Does Medicare Cover Hormone Replacement Therapy?

Many Medicare Advantage plans may provide prescription drug coverage, which may include some hormone replacement therapy drugs, depending on your plan. Plan coverage varies, so learn more about the plans available where you live.

Many Medicare Advantage (Part C) plans may cover prescription drugs, which may cover hormone replacement therapy drugs.

The drugs that are covered by a Medicare Advantage plan or a Medicare Part D prescription drug plan may vary. To find out what drugs are covered by your plan, you should refer to your plan formulary, or list of drugs that are covered by the plan.

A licensed insurance agent can help you compare Medicare Advantage plans that are available in your area and help you find a plan that may cover your hormone replacement therapy drugs.

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Does Medicare pay for estrogen, testosterone and other hormone replacement?

Original Medicare (Part A and Part B) typically does not cover hormone replacement therapy.

If you need Medicare coverage for prescription drugs related to hormone replacement therapy, you can consider a Medicare Advantage plan or a Medicare Part D plan that includes coverage for these types of drugs.

Hormone replacement therapy is often used to treat conditions like menopause in women and low testosterone in men.

Synthetic hormones can be taken to supplement the body’s natural production. Hormone replacement can include bioidentical hormones such as:

  • Estrogen
  • Progesterone
  • Testosterone

Some hormone replacement therapy drugs like Estrace may be covered by a number of Medicare Advantage plans and Medicare Part D plans.

How much does hormone replacement therapy cost with Medicare?

If your Medicare Advantage prescription drug plan (MA-PD) or your Medicare Part D plan cover hormone replacement therapy drugs, your costs may vary depending on your plan.

Some plans may include $0 deductibles, and the coinsurance or copayments for drugs may vary.

Speak to your plan carrier for specific cost and coverage information related to your hormone therapy drugs.

You can also review your plan’s drug formulary for more information on the drugs covered by your plan, such as the drugs that are covered and what tier those drugs are in.

Many Medicare Advantage plans cover prescription drugs

Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare. Every Medicare Advantage plan must cover everything that Original Medicare covers, and most Medicare Advantage plans may offer prescription drug coverage.

Some Medicare Advantage plans may also offer additional benefits, such as:

Learn more about Medicare Advantage plans that are available where you live by calling to speak with a licensed insurance agent today. Find out if you’re eligible to enroll.

Compare Medicare Advantage plans in your area

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.