Does Blue Cross Blue Shield Federal Cover Vasectomy
Vasectomies can be covered by health insurance depending on the type of insurance one has and the state they live in. A vasectomy is a popular, permanent form of birth control for men which prevents sperm from entering the semen. Understanding the benefits, risks, and costs of vasectomy will help one make an informed decision.
Cost of a Vasectomy
The cost of a vasectomy can range from $0 to $1000. The Arizona Center for Vasectomy and Urology cites that vasectomies are covered by about 70 percent of health insurance plans. However, plans can vary so it is extremely important to confirm coverage with your insurer. Some insurers that regularly cover vasectomies include PacifiCare, BlueCross BlueShield, United Healthcare, and Medicare. The cost of a vasectomy is based on multiple factors:
- Insurance Type
- Facility operation completed at (Clinic, Outpatient Facility, Hospital, etc.)
- Type of Vasectomy (Conventional vs. No-Scalpel Method)
According to Planned Parenthood, for patients not covered by insurance, a vasectomy typically costs $250 to $1,000 out-of-pocket. Whereas for patients covered by insurance, out-of-pocket costs typically consist of a $10 to $30 copay for the initial consultation and another copay of $10 to $100 for the procedure. The total cost for a Vasectomy will usually include these services:
- Consultation
- Anesthesia
- Procedure
- Any follow-up visits
- Semen analysis post-procedure
Affordable Care Act (ACA) and Medicaid
The ACA does not mandate insurance plans to cover vasectomies, however, they do require that plans cover other forms of birth control with no out-of-pocket cost. Contraceptives, including sterilization, are covered only for women as a preventative service under the ACA expansion. Many states do not view a vasectomy as a preventative procedure and are not required to by federal laws, so, therefore, do not cover it. Your individual health plan will have its own coverage and deductible costs for the procedure. If you have health insurance through the Affordable Care Act it is important to check with your plan to confirm if a vasectomy is covered, and what specific services the coverage extends to.
However, eight states (Illinois, Maryland, New Jersey, New Mexico, New York, Oregon, Vermont, and Washington) require state-regulated health insurance plans to cover vasectomies at no cost to the patient. If one doesn't live in any of the previously mentioned above that mandate vasectomy coverage, they should check with their Medicaid plan.
Private Health Insurance
If one's current plan does not cover a vasectomy, or if one does not have insurance, they may be able to buy supplementary coverage or look for an insurer that includes vasectomy as one of its covered services during the next open insurance enrollment period. Kaiser Family Foundation states that most health insurance firms will cover the cost of a vasectomy if it's done as an outpatient operation. However, one should confirm with their insurance provider to ensure that their family planning benefits include vasectomies.
Paying Out of Pocket
If one's insurance doesn't cover vasectomies and they do not get supplementary coverage, one may 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 birth control costs long-term. It may cost more upfront than other methods, but it has been shown to be cost-effective in the long run. Vasectomies are approximately six times cheaper than female sterilization. Many doctors' offices and clinics also offer payment plan capabilities and well as sliding-scale prices where you pay based on your income.
Planned Parenthood Health Centers
Most Planned Parenthood health centers accept Medicaid and health insurance, and many charges less for services depending on one's income, operating on a sliding scale. One can also contact their local Planned Parenthood health center to find out more information and identify a vasectomy procedure option within one's budget.
What is a Vasectomy?
A vasectomy, also called male sterilization, is a simple surgery done by a doctor in an office, hospital, or clinic which involves cutting the supply of sperm to semen. The small tubes in the scrotum carry sperm, and these are cut, so sperm can't leave the body and cause pregnancy. Vasectomies carry a low risk for complications or problems, and the patient can go home the same day. Each year, more than 500,000 men in the U.S. choose to undergo a vasectomy as a form of permanent birth control.
There are two ways to perform a vasectomy, both involving the patient being awake during the procedure, therefore the urologist uses a local anesthetic to numb the scrotum. A medical professional will perform a vasectomy either using the conventional or "no-scalpel" method.
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Conventional Method
The doctor makes one or two small cuts in the scrotum to access the vas deferens. A small section of the vas deferens is cut out and then removed. The urologist may cauterize (seal with heat) the ends and then tie the ends with stitches.
