Does Medicare cover Cialis?
Medicare covers Cialis only for benign prostatic hyperplasia (BPH). Your Medicare Part D covers prescription drugs, but it won't cover Cialis for erectile dysfunction (ED). Medigap and Medicare Advantage plans won't cover Cialis. Therefore, you may have to rely on coupons to get lower Cialis prices. If your Medicare program doesn't cover Cialis, you may have to shop around for a health insurance provider to find a more flexible coverage.
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Leslie Kasperowicz
Farmers CSR for 4 Years
Leslie Kasperowicz holds a BA in Social Sciences from the University of Winnipeg. She spent several years as a Farmers Insurance CSR, gaining a solid understanding of insurance products including home, life, auto, and commercial and working directly with insurance customers to understand their needs. She has since used that knowledge in her more than ten years as a writer, largely in the insuranc...
Farmers CSR for 4 Years
UPDATED: Jul 6, 2023
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UPDATED: Jul 6, 2023
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance companies please enter your ZIP code on this page to use the free quote tool. The more quotes you compare, the more chances to save.
On This Page
- Medicare generally doesn’t cover Cialis for erectile dysfunction
- Cialis contains the drug, Tadalafil
- Tadalafil is used to treat pulmonary arterial hypertension
- Cialis is a tier five drug
Cialis is a popular drug with several benefits, like improved blood flow, and some side effects. But does Medicare cover Cialis? That answer depends on what Cialis is treating in your body. Even the best insurance companies may decide against giving you money for a Cialis prescription.
Continue reading our guide to learn how you can get affordable Medicare to cover Cialis, and what conditions it’s covered for.
Enter your ZIP code in the free comparison tool above to compare quotes for Medicare that covers Cialis.
Does Medicare cover Cialis?
It depends. Medicare Part A and Part B won’t cover Cialis at all. However, Medicare Part D will provide coverage, but it won’t cover Cialis cost for erectile dysfunction (ED).
Cialis is the brand name of the drug, Tadalafil. Tadalafil is used in generic brands such as Adcirca and Alyq. However, Adcirca and Alyq are covered under Medicare Part D.
Does Medigap or Medicare Advantage cover Cialis?
Medigap is supplemental health insurance that won’t cover Cialis. Medicare Advantage is similar to Medicare Part A and B, and it won’t cover Cialis. Even Tadalafil isn’t covered.
Why? Prescription drug coverage is only provided for approved medications covered by Medicare Part D.
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How much does Cialis cost?
Cialis (Tadalafil) is a tier five drug. The cost of tier five drugs are usually more expensive than tier one, two, three, and four. Let’s examine the cost of Cialis by milligrams (mg).
| Prescriptions | Average Price | GoodRx Coupon Price |
|---|---|---|
| Cialis (30 Tablets, 2.5 mg each) | N/A | $11 |
| Cialis (30 Tablets, 5 mg each) | $298 | $25 |
| Cialis (30 Tablets, 10 mg each) | $1,475 | $31 |
| Cialis (30 Tablets, 20 mg each) | $1,339 | $30 |
The best way to save on Cialis (Tadalafil) is through coupons. Medicare doesn’t appear to cover Cialis as much as other prescriptions, so that you may be stuck with the bill. However, shop around the web for coupons to get a discount on Cialis.
Does Medicare cover Cialis for BPH?
If your Cialis prescription is for benign prostatic hyperplasia (BPH), your Medicare Part D could help you pay for the medication.
However, you will need to get the Cialis recommendation from your healthcare provider.
BPH Prescriptions Alternatives that Medicare Covers
Tadalafil comes in 2.5, five, ten, or 20 mg tablets (usually 30 pills). If Medicare doesn’t accept your Cialis prescription for BPH, your doctor may prescribe these instead:
- alfuzosin (Uroxatral)
- doxazosin (Cardura)
- silodosin (Rapaflo)
- terazosin (Hytrin)
Your doctor may suggest these medications before conducting other procedures to treat your BPH.
Cialis Medicare Coverage: The Bottom Line
If you happen to get Medicare Part D to approve your Cialis for BPH, you may be limited to one round of prescription at a time or a limited number of Cialis tablets. Medicare is firm on Cialis authorization, so you may have difficulty getting them up to speed.
Health insurance companies may have a little more flexibility with these kinds of covered drugs. You may be able to buy Medicare that covers Cialis through a Part D plan, but companies tend to share the same restrictions as Medicare. It’s always worth shopping around, however.
To find rates for Medicare that covers Cialis, or to look for alternate health insurance options, compare multiple companies in your local area by entering your ZIP code below.
Case Studies: Understanding Medicare Coverage and Out-of-Pocket Costs for Cialis
Case Study 1: John’s Medicare Coverage for Cialis
John, a Medicare beneficiary, was prescribed Cialis for erectile dysfunction (ED). However, he found out that Medicare Part D does not cover Cialis for ED. John had to explore alternative options and relied on coupons to lower the price of Cialis.
This case highlights the limitations of Medicare coverage for certain medications and the need for individuals to seek additional coverage or financial assistance.
Case Study 2: Mary’s Medicare Advantage and Medigap Plans
Mary, another Medicare beneficiary, had both a Medicare Advantage plan and a Medigap plan. However, she discovered that neither of these plans covered Cialis, regardless of the condition it was treating. Mary had to consider shopping around for a different health insurance provider that offered more flexible coverage options.
Case Study 3: Bill’s Medicare Coverage for BPH
Bill, who was diagnosed with benign prostatic hyperplasia (BPH), found that his Medicare Part D covered Cialis for this condition. However, he experienced limitations in the amount of Cialis prescribed and the frequency of prescription refills. Bill had to work closely with his healthcare provider to ensure he received the necessary medication within Medicare’s authorization guidelines.
Frequently Asked Questions
Does Medicare provide coverage for Cialis?
Yes, Medicare can cover Cialis under certain circumstances. Medicare is a federal health insurance program in the United States that primarily provides coverage for individuals who are 65 years or older, as well as certain individuals with disabilities or specific medical conditions.
Is Cialis considered a prescription drug?
Yes, Cialis is a prescription medication, and you will need a doctor’s prescription to obtain it.
Can I get financial assistance for Cialis if Medicare doesn’t cover it?
If Medicare doesn’t cover Cialis or if the cost is too high, you may be eligible for other financial assistance programs, such as manufacturer discounts, patient assistance programs, or state pharmaceutical assistance programs (SPAPs).
Can a Medicare Advantage plan cover Cialis?
Medicare Advantage plans (Part C) are offered by private insurance companies and may provide coverage for Cialis. The coverage and cost-sharing may vary depending on the specific plan.
Are generic versions of Cialis covered by Medicare?
Medicare may cover generic versions of Cialis if they are approved by the U.S. Food and Drug Administration (FDA) and listed on the plan’s formulary.
Can I appeal if Medicare denies coverage for Cialis?
Yes, you have the right to appeal if Medicare denies coverage for Cialis. The appeals process allows you to challenge the decision and provide additional information supporting the medical necessity of the medication.
Are you looking for free insurance quotes?
Your one-stop online insurance guide. Get free quotes now!
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Leslie Kasperowicz
Farmers CSR for 4 Years
Leslie Kasperowicz holds a BA in Social Sciences from the University of Winnipeg. She spent several years as a Farmers Insurance CSR, gaining a solid understanding of insurance products including home, life, auto, and commercial and working directly with insurance customers to understand their needs. She has since used that knowledge in her more than ten years as a writer, largely in the insuranc...
Farmers CSR for 4 Years
Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.