and retirees in the United States.

Although Medicare coverage is available for a large number of prescription drugs primarily through Medicare Part D prescription drug coverage, Cialis is not covered by Medicare Part D. The Centers for Medicare & Medicaid Services (CMS) deems erectile dysfunction medications as lifestyle treatments and does not view them as medically necessary.

Viagra may be covered by some Medicare Part D prescription drug plans when it is prescribed to treat cardiovascular conditions, but it will also be denied coverage if prescribed to treat erectile dysfunction. This also proves true for outpatient (Medicare Part B) and inpatient (Medicare Part A) treatment with Viagra for erectile dysfunction. Essentially, Medicare coverage does not apply toward the cost of any medication or treatment that is designed to enhance the sex lives of Medicare recipients.

Does Medicare Advantage cover Cialis?

Cialis may be covered by some Medicare Advantage plans in the form of rebates, coupons or discounts. Medicare Advantage plans carry the same benefits as Original Medicare, but providers have the option to offer additional coverages.

Some form partnerships with drug manufacturers to provide discounts when Medicare recipients pay for non-covered medications out-of-pocket. These additional benefits vary from provider to provider and plan to plan.

Additionally, the state in which you reside may have its own regulations regarding what Medicare Advantage plan providers can offer. To learn more, contact a Medicare advisor or broker in your state, or speak with a representative of your Medicare Advantage plan provider.