Does Health Insurance Cover Hormone Replacement Therapy for Woman?

Hormone replacement therapy (HRT) can be used by many patients for various needs. While HRT is primarily used to address symptoms of menopause in women, men can also undergo hormone replacement to manage any hormone imbalance. Transgender patients who experience gender dysphoria would also need to take synthetic hormones as they transition. However, hormone treatment can be cost prohibitive, even if it’s recommended by your physician. 

So can your health insurance cover hormone replacement therapy? It depends on your insurance provider. Usually, insurance will cover the full or partial cost of bioidentical hormone replacement therapy (BHRT) if it’s prescribed by a healthcare provider to treat menopausal symptoms. One the other hand, seeking an alternative specialist outside your insurance network may be an out-of-pocket cost. As insurance differs on a case-to-case basis, it’s best to check with your provider as well before undergoing treatment.

How Much Does Bioidentical Hormone Therapy Cost?

With aging comes the natural decline in the production of hormones that help maintain our quality of life. For men, testosterone levels drop at around age 50 and trigger andropause. Women, on the other hand, experience a decrease of female hormones like estrogen and progesterone when they’re in their mid-40s to early 50s. This hormonal imbalance during perimenopause and menopause can cause an uncomfortable number of menopause symptoms, such as hot flashes, night sweats, vaginal dryness, and mood swings. 

In order to ease the immediate symptoms of low hormone levels and prevent future health complications, most doctors would prescribe bio identical hormones in pill, patch, gel, cream, ring, or pellet form; these compounded bioidentical hormones are derived from natural products like yam and soy to mimic the structure and function of human hormones to alleviate symptoms of menopause.

The cost of bioidentical hormone replacement therapy is around $200 - $500 per month, which includes the medication, a customized treatment plan, and follow-up appointments. Added costs include the initial consultation with a doctor -- which may cost $75 - $200 -- and a blood test to check the hormones, which can cost around $80 - $500 without insurance. 

The basic cost of HRT covers the bioidentical hormones; prices may vary depending on the treatment method, the drug used, the dosage, and other factors. Generic estrogen-only or progestin-only pills usually fall at a lower price range, while combined HRT and brand-name products may be at the higher end. 

Many hormone therapy patients have found the long-term benefits and relief from symptoms to be worth the cost, as well as any potential health risks. As long as your physician prescribes quality, compatible hormones and manages your condition through regular check-ups, there is little to no increased risk of breast cancer, weight gain, heart disease, or other medical problems associated with hormone replacement therapy.

Is Bioidentical Hormone Replacement Therapy Covered By Health Insurance? 

No health plan is created equal, especially in the United States, where you can get an individual plan, an employer-sponsored health plan, or a government-based health plan like Medicare or Medicaid. As each plan takes into account factors like healthcare providers, medication, and types of treatment, there is no simple answer to the question. 

Whether or not bioidentical hormone replacement therapy falls under your insurance coverage ultimately depends on your insurance provider and your health insurance plan. Most insurance plans do cover hormone replacement therapy or a patient experiencing symptoms of menopause, as long as it’s recommended by your primary health care provider. However, some health plans -- like Kaiser -- don’t cover hormone therapy. 

It’s also possible that your insurance will cover some types of hormones, but not others, which is especially true if you're interested in getting bioidentical hormones. If your insurance company does not cover “holistic” or “natural” treatments, BHRT is not likely to be included. In other cases, a patient experiencing menopausal symptoms would have a similar coverage guideline as a male patient experiencing andropause, but most insurance carriers won’t cover testosterone when it’s prescribed for a female patient with low testosterone levels. 

Other health policies also cover more than others. Medicare, for example, has a limited prescription drug coverage under its original Part A and B plans. You would have to add a stand-alone plan to your original Medicare or opt for a private insurance company if you want to get prescription coverage. For hormone treatment, you should consider the Medicare Advantage Plan (Part C) or Part D Prescription Drug Plan. 

With health insurance, the out-of-pocket expense for hormone treatment can range from $5 - $30 per month, as a form of copay. This could still change, depending on the form of hormones you’ll take:

• Pills: A monthly prescription for oral HRT is around $130 - $240 per month, but most insurance companies do cover hormone pills to treat menopause symptoms. Women would only need to pay the prescription co-pay costs at around $30 per month. 
• Creams, gels, patches: Applying creams, gels, or patches for hormone treatment can be tricky, but they are preferred by some patients because they produce fewer side effects. At $120 - $1020 per month, however, these forms of hormone replacement therapy are not always included in insurance plans. 
• Hormone pellet therapy: Pellet therapy involves implanting a slow-release pellet under the skin, so the cost may vary depending on your healthcare provider. As it’s a cash-based procedure, hormone pellets are typically not covered by health insurance and a patient would have to shoulder the total cost on their own. 

Read more: How Does Hormone Replacement Therapy Benefit a Woman Going Through Menopause

Tips for Lower HRT Costs 

As a patient dealing with the symptoms of hormonal imbalance, it can already be stressful enough -- even before you even think about payments and insurance coverage. Here are a few tips to help you lower your hormone replacement therapy costs:

• If you choose a private clinic for treatment, you will pay out-of-pocket for their services. However, you may be able to file a claim for the tests ordered by the HRT clinic, or you can go to a provider site to get the tests done for a covered cost. 
• Ask your HRT provider if they offer payment plans, interest-free financing, or discounts on large-quantity orders, like a six-month supply of estrogen. 
• Do your research and find the best treatment option for you. Beyond the costs of the treatment itself, it’s hard to identify other hidden factors or prices. Call your insurance provider, talk to your physician, and find what works for you to get the most value with what you’re paying. 

Affordable Hormone Replacement Therapy at RevitalizeYou MD 

Undergoing hormone replacement therapy is a long-term medical procedure that can be demanding for a patient. At RevitalizeYou MD, we understand how important it is to keep costs down and quality high. Let our certified and licensed medical staff help you address your physiological needs and alleviate uncomfortable symptoms. Contact us today to learn more about our services.