Does Insurance Cover Vasectomy?

Vasectomy is a highly effective and permanent form of male birth control. While coverage varies, most private and employer-based health insurance plans cover vasectomy, often with partial or full reimbursement. Here’s how to know what your plan covers and how to minimize costs.

1. Is Vasectomy Covered by Insurance?

• Vasectomy is not federally required to be covered under the Affordable Care Act, unlike female sterilization procedures.

• Still, over 85% of private health plans offer at least partial coverage.

• In 9 states, insurers must cover vasectomies without cost-sharing. These include California, New York, New Jersey, Maryland, and others.

• Medicaid covers vasectomy in most states as part of family planning services.

• Coverage typically includes consultation, procedure, and follow-up.

2. How Much Does a Vasectomy Cost Without Insurance?

• The average out-of-pocket cost ranges from $350 to $1,000.

• This includes local anesthesia and the procedure itself.

• Costs may be higher at private clinics or for advanced techniques.

• Reversals are rarely covered and can cost between $5,000 and $15,000.

3. What Affects Your Out-of-Pocket Cost?

• Your deductible: If you haven’t met it, you may pay most or all of the bill.

• Copays and coinsurance: You might pay 10%–30% of the procedure fee.

• Out-of-network providers: Going outside your insurance network usually means higher costs.

• Plan type: High-deductible health plans (HDHPs) typically cover less upfront.

4. How to Confirm Coverage

Call your insurance company and ask:

• Is vasectomy (CPT code 55250) covered?

• What portion does the plan pay?

• Does my deductible apply?

• Are there any network restrictions?

• Is prior authorization required?

Ask your provider for help verifying benefits if you’re unsure.

5. What to Do If You’re Uninsured or Not Covered

• Look for clinics with sliding scale fees

• Ask for cash pay discounts—many clinics offer them

• Use savings programs or community health centers

• Consider scheduling during open enrollment to choose a better plan for next year

Summary Table

Final Takeaway

Most health insurance plans cover vasectomy either partially or in full—even though it’s not federally required. Your costs depend on your provider, plan, and state. Always confirm details in advance to avoid surprise expenses.

Want help checking if your insurance covers vasectomy or finding a better plan?
With 30+ years of experience and access to nearly 100 insurance carriers, THAgency will find the best option for your situation. Send your inquiry now—fast, free, and confidential.