Are Vasectomies Covered by Insurance?

Tamsen Butler
Patient in hospital gown waiting in examination room

Considered a relatively inexpensive option when compared to sterilization procedures for women, vasectomies are not typically viewed as medically necessary procedures. Still, most health insurance providers will cover the cost of this procedure for adult men.

Partial or Full Coverage

Some insurance companies put a monetary limit on the amount of money they will cover for a vasectomy, but most will cover the cost of the procedure partially or fully. While most medical providers will check in with the insurer prior to scheduling the procedure to ensure sufficient coverage, the burden of payment falls upon the patient - meaning a procedure that is not covered but still performed will have to be paid for in full by the patient.

Policy-Specific

Men may be responsible for a co-payment; the amount of the policy's deductible may also impact the potential for out-of-pocket costs. Some policies require a specific waiting period prior to the procedure. Some policies may require a specialist referral if the man's primary care physician doesn't perform vasectomies; failure to obtain proper insurance authorization for the referral of procedure may result in it not being covered. Avoid this by checking directly with the insurance company beforehand to ensure coverage.

Affordable Care Act Coverage Requirements

The ACA provides ample stipulations about birth control coverage for females but does not include requirements for vasectomies.

Planned Parenthood Option

Men without insurance may be able to get a low-cost vasectomy from Planned Parenthood. Facilities unequipped to perform vasectomies will assist in finding a provider to offer the procedure on a sliding fee scale based on the person's income.

Medicaid

Medicaid will cover the cost of vasectomies in some states, but not all.

Economic Option

The cost of a vasectomy, when compared to the cost of having a baby or sterilizing a woman, continues to be the less expensive alternative. That's why some men are willing to pay for the procedure out-of-pocket if insurance won't cover the cost.

Was this page useful?
Are Vasectomies Covered by Insurance?