The doctor will then perform the same procedure on the other testicle, either through the same opening or through a second scrotal incision. For both testicles, when the vas deferens have been tied off, the doctor will use a few stitches or skin "glue" to close the opening(s) in the scrotum. (Source: NIH)
"No-Scalpel" Method
With the "no-scalpel" method, a small puncture hole is made on one side of the scrotum. The healthcare provider will find the vas deferens under the skin and pull it through the hole. The vas deferens is then cut and a small section is removed. The ends are either cauterized or tied off and then put back in place.
The procedure is then performed on the other testicle. No stitches are needed with this method because the puncture holes are so small. (Source: NIH)
Risks of A Vasectomy
The major risk with this procedure is if one changes their mind and decides they want children. Although a reversal is possible, it is not guaranteed and is usually very expensive.
Some other side effects of a vasectomy include:
- Bleeding or a blood clot inside the scrotum
- Blood in semen
- Bruising of the scrotum
- Infection of the surgery site
- Mild pain or discomfort
- Swelling
Delayed complications can include:
- Chronic pain (happens to every 1% to 2% of people who have the surgery)
- Fluid buildup in the testicle
- Inflammation caused by leaking sperm
- Pregnancy, in the event that the vasectomy fails, which is rare.
- A fluid-filled sac surrounding a testicle that causes swelling in the scrotum
Vasectomy vs. Other Forms of Birth Control
The cost of a vasectomy is far less than the cost of female sterilization (tubal ligation) or the long-term cost of birth control medications for women (Mayo Clinic). The procedure also has an extremely high efficacy rate (99.9%) and a low failure rate (0.15%).
When compared to other forms of birth control such as condoms, cervical caps, oral contraceptives, hysterectomies, etc., the average annual cost of a vasectomy is extremely low. The Urology Care Foundation stated that "many men are choosing a vasectomy as a permanent form of birth control because of its cost, effectiveness, and minimal side effects".
Cost and Effectiveness of Birth Control by Type
| Birth Control Form | Average Annual Cost | Failure Rate |
|---|---|---|
| Condoms | $168.91 | 2-18% |
| Cervical Cap | $100 | 23% |
| Sponge | $2000 - $4000 | 24% |
| Oral Contraceptives | $600 | 2-9% |
| Hysterectomy | $760 - $1170 (over 10 years) | 0% |
| Vasectomy | $86 (over 10 years) | 0.15% |
Source: Urology Care Foundation
Male Vasectomy Frequently Asked Questions (FAQs)
Consider this additional information when it comes to considering and paying for a vasectomy.
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What are the reasons a man would get a vasectomy?
Vasectomies are almost 100% effective (99.9%) at preventing pregnancy. It is for this reason that many men decide to get the procedure - they are certain that they do not want any (more) children.
Are vasectomies reversible?
Although vasectomy reversals are possible, a vasectomy should be considered a permanent form of male birth control. Vasectomy reversals are usually much more expensive and generally not covered by insurance. The probability of a successful vasectomy reversal declines with time, so reversals have been found to be much more successful the sooner they are done after a vasectomy.
Will a vasectomy protect me from sexually transmitted diseases?
A vasectomy does not protect against sexually transmitted diseases (STDs). One should use condoms to protect against STDs if they are sexually active.
After a vasectomy, can I stop using other birth control methods right away?
No, a vasectomy does not provide immediate protection from pregnancy. Sperm can remain in one's semen for many months after a vasectomy. A doctor will test one's sperm count approximately three months after surgery. Until the sperm count is zero or there are less than 100,000 sperm, sex without another method of birth control may lead to pregnancy.
Having a semen analysis after a vasectomy is the only way to confirm that one no longer has sperm present in their semen. Until a doctor confirms this, one should use an alternative form of birth control.
What does recovery look like?
After a vasectomy, most men go home the same day and fully recover in less than a week. There may be some discomfort or pain after a vasectomy, but it should not be unbearable. Majority of people recover and resume normal activities within a few days to a week after surgery. (Source: Urology Care Foundation)
Bottom Line
The decision to have a vasectomy is a very personal one and requires much consideration. All options should be weighed and considered, specifically with regards to the safety, cost, and permanence of the procedure. The actual price for a vasectomy varies depending on whether or not one has health insurance, or if they qualify for Medicaid or other government programs that cover the cost of the procedure.
If one doesn't have insurance, Mira may be a good option to access affordable birth control. With Mira, one can go to urgent care for a small co-pay, get discounts on birth control, and continue to get care for just $45 per month. Start coverage today.
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