{"id":53342,"date":"2022-08-26T20:11:11","date_gmt":"2022-08-27T00:11:11","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=53342"},"modified":"2025-12-15T20:13:16","modified_gmt":"2025-12-16T01:13:16","slug":"does-medicare-cover-hormone-replacement-therapy","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-hormone-replacement-therapy\/","title":{"rendered":"Does Medicare cover HRT?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Hormone replacement therapy (HRT) is a treatment that your doctor can prescribe for many health problems. It\u2019s often used to help balance progesterone and estrogen levels during or near menopause. <\/span><a href=\"https:\/\/www.nia.nih.gov\/health\/what-menopause\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Menopause typically begins<\/span><\/a><span style=\"font-weight: 400;\"> between ages 45 and 55 and can last seven to 14 years. Many people age into Medicare at 65 years old, so Medicare beneficiaries may be wondering what type of HRT or menopause treatments are covered.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">HRT, also known as menopausal hormone therapy, can bring great relief to someone who has hot flashes, excessive sweating, and many other symptoms of menopause. However, you might be surprised to find that it can also reduce the risk of osteoporosis.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">Some types of HRT have both <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/estrogens\"><span style=\"font-weight: 400;\">estrogen<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/progesterones\"><span style=\"font-weight: 400;\">progesterone<\/span><\/a><span style=\"font-weight: 400;\">, while others will only have estrogen. In addition, some also contain <\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/low-testosterone-treatment-and-medications\"><span style=\"font-weight: 400;\">testosterone<\/span><\/a><span style=\"font-weight: 400;\">. The right combination and dosage of these hormones will depend on why it\u2019s being prescribed as a form of treatment.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Types of hormone replacement therapy<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">When women go through menopause, they experience hormonal imbalances. Hormone replacement therapy focuses on replacing estrogen in the body that you don\u2019t have after menopause.\u00a0<\/span><\/p>\n<p><a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/menopause\/in-depth\/hormone-therapy\/art-20046372\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">There are two main types<\/span><\/a><span style=\"font-weight: 400;\">:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Systemic hormone therapy drugs<\/b><span style=\"font-weight: 400;\">, which come in pill form, ring, gel, skin patch, and spray. These drugs contain a higher dose of estrogen.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Low-dose vaginal products<\/b><span style=\"font-weight: 400;\">, which come in cream, ring, or tablet form. These low-dose vaginal preparations are used to treat the vaginal and urinary symptoms of menopause.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Topical creams, like estrogen creams, are used to treat vaginal dryness. While oral medications are usually prescribed for hot flashes.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are two types of standardized hormone therapy:<\/span><\/p>\n<ol>\n<li><b>Estrogen therapy-only therapy (ET): <\/b><span style=\"font-weight: 400;\">By taking estrogen, women will find relief from many harsh menopausal symptoms. ET is most used for women who had a hysterectomy.\u00a0<\/span><\/li>\n<li><b>Estrogen plus progesterone therapy (EPT): <\/b><span style=\"font-weight: 400;\">With EPT, you\u2019re taking both estrogens along with progesterone hormones. Progesterone can protect women from endometrial cancer.<\/span><\/li>\n<\/ol>\n<h2><span style=\"font-weight: 400;\">Does Medicare cover hormone replacement therapy?<\/span><\/h2>\n<p><b>Medicare Part A coverage:<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Part A is your hospital or inpatient coverage. Part A will not cover components of HRT unless inpatient care is required.