Health Insurance Options for Hormone Replacement Therapy

Hormone replacement therapy may be used by multiple people for various needs. For instance, women who are undergoing menopause may consider undergoing hormone replacement therapy due to severe side effects of menopause. In addition, people who are looking to transition and become transgender will also need to undergo hormone replacement therapy. Even if your physician recommends you to take part in hormone replacement therapy, the prices may be prohibitive and you will likely need your health insurance to cover much of the cost.

In the United States, there are three ways you can obtain health insurance and cover various medical services. These methods include:

  • Individual plans available on the health insurance exchange
  • Employer-sponsored health insurance plans
  • Government-based health plans such as Medicare or Medicaid

Various private sector companies have gone forward with removing exclusions regarding transgender medical care from employer-sponsored health insurance plans. In addition, a number of state and federal government employees also qualify for hormone replacement therapy and transition-related medical care through group benefit plans.

Americans who are disabled and/or 65 years of age or older qualify for Medicare, which covers gender reassignment surgery, hormone replacement therapy, and other routine medical care services. Some state Medicaid programs also cover hormone replacement therapies. Additionally, state health insurance exchanges may offer to cover the cost of hormone replacement therapy, but this varies on a state-to-state basis.

The insurance coverage offered on the federal health insurance exchange is required to cover preventive services such as immunizations and screening tests with no copays required by the patient when delivered by your doctor or a provider in your network. Sex-specific recommended preventive services based on gender identity or sex at birth (such as a pap smear or mammogram) cannot be eliminated by the health insurance provider.

In addition, if any plan includes transgender health insurance exclusions, it may be unlawful gender discrimination. As such, you can file discrimination complaints with your state’s Department of Insurance, or send a report to the Centers for Medicare & Medicaid Services by email to marketconduct@cms.hhs.gov.

Employers also often negotiate health insurance plans by removing exclusionary statements and ensuring various treatments such as hormone replacement therapy are covered in the plans.

What are the Costs of Hormone Replacement Therapy?

The cost of hormone replacement therapy out of your pocket with the help of a health insurance plan will be around $5 to $30 per month as a form of copay. Those who lack health insurance coverage will be spending anywhere from $10 to $85 per month.

Generic estrogen-only or progesterone-only medicine are some of the more affordable drugs in this area while brand name estrogen-plus-progesterone drugs or patches such as the Prempro the CombiPatch are some of the more expensive types of hormone replacement medications.

Most health insurance plans do cover hormone replacement therapy for women who are undergoing menopause. However, some health plans like Kaiser do not cover this type of treatment. Typically, women are given the hormones estrogen and progestin or a combination of the two to treat the symptoms of menopause. These drugs come in many forms such as a patch, a pill, a cream, or a gel.

Some additional costs of this treatment includes a $75 to $200 physician visit for those who lack health insurance. In addition, with insurance, a blood test ordered by the doctor can cost as much as $1,000. Furthermore, it is beneficial for a patient to speak with their doctor about the various risks of hormone replacement therapy. According to a study conducted in 2002, this type of treatment for menopause can increase the risk of blood clots, heart disease, strokes, and breast cancer.

If you do decide to proceed with hormone replacement therapy, you will likely first consult with a nurse practitioner and then obtain a comprehensive blood panel. This will explain your metabolic function, thyroid, liver enzymes, and hormone levels. Then a plan will be put together by a medical team to deliver to you. You’ll be updated and a follow-up consultation will occur. The hormone replacement therapy plan will be discussed and you will start treatment.

It is a good idea to obtain health insurance coverage before attempting to undergo medical treatments such as hormone replacement therapy. This will save you money in the long run. Lastly, you’ll need to consider all of your options and the most affordable, high quality clinics to go to for your treatment. Are you ready to get started on your journey? Call us today at (205) 352-9141

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