Whether hormone replacement therapy (HRT), now known as menopausal hormone therapy (MHT), is covered by insurance depends on your particular plan and whether your provider deems it medically necessary.
Your provider will typically offer coverage for MHT as long as your doctor or healthcare professional prescribes it. The coverage for your specific treatment will vary depending on certain factors such as:
- your specific plan
- medications you need to purchase
- whether it’s deemed medically necessary
For example, Original Medicare, which includes Part A and Part B, might typically cover any doctor’s appointments and MHT-related treatments. However, it may not cover the hormones or drugs you need to purchase as part of your treatment.
To cover the costs of the drugs, you could enrol in Medicare Part D. However, the coverage for the drugs and how much you might have to pay out of pocket will depend on what tier the drug is placed in its formulary.
The cost of HRT will depend on a few factors. These include:
- whether you have insurance
- your plan and coverage
- your specific treatment
- the drugs you’re prescribed
- brand you need buy
- dosage of the drug
- the pharmacy you’re using
If you don’t have insurance, the costs for the treatment will vary, but for certain MHT drugs, it might cost up to $80 per month. Generic drugs typically cost less than their brand-name versions. On Optum Perks, the cost of generic estradiol is between $9 and $13.79.
Other hormone drugs, such as progesterone, may be prescribed for MHT. Contact a doctor or healthcare professional for more in-depth advice on what specific treatment they recommend for your condition. They may be able to prescribe you a generic version of the medication that can work for you.