<\/span><\/p>\n<p><b>Medicare Part B coverage:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Any diagnostic testing<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Lab work associated with hormone replacement therapy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Doctor visits for diagnosis and to monitor your response to hormones<\/span><\/li>\n<\/ul>\n<p><b>Medicare Advantage plans (Part C) or Original Medicare with Medicare Part D coverage:<\/b><\/p>\n<p><span style=\"font-weight: 400;\">In order to have HRT prescriptions covered, you\u2019ll need to enroll in either a <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-medicare-advantage\/\"><span style=\"font-weight: 400;\">Medicare Advantage plan<\/span><\/a><span style=\"font-weight: 400;\"> with prescription drug coverage or Original Medicare with a stand-alone <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-part-d-plans\/\"><span style=\"font-weight: 400;\">Part D prescription drug plan<\/span><\/a><span style=\"font-weight: 400;\"> that includes HRT drugs on the formulary. Some medications for HRT that may be covered under a MAPD or Part D plan include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Estrogen (Estraderm, Premarin, Cenestin, Divigel, and Climara)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Progestin (Prometrium or Provera)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Estrogen plus progestin (Prempro, Activella, Femhrt, and Climara Pro)<\/span><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">Hormone replacement therapy for transgender people<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Medicare will cover <\/span><a href=\"https:\/\/transequality.org\/know-your-rights\/medicare\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">HRT for transgender beneficiaries<\/span><\/a><span style=\"font-weight: 400;\"> the same way it would for any other beneficiary. Medicare covers preventive care, medically necessary hormone therapy, and medically necessary transition-related surgery.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">What happens if I am denied Medicare coverage?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">If you are denied insurance coverage for HRT, and your healthcare provider believes that it\u2019s a medically necessary treatment, you can appeal Medicare\u2019s decision. The Part D appeals process starts with an <\/span><a href=\"https:\/\/www.medicareinteractive.org\/get-answers\/medicare-denials-and-appeals\/part-d-appeals\/introduction-to-part-d-appeals\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">exception request<\/span><\/a><span style=\"font-weight: 400;\">, and if the request is denied, a formal appeal can be filed.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">An authorized representative can also file an appeal on your behalf. You can use your healthcare provider as the authorized representative. You would just need to complete the <\/span><a href=\"https:\/\/www.cms.gov\/Medicare\/CMS-Forms\/CMS-Forms\/downloads\/cms1696.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Appointment of Representative<\/span><\/a><span style=\"font-weight: 400;\"> form along with your Redetermination Request form.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Does Medicare pay for hormone replacement therapy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">How much hormone replacement therapy costs under Medicare really depends on the parts of Medicare you\u2019re enrolled in.<\/span><\/p>\n<p><b>Medicare Part B costs:<\/b><\/p>\n<p><span style=\"font-weight: 400;\">If you are enrolled in Original Medicare, any outpatient services received while at the doctor&#8217;s office, including diagnostic testing, will be covered at 80%. You\u2019ll be responsible for the remaining 20% as well as the Part B deductible. If you have a Medicare supplemental plan (Medigap), you\u2019ll probably have the 20% coinsurance covered. Depending on what letter Medigap plan you have, your Part B deductible may also be covered.<\/span><\/p>\n<p><b>Medicare Advantage plans (Part C) or Medicare Part D costs:<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Since Medicare Advantage plans (Part C) are not standardized by the federal government, you\u2019ll need to contact your insurance company directly to find out what your out-of-pocket costs will be. These plans must cover the same services as Original Medicare. However, they can decide what your out-of-pocket costs will be.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The Centers for Medicare &amp; Medicaid Services (CMS) created an <\/span><a href=\"https:\/\/www.medicare.gov\/plan-compare\/#\/?lang=en&amp;year=2022\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">online tool<\/span><\/a><span style=\"font-weight: 400;\"> that allows you to compare all Part D and Medicare Advantage plans that are available in your area side by side. You just enter your zip code, prescriptions, and pharmacy of choice. This will give you a breakdown of the plan and all the out-of-pocket costs you can expect. <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-formulary\/\"><span style=\"font-weight: 400;\">Always pay close attention to the plan&#8217;s formulary<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Typical costs of hormone replacement therapy<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Below are the <\/span><a href=\"https:\/\/health.costhelper.com\/hormone-replacement-therapy.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">typical costs<\/span><\/a><span style=\"font-weight: 400;\"> of hormone replacement therapy.