Does Medicare Cover Sex Therapy? Exploring Your Options

Written By

Erica Barnes

Updated:

Fact Checked

Does Medicare Cover Sex Therapy

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Imagine feeling confident and fulfilled in your sexual life, even as you age. For many adults, reaching their golden years coincides with concerns about physical changes and their impact on intimacy.

Sex therapy can be a powerful tool to navigate these changes, but accessing affordable care can be a daunting task. The question arises: Does Medicare cover sex therapy?

This article unpacks the confusing world of Medicare and its potential to support your sexual health journey.

Let’s embark on this discovery together, shedding light on the possibilities and empowering you to make informed decisions for your well-being.

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Sexuality: More Than Just “Physical Matters”

Think of your sexual health as the vibrant tapestry woven from physical, emotional, and psychological threads.

While physical changes associated with aging are inevitable, neglecting the emotional and psychological aspects of sex can leave you feeling dissatisfied and disconnected.

Sex therapy addresses these very aspects, fostering communication, emotional intimacy, and exploring solutions to enhance your sexual enjoyment.

Here’s the exciting part: Studies show that older adults who engage in regular sexual activity experience numerous benefits, including:

  • Reduced stress and anxiety
  • Improved sleep quality
  • Stronger immune system
  • Enhanced cognitive function
  • Deeper connection with their partner

Medicare Coverage

Now, back to the burning question. Does Medicare, the health insurance program for Americans aged 65 and older, unlock the door to sex therapy?

Breakdown

Medicare boasts multiple parts, each with its own coverage areas:

  • Part A: Covers hospitalization and skilled nursing facility care. (Not relevant to sex therapy)
  • Part B: Covers outpatient care, including doctor visits, preventive screenings, and some mental health services. (Potential for sex therapy coverage)
  • Part D: Covers prescription drugs. (Potentially covers drugs relevant to underlying medical conditions causing sexual dysfunction)
  • Medicare Advantage Plans: Private insurance plans approved by Medicare, offering additional benefits beyond traditional Medicare coverage. (Coverage varies depending on the specific plan)
ServiceCoverageNotes
Individual psychotherapy for mental health conditions affecting sexual functionPossible coverage under Part BRequires diagnosis from a physician, must be medically necessary, and provided by a qualified mental health professional. Out-of-pocket costs (deductible, coinsurance) may apply.
Couples therapy for sexual concernsLimited coverage under Part BSimilar requirements as individual therapy, but coverage may be more restrictive. Check with your plan for specific details.
Medications for sexual dysfunctionPossible coverage under Part DDepends on the specific medication and the individual plan formulary. Some medications, like Viagra, are often excluded.
Devices for sexual dysfunction (pumps, implants)Generally not coveredExceptions may exist for specific, medically necessary cases. Check with your plan and physician.
Surgery for sexual dysfunctionPossible coverage under Part BMust be medically necessary and performed in a hospital or outpatient setting approved by Medicare. Out-of-pocket costs apply.
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Coverage Potential

While Medicare doesn’t directly cover “sex therapy,” it might support related services under specific circumstances:

  • When sex dysfunction is a symptom of a covered medical condition: If, for example, diabetes or a neurological disorder affects your sexual function, Medicare Part B might cover treatments addressing the underlying condition, indirectly impacting your sexual health.
  • Psychological therapy: Individual or couples therapy prescribed by a doctor and deemed medically necessary for a mental health condition impacting your sex life (e.g., anxiety, depression) might be covered by Part B.
  • Surgery: In rare cases, penile implant surgery might be covered as a last resort for treating severe erectile dysfunction if other treatments haven’t worked.

Remember: Coverage isn’t guaranteed and often depends on:

  • Diagnosis: The underlying medical or mental health condition.
  • Treatment plan: The doctor’s justification for deeming therapy medically necessary.
  • Provider: Therapist participation in the Medicare program.
Medicare Coverage Of Sex Therapy

Out-of-Pocket Costs

Even when covered, expect out-of-pocket expenses:

  • Deductibles: An annual amount you pay before Medicare starts covering services.
  • Coinsurance: A percentage of the cost you share after meeting the deductible.
  • Copays: Fixed fees for certain services.

Beyond Medicare: Exploring Your Options

If Medicare doesn’t fully cover your needs, don’t lose hope! Here are other avenues to explore:

  • Medicare Advantage plans: Some plans offer broader coverage for mental health services, including sex therapy. Research and compare plans carefully.
  • Financial assistance programs: Non-profit organizations or charities might offer financial aid for therapy.
  • Sliding scale therapists: Some therapists adjust fees based on your income.

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Fill out a brief questionnaire and get matched with an experienced therapist online in as little as 48 hours.

✓ Over 35K licensed professionals

✓ Financial aid available

✓ Subscriptions as low as $65/week, billed every four weeks

✓ Cancel plan or change therapist anytime

20% off your first month through Therapy Helpers

Finding the Right Therapist

Now that you have a roadmap, here’s how to find a qualified therapist who accepts Medicare:

  • Online directories: Utilize national databases like the American Association of Sexuality Educators, Counselors & Therapists (AASECT).
  • Contact your insurance provider: They can verify if specific therapists accept Medicare.
  • Ask your doctor for recommendations: Many physicians have networks of trusted therapists.

Conclusion

Medicare coverage for sex therapy can be a complex puzzle, but understanding your options empowers you to seek the support you deserve.

Remember, prioritizing your sexual well-being isn’t selfish; it’s an investment in your overall health and happiness.

Looking for more mental health tips? Make sure to follow our Mental Health Board on Pinterest!

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About the author

Erica Barnes

Erica Barnes

I’m an African American woman living in New York, with a Bachelor's degree in Communication. I’m passionate about researching mental health topics, spirituality, and breaking down stigma in my community. I’ve dedicated my life to shedding light on important issues surrounding mental health and working towards creating a more understanding and compassionate society. As a researcher at Therapy Helpers, I’m here to use my skills to educate and inspire others through insightful articles. Thank you for being here!Social

1 thought on “Does Medicare Cover Sex Therapy? Exploring Your Options”

  1. I was surprised to see this article because I didn’t realize sex therapy was something that could be covered by Medicare. As a 65-year-old on Medicare myself, I never considered it before. After reading though, it sounds like coverage depends on treating an underlying medical issue. That makes sense – if you have a medical problem causing sexual dysfunction, then working with a sex therapist would be part of the treatment plan.

    I could see how sex therapy could really help some seniors struggling with intimacy after illness or loss of a spouse. It’s nice to see Medicare taking a more holistic view toward health that includes this type of counseling. However, the article wasn’t totally clear if things like relationship counseling would be covered if medical necessity wasn’t demonstrated.

    Either way, my takeaway is that there are scenarios where Medicare might cover sex therapy, especially if you get a referral from your regular doctor. It’s worth asking about if you think it could help improve your mental health and quality of life. This wasn’t something on my radar before, but good to know as we age, maintaining a healthy sex life can still be important.

    Reply

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