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Below we’ll cover a topic many older adults are curious about: does Medicare cover testosterone injections?
Testosterone is a crucial hormone for both men and women. As we age, our testosterone levels may decrease. This can lead to issues like trouble with sex, weak bones, and slowed muscle growth.
In this article, we’ll answer this question in plain English (no fancy jargon here!). We’ll also cover the cost of testosterone injections and other helpful information.
By the end, you’ll know what to expect regarding Medicare and testosterone injections.
Does Medicare Cover Testosterone Injections?
The short answer is yes; Medicare can help pay for testosterone treatments. But only sometimes. Some specific rules and conditions need to be met.
Let’s explore these rules, so you know what to expect and how to move forward with your healthcare needs.
Medicare Coverage of Testosterone Injections
Medicare Part A and Part B, or Original Medicare, can help pay for testosterone treatments. To qualify, though, your doctor must say they are medically necessary. Your doctor must order the treatment for Medicare to cover it.
When are Testosterone Injections Needed?
Testosterone therapy might be necessary if you have a health problem that causes low testosterone. Two common ones are hypogonadism and hypogonadotropic hypogonadism. Your treatment may be medically necessary if:
- Your testosterone levels are below average
- You have a health problem that causes low testosterone levels
- You are not taking other medicines that can change your testosterone levels
You must also have problems caused by low testosterone. Weight loss, weak bones, decreased bone density, or trouble with sex are common issues.
It’s important to remember that your doctor will decide if you need testosterone injections for your specific medical issues. Trust their expertise and follow their guidance.
Medicare Part A and Testosterone Injections
Medicare Part A helps pay for testosterone injections if you receive them while in the hospital as an inpatient. This is less common, but it’s still essential to know how Medicare Part A can support you in specific cases.
Medicare Part B and Testosterone Injections
Medicare Part B usually helps pay for testosterone injections if you receive them in an outpatient setting. If Medicare approves the treatment, Part B will cover 80% of the cost. You will be responsible for the remaining 20%.
Medicare Advantage and Testosterone Injections
Medicare Advantage plans, Medicare Part C, also cover testosterone injections. These plans cover the same things as Original Medicare and also offer extra benefits.
The exact coverage and costs depend on your specific plan. So be sure to review your plan details to understand your coverage.
Medicare Part D and Testosterone Injections
Medicare Part D plans, which help pay for prescription drugs, can also cover testosterone injections. Most Medicare Part C and Part D plans provide coverage for testosterone injections. This makes them accessible to many older adults who have Medicare.
Limits and Rules for Testosterone Injections
Sometimes, Medicare plans limit how much testosterone you can buy at once. If you need more, you can either wait until the next time you can refill your prescription or ask your plan for an exception. Exceptions are granted on a case-by-case basis.
Testosterone injections are considered a tier 4 drug. This means they can be more expensive than other medicines. You’ll likely need prior authorization from your plan before getting the injections. This process ensures the treatment is medically necessary and appropriate for your situation.
How Much Do Testosterone Injections Cost?
When you think about testosterone injections, you might wonder how much they cost. Usually, the monthly cost can be between $150 and $750 or more. But remember, the cost is different for each person.
How many testosterone injections people need is different, which affects the price. Since everyone has unique needs, don’t think your cost will be the same as a friend or relative.
The cost of testosterone injections can also change because of the brand and the company that makes it. Testosterone clinics may charge different prices based on their staff and location.
A common testosterone injection, Depo-Testosterone, costs about $30. The generic version costs between $12 and $26.
People usually get shots every two to four weeks, so the monthly cost is between $24 and $120, depending on how much they need.
Remember, these prices only include the medicine itself, not all the treatment costs. For example, if your doctor gives you the shots, you must pay for the office visits. Your doctor will also check your health during the treatment, which may add to the cost.
If you give yourself the shots, you’ll also need to buy needles and syringes.
Once you think about all these costs, you can expect prices closer to the range mentioned earlier.
Testosterone injections help raise low testosterone levels but don’t fix the cause. So, you might need the injections for a long time. If you have questions, ask your doctor.
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 phone sessions?