Many women wonder how Medicare covers hormone therapy for menopause. At a certain point, a woman will experience 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. At birth, a girl is born with a finite amount of eggs in her ovaries.
Once she matures and hits puberty, those eggs are released during ovulation, for fertilization to form a pregnancy. If conception fails, the mature egg will then start to dissolve.
It then travels down the uterus, the uterine wall sheds its tissues, and both come out of the woman’s body. Around the time a woman turns the mid to late forties or into her fifties, her ovaries fail to produce estrogen and progesterone.
Estrogen and progesterone are necessary for a woman to become pregnant. Once this happens, the ovary will no longer release an egg, thus ending her menstrual cycle.
There are three stages of natural menopause:
- Perimenopause: the period of time, usually several years prior to menopause, when the ovaries start to gradually decrease their estrogen output. 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 time 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 goes through a variety of bodily changes due to the lack of natural hormone production.
Medicare Can Cover Hormone Therapy for Menopause
Medicare prescription drug coverage is not a guaranteed service offered with Traditional Medicare benefits. Part A will only cover services rendered and medications administered during an inpatient hospital admission.
Medicare Part B covers your outpatient services and may cover some in-office procedures such as injectables; however, at home injectable medications wouldn’t necessarily be covered.
The only surefire way to get medication coverage is by obtaining a Medicare Prescription Drug Plan. Most people choose to go with a Prescription Drug Plan as Part C Plans come with policy restrictions and can cost the customer more money over time.
Prescription Drug Plans are a standalone plan offered through the private health insurance companies with each plan offering the same exact coverage, just at competitive rates.
The Breakdown of Menopause
If you are in your mid to late forties or early fifties and start to experience any of the above, there is a very good chance you’re approaching menopause. Your physician can perform a simple blood test to check the FSH levels (hormone levels) which will show a decrease as your ovaries start to deteriorate.
In some cases, women in their thirties and even younger can experience the same symptoms due to premature menopause. Premature menopause usually occurs after having a medically necessary hysterectomy, if there is damage or an injury to the ovaries or other medical conditions such as cancer, thyroid disease, epilepsy or rheumatoid arthritis.
Additionally, genetics play a big role in early menopause so if a woman’s mother experienced early menopause, there is a chance she may also. Also, certain lifestyle factors can lead to premature menopause.
For instance, women who smoke, are overweight or on certain diets can also experience earlier menopause. If you’re younger and start to experience any of the menopausal symptoms, you’ll want to follow up with your gynecologist or primary care physician for diagnostic testing and further treatment recommendations.
Hormone Therapy 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 like a selective serotonin and norepinephrine reuptake inhibitor or anticonvulsants that can change certain 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 medication 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 medication 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!
Learn More About How Medicare Will Cover Hormone Therapy for Menopause
A Medicare Supplement Plan works with your Traditional Medicare and picks up coverage for deductibles, copayments, coinsurance and other out of pocket costs associated with medical care.
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