Does Medicare Cover Testopel?

Testosterone is a very important hormone for both men and women. Men have higher levels of testosterone than females. But as we age, the amount of testosterone decreases. Additionally, certain illnesses can cause a shortage of testosterone. This can be treated using testosterone pellets. One type of these pellets is Testopel.

If this is a treatment you need, or are considering, you probably want to know “does Medicare cover Testopel?” In this article, we answer that question in clear, plain English. You will also find the average costs of Testopel for those who have to pay out of pocket.

The short answer is yes; Medicare will cover the cost of Testopel. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your Testopel. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for Testopel. Medicare provides coverage for your Testopel if it is considered medically necessary. The treatment must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

Coverage for Testopel is provided by Medicare Part B. Most of the time, Original Medicare does not provide coverage for hormone pellets. After all, they mainly cover medically necessary services, equipment, and treatment rather than prescription drugs.

However, in some cases, Medicare Part B provides coverage for testosterone pellets such as Testopel. Medicare Part B provides coverage for beneficiaries who are suffering from low testosterone caused by a medical condition.

Most of the time, low testosterone levels are caused by medical conditions such as hypogonadism and hypogonadotropic hypogonadism.

Again, for Medicare Part B to provide coverage for Testopel, it must be medically necessary. There are certain conditions that meet this requirement. It may be medically necessary to take testosterone pellets such as Testopel 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

Before Medicare Part B provides coverage for Testopel, the patient must also be experiencing effects caused by lowered levels of testosterone. These effects include significant weight loss, osteoporosis, decreased bone density, or decreased sex drive.

Once Medicare Part B approved you for Testopel therapy, you must continue to meet certain conditions for therapy continuation. These conditions include testosterone level testing to ensure the pellet’s effectiveness.

Medicare Part B only covers a total of 6 pellets of Testopel, however, they can increase the amount if it is medically necessary.

Part C Coverage of Testopel

Medicare Advantage plans (Medicare Part C) also provide coverage for Testopel. They have to cover all the same treatments and services as Original Medicare. Part C plans can also offer coverage for additional treatments and services. Exactly what a Part C plan will cover and what your out-of-pocket costs are will vary depending on the specifics of your plan.

How Much Does Testopel Cost?

The cost of 10 implants of 75 mg Testopel pellets is $1,140. This cost is unlikely to vary greatly.

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.