Does Medicare Cover Hormone Pellets?

There are many types of hormone medications. And there are plenty of reasons someone may take hormone medications.

For example, there are hormone medications for women after they go through menopause. There are also testosterone pellets for people who are low on testosterone.

So a common question many people have is, “does Medicare cover hormone pellets?” In this article, we answer that question in clear, plain English. You will also find the average costs of Hormone Pellets and other helpful info.

Does Medicare Cover Hormone Pellets?

The short answer is no. In most cases, Medicare will not cover the cost of hormone pellets. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your hormone medications.

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for hormone medications. Parts A and B do not provide coverage for hormone medications because they mainly cover medically necessary services, equipment, and treatment rather than prescription drugs.

However, in some cases, Original Medicare may provide coverage for testosterone pellets for beneficiaries who are suffering from low testosterone caused by a medical condition. The most common causes of low testosterone are hypogonadism and hypogonadotropic hypogonadism.

However, for Medicare to provide coverage for testosterone pellets, it must be first medically necessary. It may be considered medically necessary to take testosterone pellets if:

Your testosterone is below-average
You are diagnosed with a medical condition and that condition causes low levels of testosterone
You are not taking other supplements that may either boost or lower your testosterone levels

The patient must also be experiencing effects caused by lowered levels of testosterone, such as significant weight loss, osteoporosis, decreased bone density, or decreased sex drive for Medicare to provide coverage.

Part C and Part D Coverage for Hormone Pellets

However, Medicare Advantage plans (Medicare Part C) may provide coverage for hormone medications. Medicare Advantage plans cover everything Original Medicare covers but usually also offer some additional benefits. However, coverage and out-of-pocket costs will vary depending on the specifics of your plan.

Since many Medicare Part C plans have prescription drug coverage, they also provide coverage for the purchase of hormone pellets which are not covered by Original Medicare.

Medicare Part D plans also provide coverage for hormone medications. Medicare Part D is a prescription drug plan. Just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

Medicare may also provide coverage for hormone therapy for transgender beneficiaries the same way they provide coverage for hormone therapy for any other Medicare beneficiaries.

How Much Do Hormone Medications Cost?

The cost of hormone pellets may range from $300 to $350 for women and $650 to $750 for men. The cost may depend on the number of doses as well as the type of hormone needed.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. 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.