June 21, 2023

Understanding Hormone Replacement Therapy Coverage: Benefits, Eligibility, and Insurance Information

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Is Hormone Replacement Therapy Covered by my Insurance?

As women approach menopause, they begin to experience various symptoms that can be uncomfortable. Many would want to refer to hormone replacement therapy to help reduce or manage the physically and emotionally tiring effects of these symptoms. However, the big question is “Will my insurance pay for the service?”, and if yes, “Are there limitations on what will be covered?”

Hormone Replacement Therapy Cost

For starters, the total cost of hormone therapy is dependent on the type of therapy, type of hormones, the number of hormones required for each dose, therapy duration, number of doctor visits, tests performed, insurance rates, and copays. Next, is the insurance plan and policy. Some insurance will cover the full cost, a certain number of sessions, certain parts of the therapy, or not at all. Drugs that are non FDA approved will have a lower chance of being covered. In addition, private insurance is less likely to cover hormone replacement therapy compared to public/government insurance. 


Medicare recipients would need to have Medicare Advantage (part C) or part D in order for hormonal therapy to be covered. This is because doctors will prescribe estrogen pills, estrogen patches, or other estrogen based prescriptions for therapy. As a result, Medicare parts A and B alone are insufficient. 

United Healthcare

UnitedHealthcare is a health insurance company that serves over 27.4 million Americans. Bioidentical hormone replacement therapy are often partially to fully covered by their plan if it is referred by a healthcare provider for the purpose of treating menopausal symptoms. However, seeing a menopause specialist, especially if it is outside of the plan’s network will be fully out of pocket. 

Kaiser Permanente

Kaiser Permanente Medical Plan does cover hormone replacement therapy for relief of menopause symptoms. FDA-approved bioidentical hormone prescriptions will also be covered. However, similar to most insurance companies, the extent to which insurance will pay for all the services is dependent on the plan. 

Major insurance companies are likely to have menopause related care compared to smaller insurance companies. Hormone replacement therapy are also more likely to be covered by insurance if it is referred by a provider for menopause related purposes. Furthermore, prescription drug coverage is an essential part of the insurance plan.  

At It’sFetch.co we strive to provide valuable and reliable health information through our blog. We believe in empowering individuals to make informed decisions about their health and well-being. However, it is important to understand that the content on our blog is not intended to replace the advice, diagnosis, or treatment provided by a qualified medical professional.

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