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The monthly cost of hormone replacement therapy without insurance can range between $10 and $85 or more, depending on what drugs are prescribed. Generic prescriptions will typically cost less.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Medicare beneficiaries enrolled in a drug plan or Part C plan with drug coverage can expect prescription drug copays to range from approximately $5 to $30 a month.<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Other ways to save on HRT<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">One of the ways in which you can save on hormone replacement therapy is to have your healthcare provider prescribe generic drugs instead of name-brand drugs as they are typically cheaper.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">1. SingleCare coupons<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">SingleCare has free coupons available that will help you to save on thousands of prescriptions. A <\/span><a href=\"https:\/\/www.singlecare.com\/prescription-discount-card\"><span style=\"font-weight: 400;\">SingleCare discount card<\/span><\/a><span style=\"font-weight: 400;\"> can help you save 80% on prescriptions, including bioidentical hormones used in HRT.<\/span><\/p>\n<table class=\" singlecare-table\">\n<thead>\n<tr>\n<th>\n<h2><span class=\"title\">Compare HRT drug prices<\/span><\/h2>\n<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"header-row\">\n<th><b>Drug name<\/b><\/th>\n<th><b>Price without insurance<\/b><\/th>\n<th><b>SingleCare price<\/b><\/th>\n<th><b>Savings options<\/b><\/th>\n<\/tr>\n<tr>\n<th><a href=\"https:\/\/www.singlecare.com\/prescription\/premarin\/what-is\"><span style=\"font-weight: 400;\">Premarin<\/span><\/a><\/th>\n<th><span style=\"font-weight: 400;\">$283 for 30, 0.625 mg tablets of brand-name Premarin<\/span><\/th>\n<th><span style=\"font-weight: 400;\">$81 for 30, 0.625 mg tablets of brand-name Premarin<\/span><\/th>\n<th><a class=\"cta-button\" href=\"https:\/\/www.singlecare.com\/prescription\/premarin#coupons-prices\"><span style=\"font-weight: 400;\">Free coupons<\/span><\/a><\/th>\n<\/tr>\n<tr>\n<th><a href=\"https:\/\/www.singlecare.com\/prescription\/estrace\/what-is\"><span style=\"font-weight: 400;\">Estrace<\/span><\/a><\/th>\n<th><span style=\"font-weight: 400;\">$438 for 30, 1 mg tablets of brand-name Estrace<\/span><\/th>\n<th><span style=\"font-weight: 400;\">$33 for 30, 1 mg tablets of generic Estrace<\/span><\/th>\n<th><a class=\"cta-button\" href=\"https:\/\/www.singlecare.com\/prescription\/estrace#coupons-prices\"><span style=\"font-weight: 400;\">Free coupons<\/span><\/a><\/th>\n<\/tr>\n<tr>\n<th><a href=\"https:\/\/www.singlecare.com\/prescription\/divigel\/what-is\"><span style=\"font-weight: 400;\">Divigel<\/span><\/a><\/th>\n<th><span style=\"font-weight: 400;\">$189 for 1 box of brand-name Divigel<\/span><\/th>\n<th><span style=\"font-weight: 400;\">$74 for 1 box of generic Divigel<\/span><\/th>\n<th><a class=\"cta-button\" href=\"https:\/\/www.singlecare.com\/prescription\/divigel#coupons-prices\"><span style=\"font-weight: 400;\">Free coupons<\/span><\/a><\/th>\n<\/tr>\n<tr>\n<th><a href=\"https:\/\/www.singlecare.com\/prescription\/climara\/what-is\"><span style=\"font-weight: 400;\">Climara<\/span><\/a><\/th>\n<th><span style=\"font-weight: 400;\">$163 for 4 weekly patches of brand-name Climara<\/span><\/th>\n<th><span style=\"font-weight: 400;\">$26 for 4 weekly patches of generic Climara<\/span><\/th>\n<th><a class=\"cta-button\" href=\"https:\/\/www.singlecare.com\/prescription\/climara#coupons-prices\"><span style=\"font-weight: 400;\">Free coupons<\/span><\/a><\/th>\n<\/tr>\n<tr>\n<th><a href=\"https:\/\/www.singlecare.com\/prescription\/climara-pro\/what-is\"><span style=\"font-weight: 400;\">Climara Pro<\/span><\/a><\/th>\n<th><span style=\"font-weight: 400;\">$359 for 4 weekly patches of brand-name Climara Pro<\/span><\/th>\n<th><span style=\"font-weight: 400;\">$246 for 4 weekly patches of brand-name Climara Pro<\/span><\/th>\n<th><a class=\"cta-button\" href=\"https:\/\/www.singlecare.com\/prescription\/climara-pro#coupons-prices\"><span style=\"font-weight: 400;\">Free coupons<\/span><\/a><\/th>\n<\/tr>\n<tr>\n<th><a href=\"https:\/\/www.singlecare.com\/prescription\/prometrium\/what-is\"><span style=\"font-weight: 400;\">Prometrium<\/span><\/a><\/th>\n<th><span style=\"font-weight: 400;\">$1,817 for 30, 100 mg capsules of brand-name Prometrium<\/span><\/th>\n<th><span style=\"font-weight: 400;\">$33 for 30, 100 mg capsules of generic Prometrium<\/span><\/th>\n<th><a class=\"cta-button\" href=\"https:\/\/www.singlecare.com\/prescription\/prometrium#coupons-prices\"><span style=\"font-weight: 400;\">Free coupons<\/span><\/a><\/th>\n<\/tr>\n<tr>\n<th><a href=\"https:\/\/www.singlecare.com\/prescription\/provera\/what-is\"><span style=\"font-weight: 400;\">Provera<\/span><\/a><\/th>\n<th><span style=\"font-weight: 400;\">$71 for 10, 10 mg