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Understanding if insurance covers hormone replacement therapy (HRT) can be confusing. Many people need HRT to treat conditions like menopause and thyroid problems. But they worry about the cost.

Insurance coverage for hormone therapy varies by plan. Some plans cover traditional HRT but not bioidentical hormone replacement therapy (BHRT) or other types.

This quick guide covers everything you need to know about HRT insurance coverage, including pricing and tips to lower the costs. But this guide is just for estimation. For exact hormone therapy costs, no matter your gender or specific needs, schedule an appointment today.

Does Insurance Cover Hormone Replacement Therapy?

Insurance coverage for hormone replacement therapy (HRT) can vary based on your provider and specific health plan. Most insurance plans will cover HRT if it is recommended by your primary care provider, particularly when used to treat symptoms of menopause.

But, some insurance companies, like Kaiser, do not offer coverage for hormone therapy. Medicare does not cover HRT either. Many insurance companies may categorize it as “medically unnecessary” or “elective,” especially if it involves non-FDA approved options like compounded hormones.

Insurance coverage also depends on the type of HRT, with FDA-approved treatments receiving better coverage. For treatments like bioidentical hormone replacement therapy (BHRT), insurers are more likely to cover some or all of the costs. Also, alternative therapies like hormone pellets may not be covered, especially if rendered outside of network providers.

Insurance coverage for HRT depends on your treatment type, health plan, and healthcare provider. FDA-approved bioidentical hormones are usually covered more often than non-FDA regulated compounded hormones.

Look at this table quickly outlining if insurance covers a specific type of therapy:

Before starting treatment, contact your insurance company to learn what they’ll pay for and what you’ll need to pay yourself. Some Medicare plans, like Medicare Advantage, can help pay for hormone treatments if you sign up for extra coverage.

How Much Does Hormone Replacement Therapy Cost?

The cost of hormone replacement therapy costs range from $10 to $500 per month, or even more, depending on these factors:

• The type and amount of medication
• Whether you use generic or brand-name drugs
• If you have insurance and use in-network providers
• The specific therapy method chosen

Insurance often helps with hormone therapy costs, but you may still need to pay some expenses yourself. This is especially true for non-FDA approved treatments, like hormone pellets.

Here’s a breakdown of typical hormone therapy costs:

Creams:

Estrogen creams, such as Premarin, can cost up to $400 per tube, but generic Estrace cream costs around $131 per tube.

Gels:

Estradiol gels can range from $40 for generic packets (Divigel) to $305 for brand-name gels like Elestrin.

Injections:

Estrogen injections like Delestrogen can cost less than $50 for a generic vial, while brand-name options like Depo-Estradiol may cost around $180 per vial.

Patches:

Estrogen patches typically cost between $40 to $317 per month, depending on whether they are generic or brand-name (e.g., Climara Pro).

Tablets:

Oral HRT tablets like Estrace can cost $10 or less for a generic 90-day supply, while brand-name versions may exceed $500.

Vaginal Suppositories:

Vagifem (estradiol) vaginal tablets cost around $40 for a generic 8-pack, while brand-name Imvexxy can exceed $200.

Vaginal Rings:

Estrogen rings like Estring and Femring cost $500 to $700 for a 90-day supply.

Hormone Pellet Therapy:

Pellets are typically not covered by insurance and can cost around $45 per pellet, with insertion fees ranging from $130 to $150 each.

But again, these costs are just the estimates. And the costs for hormone replacement therapy ultimately depend on your treatment plan, healthcare provider, and insurance coverage. Consult with your provider to confirm the exact costs of the kind of therapy you need.

Proven Tips for Lowering Hormone Therapy Costs

You can reduce costs of your hormone therapy with these proven tips as a patient.

1. Choose generic drugs, they work the same but cost less.

2. Use mail-order pharmacies through your insurance.

3. Apply for healthcare help programs if you qualify.

4. Ask your doctor about payment plans or discounts.

5. Look into compounded hormones (cheaper but need doctor supervision)

7. Check prices at different pharmacies.

8. Ensure your insurance plan gives you the best deal. 9. Use Flexible Spending (FSA) or Health Savings (HSA) accounts to pay with pre-tax money.

Common FAQs About Hormone Therapy Coverage

If we didn’t answer your question about hormone therapy, you can contact us right away.

What is Hormone Replacement Therapy and what are its types?

Hormone replacement therapy helps treat symptoms of menopause such as hot flashes and vaginal dryness and other signs that you need HRT. There are different types of HRT, including estrogen-only therapy, progestogen therapy, or a combination of both.

You can get therapy in various forms like tablets, patches, gels, sprays, vaginal rings, or creams. The choice of HRT depends on factors like whether you’ve had a hysterectomy, the stage of menopause you’re in, and your personal preferences.

Remember: Hormone therapy is also available for men, other genders and medical needs, with different types of treatments for each situation.

How do you get approved for hormone replacement therapy?

To start hormone therapy, you usually need a letter from a mental health professional who follows WPATH care guidelines, particularly for gender-related treatment. Many doctors can start you on hormones if you’re at least 16 years old and have your parents’ permission.

Does insurance cover hormone replacement therapy (HRT) for menopause, testosterone therapy, or bioidentical hormones?

Most health insurance plans cover hormone replacement therapy (HRT) when a doctor prescribes it for menopause symptoms. This includes major insurers like Blue Cross Blue Shield, Tricare, Medicare, AETNA, UnitedHealthcare, Kaiser, and others. 

But, some newer treatments, like bioidentical hormones or hormone pellets, might not be covered unless they’re FDA-approved and prescribed by a licensed doctor.

For men, testosterone therapy is usually covered if they have a medical need, like low testosterone levels. To know exactly what your insurance covers, it’s best to call them directly and ask about coverage details and any required approvals.