Hormone replacement can be a transformative treatment. When used to treat hormone imbalance or age-related hormonal changes, its ability to relieve symptoms and help you feel better quickly should not be underestimated. Many people find the restoration of their health and quality of life to be priceless.
But does insurance cover hormone replacement therapy (HRT)?
If you are concerned about managing the cost of your treatment, you are wise to get the information up front so there are no surprises. Knowing what to expect can help you decide if HRT is a good investment and prepare for what’s ahead.
Does Insurance Cover Hormone Replacement Therapy?
Starting hormone replacement therapy is a multi-step process, and each step has associated costs. Depending on your insurance plan, some or all of these may be covered.
To get started, you will schedule an initial consultation with your doctor. Choosing a doctor who specializes in hormonal health will help to ensure that you get the best treatment to support your wellbeing.
Will insurance cover it? Your initial consultation may be covered under your insurance policy. If it is, the level of coverage may depend on whether the doctor is in-network or an out-of-network provider. Typically, you will be asked to pay for your visit at the time of service, then submit a claim to your insurance provider for reimbursement.
Once your doctor has taken a thorough medical history and assessed your symptoms, they will order comprehensive testing to get greater insight into your health. This may involve blood, urine, or saliva testing to measure your hormone levels. The samples will be processed through a medical lab, and your doctor will receive a detailed report of the results, which will help them make an appropriate diagnosis and design a personalized treatment plan. The lab will bill for its services.
Will insurance cover it? With appropriate diagnostic codes, many insurance plans will cover some or all of the testing necessary to identify hormonal health issues.
If you are a good candidate for HRT, your doctor will prescribe the appropriate hormones. Today, there are many hormone therapies available, including synthetic and bioidentical options. You and your doctor will decide which is best for you, taking into account your personal preferences and lifestyle. The pharmacy may charge you directly for topical medications, while the cost of injections or pellets is usually paid through your doctor’s office.
Will insurance cover it? Some HRT medications may be covered, while others are not. Custom-compounded hormone therapy is typically not covered. Once your doctor has proposed a treatment plan, you can check with your insurance provider to better understand your coverage.
Regular follow-up and re-testing allow your doctor to see how treatment is progressing and help them fine-tune your treatment plan to help you achieve your goals. These check-in appointments will likely be shorter than the initial consultation, and the doctor’s office will bill for them, while hormone testing may be billed by the lab.
Will insurance cover it? Like your initial consultation, your follow-up visits may be covered by your insurance policy, and coverage can depend on whether the doctor is in-network for you. You may be asked to pay for your visit at the time of service, then seek reimbursement from your insurance company. Lab testing may also be covered.
Supplements and Over-the-Counter Medications
Your doctor may make recommendations for supplements or over-the-counter medications that will complement your hormone therapy and increase its benefits to your overall health. These may be purchased online or over-the-counter, or they may be available directly from your doctor’s office.
Will insurance cover it? Supplements and over-the-counter medications are generally not covered by insurance.
|If your insurance does not cover your chosen hormone replacement therapy, the out-of-pocket cost is still very manageable.
For a woman, the daily cost is about equivalent to a tall latte at Starbucks ($3.66)
For men, the daily cost is comparable to that of a double quarter pounder with cheese at McDonald’s ($4.33)
Considering the benefits HRT can have for your health, your relationships, and your sense of well-being, these costs are a small price to pay.
Is HRT an Allowable Expense for FSA, HSA, and HRA?
All costs involved in hormone replacement therapy may qualify as allowable expenses. This includes doctor visits, lab testing, and prescriptions, including those prepared by a compounding pharmacy. Supplements and over-the-counter medications are often allowable, although they may require a Letter of Medical Necessity from your doctor.
To use FSA, HSA, or HRA funds to cover the expenses associated with HRT, you can make payments directly with your account’s debit card. Alternatively, you can pay for the expenses yourself and seek reimbursement from the account. It is essential to maintain an accurate record of all of your receipts, as these are typically required for reimbursement.
Are There Financing Options?
CareCredit is a good option if you want to finance out-of-pocket costs. Once qualified, you can set up low-interest or interest-free payments to cover the costs over time. Be sure you understand all the details before signing up.
Investing In Yourself
It is impossible to put a price tag on your health. With so much at stake, your treatment should be designed around you, not your insurance company.
Hormone replacement therapy can be invaluable for treating hormone imbalance and supporting midlife wellness. Once physical and emotional symptoms start to lift, many patients tell us they regret not seeking help sooner. Though you may bear some out-of-pocket costs, investing in yourself can give you so much in return.