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Insurance Health Insurance

Does Health Insurance Cover the Cost of a Vasectomy?

Vasectomies, also known as male sterilization, are a common medical procedure, with a 2010 study estimating that between 175,000 and 354,000 vasectomies are performed annually in the United States.

Vasectomies are common because they’re an effective method of family planning and a reliable form of birth control.

This guide will talk about the costs of a vasectomy, how to determine whether your health insurance covers one, and what to do if it does not.

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Cost of a Vasectomy

Vasectomy costs are also typically pretty affordable, with out-of-pocket expenses usually ranging between $350 and $4,000. Of course, paying several hundred or thousands of dollars can still create a financial burden for men hoping to prevent pregnancy using a vasectomy.

The good news is that health insurance often helps to defray these costs and, sometimes, even covers the cost of a vasectomy entirely.

How to Determine if Your Health Insurance Covers a Vasectomy

Health insurance coverage varies from policy to policy.

The Affordable Care Act requires private health plans to provide reproductive health coverage for at least one form of the 18-FDA approved contraceptive methods for women. This means female sterilization procedures such as tubal ligation must be covered with no out-of-pocket costs for women.

Consider Your State of Residence

Federal law doesn’t require coverage for vasectomies, but nine states (California, Illinois, Maryland, New Jersey, New Mexico, New York, Oregon, Vermont, and Washington) do mandate that vasectomies are covered at no cost to patients.

Most state Medicaid programs also cover vasectomy, so you should be covered if you get insurance through Medicaid.

Look at Your Health Insurance Policy

If you don’t live in one of the five states that mandate vasectomy coverage and you have private insurance instead of Medicaid, you’ll need to look at your specific insurance policy terms.

You can contact your insurance company to ask about coverage or look at the list of covered benefits in your policy terms to find out the rules for vasectomies.

If your current policy doesn’t cover vasectomy, you may be able to buy supplementary coverage. Or, during the next open enrollment period for insurance, you could look for an insurer that includes vasectomy as one of its covered services.

Other Things to Consider

Even if your health insurance provides coverage for a vasectomy, this does not necessarily mean 100 percent of costs will be paid. There are a few other key things to consider.

Have You Met Your Deductible?

Most health insurance policies have a deductible, which is an amount you pay upfront before insurance coverage kicks in.

For example, if you have a $1,000 deductible, you’d need to pay $1,000 for covered services before your insurer pays.

If your policy has a deductible and you haven’t met it, you’d need to find out if the deductible applies to vasectomy. Some kinds of care are covered even if your deductible hasn’t been met, and your policy terms will specify if this is the case.

Do You Have a Copay?

Typically, when you visit a doctor for a procedure, you have to provide a copay at the time of service. This is usually a flat fee based on the type of doctor or service.

For example, you may have a $30 copay for a typical doctor’s visit, a $50 copay for a specialist visit, or a $100 copay for outpatient surgical procedures.

You should find out the copay before scheduling your vasectomy, as it may differ depending on where you have the operation performed.

Do You Have Coinsurance Costs?

Many insurers cover a portion of your care, leaving you to pay for the rest.

For example, if you have a coinsurance cost of 20 percent, your insurer would pay 80 percent of your care expenditures, and you’d be left paying for the other 20 percent.

Is Your Provider In-Network?

Many insurers limit coverage to physicians who belong to a participating network of doctors. If you’re allowed to see an out-of-network doctor, your services may only be partially paid for and you may incur significant out-of-pocket expenses.

The cost of vasectomy can vary dramatically depending on where you have it performed, as well as the specific procedure you choose (you typically have a choice between a no-scalpel vasectomy or a VasClip implant procedure).

So, if you’re paying out-of-pocket or your insurer provides only partial coverage, be sure to compare your options before choosing a care provider.

Paying for a Vasectomy Out of Pocket

If your insurer won’t cover vasectomy, you could potentially be forced to pay the full cost of the procedure. The good news is the average cost of a vasectomy is relatively affordable compared to other medical treatments, so hopefully, you’ll be able to afford this family planning technique if you want to.

If you can’t come up with the full costs upfront, you could talk with your doctor’s office about a payment plan.

You could also choose to take out a small personal loan or pay for the procedure using a credit card. Look for a 0% APR card if you’re going to charge the operation so you can pay off the costs over time without incurring interest.

When paying out of pocket, it’s even more important to shop around for an affordable caregiver. Consider asking if a cash discount as available, as some providers offer cheaper services if they don’t have to deal with insurance.

Bottom Line

If you want a vasectomy, check with your insurer to see if you can get the procedure paid for. If you can’t, you should still have options to pay for the care you need, especially if you shop around among caregivers and find someone charging an affordable price.