Does Medicare Cover Hormone Replacement Therapy?

• by Christian Worstell
• August 1, 2023
• Reviewed by John Krahnert

Medicare Part D and Medicare Advantage Prescription Drug Plans (MA-PD) plans cover prescription drugs, which may cover hormone replacement therapy drugs.

The drugs that are covered by an MA-PD plan or a 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.

Call 1-800-557-6059 1-800-557-6059 TTY Users: 711, 24/7 to speak with a licensed agent to find out if you’re eligible to enroll.

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 an MA-PD 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 MA-PD plans and Medicare Part D plans.

How much does hormone replacement therapy cost with Medicare?

If your MA-PD or Medicare Part D plan cover hormone replacement therapy drugs, your costs may vary depending on your plan. Deductibles and 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.

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 some Medicare Advantage plans may also offer benefits not found in Original Medicare. 

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.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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