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Hormonal changes or imbalances in our bodies can cause serious medical problems. Having low testosterone levels is an example of a hormonal imbalance, especially for male patients. It can cause conditions such as hypogonadism. In order to treat it, some people use testosterone pellets.
If you’re looking into this as a possible treatment option, you probably want to know “does Medicare cover testosterone pellets?” In this article, we answer that question in clear, plain English. You will also find the average costs of testosterone pellets for those who have to pay for them out-of-pocket.
Does Medicare Cover Testosterone Pellets?
The short answer is maybe. Medicare may cover the cost of testosterone pellets but not 100% of the time. There are very specific conditions have to be met in order for Medicare to pay for your testosterone pellets. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) may provide coverage for testosterone pellets. Parts A and B provide coverage for your testosterone pellets 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 testosterone pellets will generally fall under Medicare Part B.
There are many situations where Original Medicare will not provide coverage for hormone pellets. That is because Original Medicare often does not provide coverage for hormone medications. 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. 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 or hypogonadotropic hypogonadism.
Testosterone Pellet Coverage Conditions
However, for Medicare Part B to provide coverage for testosterone pellets, it must be first medically necessary. It may be medically necessary to take testosterone pellets such as 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
Before Medicare Part B provides coverage for testosterone pellets, 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 approves you for testosterone pellets 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 testosterone pellets, however, they can increase the amount if it is medically necessary.
Part C Coverage for Testosterone Pellets
Medicare Advantage plans (Medicare Part C) also provide coverage for testosterone pellets. They have to cover everything Original Medicare does. But they will also provide coverage for some things Original Medicare does not. Exactly what that coverage is, and what the costs are, will depend on what plan you have.
How Much Do Testosterone Pellets Cost?
The insertion of testosterone pellets can cost between $300 and $750. This cost depends on the amount of testosterone in a pellet along with other factors such as the provider.
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.
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 hyperbaric treatment?