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Does Medicare Cover estrace cream

Does Medicare Cover Estrace Cream?

Estradiol (Estrace, Vivelle-Dot, Climara) is used to treat hot flashes and osteoporosis. It is also a treatment used by some women who have had their ovaries removed or have low estrogen levels. Various generic and brand variants are available, but Estrace is the most popular. 

Estrace is a vaginal cream intended to alleviate menopause symptoms such vaginal irritation and dryness. Despite the availability of estradiol in different formulations, such as oral tablets and vaginal rings, some individuals may prefer using a cream.

One common question those who use this treatment have is, “Does Medicare cover Estrace Cream?” In this article, we answer the question in clear, plain English. You will also find the average costs of Estrace Cream if you have to pay for it out of pocket as well as other helpful info.

Does Medicare Cover Estrace Cream?

The short answer is no. Original Medicare will not cover the cost of Estrace Cream. However, if you have Medicare Part C or D, these plans may cover at least part of your costs. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your Estrace Cream. 

Medicare Part A and Part B

Original Medicare (Medicare Part A and Part B) does not provide coverage for Estrace Cream. That is because Original Medicare mainly covers medically necessary services, equipment, and treatment rather than prescription drugs. Prescription drug coverage may be provided by either Medicare Advantage plans or Medicare Part D.  

Medicare Advantage Plans

However, some Medicare Advantage plans (Medicare Part C) provide coverage for Estrace Cream. Medicare Advantage plans cover everything Original Medicare covers but will also offer additional benefits.

What these additional benefits are, and how much your out-of-pocket costs will vary depending on your plan.

Medicare Part C plans that include prescription drug plans will also provide coverage for many medications your healthcare provider may prescribe for you.

Medicare Part D plans also provide coverage for Estrace Cream. Part D is a prescription drug plan. Like Medicare Part C, Medicare Part D plans are provided by private insurance companies. Ninety-nine percent of both Medicare Part C and Part D plans provide coverage for the medication Estrace Cream. 

The Medicare drug formulary lists Estrace Cream as a tier 2 drug. Tier 2 medications are preferred over Tier 1 medications. Tier 2 medications are more expensive than Tier 1. 

Medicare Advantage plans also provide coverage for other hormone replacement therapy. Since many Medicare Part C plans have prescription drug coverage, they also provide coverage for purchasing hormone replacement therapy which Original Medicare does not cover.

Medicare Part D plans also provide coverage for other hormone medications.

How Much Does A Tube Of Estrace Cream Cost?

The average retail price of a liquid (42.5g) of 0.01% estradiol cream is around $165.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series, including: Does Medicare cover lift chairs?

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Medicare Plan Tips Team

Annie Kaye is a writer and researcher who was thrown into the Medicare world while taking care of her ailing mother. Even with a degree in Library Science and a long history of fighting for what's right, she felt lost. She learned a lot about Medicare during that time and now writes to help others understand how the system works.