Does Medicare Cover Hormone Replacement Therapy?

Hormones change for everyone as we grow older. For example, in women, once they reach a certain age, they will have menopause.

Men or even women may experience a lack of testosterone and may need certain medications. For transgender people, they may need hormone medications too. And all of these situations may require hormone replacement therapy.

If this is something that you are considering, you probably have the common “does Medicare cover hormone replacement therapy?” In this article, we answer that question in clear, plain English. You will also find the average costs of hormone replacement therapy if you have to pay for it yourself.

Does Medicare Cover Hormone Replacement Therapy?

The short answer is no. In most cases, Medicare will not cover the cost of hormone replacement therapy. 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/or B do not provide coverage for hormone medications because they mainly cover medically necessary services, equipment, and treatment rather than prescription drugs. However, you can have prescription drug coverage by enrolling in either Medicare Advantage plans or Medicare Part D.

In some cases though Original Medicare may provide coverage for testosterone replacement therapy 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 replacement therapy, it must be first medically necessary. It may be considered medically necessary to take testosterone replacement therapy 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 Replacement Therapy

However, Medicare Advantage plans (Medicare Part C) provide coverage for hormone replacement therapy. Medicare Advantage plans have to cover everything Original Medicare covers but they also offer some additional benefits. Exactly what additional benefits are included in coverage and how much out-of-pocket costs are 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 replacement therapy which are not covered by Original Medicare.

Medicare Part D plans also provide coverage for hormone medications. Part D is a prescription drug plan, and 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.