tablets of brand-name Provera<\/span><\/th>\n<th><span style=\"font-weight: 400;\">$6 for 10, 10 mg tablets of generic Provera<\/span><\/th>\n<th><a class=\"cta-button\" href=\"https:\/\/www.singlecare.com\/prescription\/provera#coupons-prices\"><span style=\"font-weight: 400;\">Free coupons<\/span><\/a><\/th>\n<\/tr>\n<tr>\n<th><a href=\"https:\/\/www.singlecare.com\/prescription\/prempro\/what-is\"><span style=\"font-weight: 400;\">Prempro<\/span><\/a><\/th>\n<th><span style=\"font-weight: 400;\">$347 for 28 tablets of brand-name Prempro<\/span><\/th>\n<th><span style=\"font-weight: 400;\">$231 for 28 tablets of brand-name Prempro<\/span><\/th>\n<th><a class=\"cta-button\" href=\"https:\/\/www.singlecare.com\/prescription\/prempro#coupons-prices\"><span style=\"font-weight: 400;\">Free coupons<\/span><\/a><\/th>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><i><span style=\"font-weight: 400;\">Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. Click the link under \u201cSavings options\u201d to see updated drug prices.<\/span><\/i><\/p>\n<h3><span style=\"font-weight: 400;\">2. Ask the pharmacy about pricing<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Sometimes, the out-of-pocket price for uninsured patients is lower than your insurance or Medicare copay. It\u2019s important to always ask the pharmacist to compare the cash price of a prescription without insurance to your Medicare copay.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Apply a SingleCare coupon on top of the cash price for an even better discount. Note: Prescriptions paid for out-of-pocket with a SingleCare coupon will not count toward your Medicare deductible.<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/can-i-use-singlecare-and-medicare\/\"><b>Can I use SingleCare if I\u2019m on Medicare?<\/b><\/a><\/p>\n<h3><span style=\"font-weight: 400;\">3. Extra Help<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Those who qualify for <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-extra-help\/\"><span style=\"font-weight: 400;\">Medicare Extra Help<\/span><\/a><span style=\"font-weight: 400;\"> will only pay up to $12.65 for brand-name medications and up to $5.10 for generic medications, including HRT medications. The Extra Help program is available to those on Medicare who have limited income and resources.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">4. HRT Access Funds<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">There are programs such as Plume\u2019s <\/span><a href=\"https:\/\/www.pointofpride.org\/hrt-access-fund\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">HRT Access Funds<\/span><\/a><span style=\"font-weight: 400;\"> that will help you with 12 months of free medical care for hormone replacement therapy. Recipients will receive 12 months of:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">3x year lab work through Quest Diagnostics<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Virtual medical care through telemedicine visits<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">24\/7 access to hormone replacement therapy care team<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prescription cost coverage<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">There are many benefits to getting hormone replacement therapy that will help you get through menopause and other health situations without too much distress. Speak to your healthcare provider about the options available to you to make the most of your situation.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hormone replacement therapy (HRT) is a treatment that your doctor can prescribe for many health problems. It\u2019s often used to help balance progesterone and estrogen levels during or near menopause. Menopause typically begins between ages 45 and 55 and can last seven to 14 years. Many people age into Medicare at 65 years old, so [&hellip;]<\/p>\n","protected":false},"author":133,"featured_media":53345,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[15],"coauthors":[20918],"class_list":["post-53342","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-medicare","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Does Medicare cover hormone replacement therapy? | SingleCare<\/title>\n<meta name=\"description\" content=\"Original Medicare does not typically cover hormone replacement therapy. But a Part C or Part D may cover HRT prescriptions. Learn the costs and how to save.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-hormone-replacement-therapy\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Does Medicare cover HRT?\" \/>\n<meta property=\"og:description\" content=\"Original Medicare does not typically cover hormone replacement therapy. But a Part C or Part D may cover HRT prescriptions. 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But a Part C or Part D may cover HRT prescriptions. 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