Many women wonder how Medicare covers hormone replacement therapy, especially for menopause. Medicare Part A and Part B do not cover hormone replacement therapies, however, a Medicare Advantage and Part D plan might.
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At a certain point, a woman will experience what is known as the change of life. This term has been used for years as a polite way of calling a woman going through menopause. Menopause is when a woman experiences a natural deterioration in the reproductive hormones.
There are three stages of natural menopause:
- Perimenopause: the period of time, usually several years prior to menopause, when the ovaries start to decrease their estrogen output gradually. This time period lasts up until menopause.
- Menopause: During this time, the egg production completely stops. A woman is menopausal once their menstrual cycle leaves for one year.
- Postmenopause: This is the period after which a woman has reached menopause.
During all phases of menopause, women can experience a multitude of symptoms. Menopause itself causes the body to go through a variety of bodily changes due to the lack of natural hormone production.
Does Medicare Cover HRT?
In order to get hormone replacement therapy covered by Medicare, you would need to either have a Medicare Advantage plan that includes prescription drug coverage, or a stand-alone Part D plan.
What Hormone Therapy Drugs for Menopausal Women Does Medicare Pay For?
An MAPD or Part C plan can help cover bioidentical hormones such as Estrogen, Progesterone, and Testosterone.
Does Medicare Cover Estrace?
Yes, some MAPD and Part C plans will cover Estrace. Make sure to check your drug formulary to see if your plan will cover it.
How Much Does HRT Cost Under Medicare?
The costs for hormone replacement therapy will depend on the type of plan in which you enroll. Some plans will leave you with zero out-of-pocket costs, others may leave you with some copays or coinsurance. Make sure to talk with your doctor before receiving therapy to confirm how much Medicare will pay for and how much you’ll have to pay out of pocket.
Will Medicare Cover Hormone Therapy for Transgender Beneficiaries?
Yes, Medicare will cover hormone therapy for transgender beneficiaries the same way it would for any other beneficiary.
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Types of Hormone Therapies for Menopause
With menopause comes the hormonal imbalances and overall bodily discomfort that most women have heard horror stories about and have come to dread. The severity of your symptoms will determine what course of action your healthcare provider will recommend.
For example, treatment for vaginal dryness is with topical creams that may include estrogen. For hot flash symptoms, oral medications can change specific amounts of brain chemicals that regulate the body’s temperature.
More commonly, physicians will prescribe hormone therapy for the multiple symptoms associated with menopause.
There are two types of standardized hormone therapy:
- Estrogen-Therapy only therapy (ET)– The estrogen hormone provides the most menopausal symptom relief. Most commonly, estrogen is for women without a uterus due to a hysterectomy.
- Estrogen Plus Progesterone therapy (EPT)– with EPT, progesterone hormones add to ET for women with a uterus. The reason, progesterone is to protect women from endometrial cancer, which is by straight estrogen alone.
Your prescription will come from your provider in one of two ways as there are two forms of hormone therapy:
- Localized (non-systemic)– With this treatment, the medication comes in a cream, tablet, or ring. The drug only affects the area it touches.
- Systemic– With systemic treatments, the medications come as an oral tablet, injection, emulsion sprays, patch, or gel. With systemic medications, the medicine enters the bloodstream and then affects all areas of the body.
Whether your physician gives your medication as localized or systemic, both ways are known to treat all the common symptoms associated with menopause. Talk to your healthcare provider to see which medication is most recommended so you can start feeling better fast!
I am a 72 year old male and I would like to know if medicare will cover hormone therapy, I have gap insurance but I would like to have hormone therapy because I feel so sluggish and tired all the time
Hi Tony! Hormone therapy is covered by Medicare, however, you must have a qualifying medical condition and the treatment must be deemed medically necessary to receive coverage. You can speak with your doctor about your options when it comes to Medicare.
Hello, does Medicare cover bioTE?
Hi Juan! Yes, Medicare should cover bioTE. I would call them directly to confirm or speak with your doctor.
Who in UTAH – covers HRT with Medicare and Regency G-Plan
Hi Steve! HRT is not an inpatient or outpatient service, so Part A, Part B, and Plan G won’t cover it. Hormone Replacement Therapy is covered if you have either a Medicare Advantage plan with prescription drug coverage or a Part D plan. Since each plan is different, you would need to contact your carrier directly to find out if HRT is covered. You can also check your plan’s drug formulary. I hope this helps!
I am having trouble with coverage for HRT, EPT. Progesterone is covered, but my Part D plan does not cover Estradiol patches even though the Formulary they publish says they do. They sent me a notice saying they would only cover one month’s worth, then they stopped covering at all. My issue is – as I’m trying to determine what Part D plan to sign up for this year, I’d like to get one that covers my Estradiol patches, but there is no information that makes it clear. They all have similar information in the formulary and here I’m also unable to tell what the rules are. I have severe problems that make continuing on a very low dose of HRT the best medical option for me, according to my doctors.
Hi Cindy! The best option in your case is to contact an agent to help you understand the formulary. It’s not easy to do, but a licensed agent will understand how to break it down for you. Once we can confirm that your Estradiol patches will be coverage monthly, we can get you enrolled. It looks like most Part D plans do cover them. The Open Enrollment Period for Part D ends on December 7th.