Coffee & Coverage: What Does Medicare Cover for Testosterone Therapy?

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It is not uncommon for older men to need testosterone therapy due to other health conditions. Testosterone therapy can be pricey. Will Medicare help with the expenses?

What is testosterone therapy?

Testosterone therapy is the practice of giving testosterone in order to treat conditions that are due to the testes not producing enough testosterone. This may be due to absence, injury, or disease.

Medicare coverage

Typically, the type of testosterone therapy that is prescribed by your doctor will be an indicator of what kind of Medicare benefits may be required for coverage and cost-sharing. Hormone replacement and testosterone therapies that are fulfilled by a pharmacy to be taken or administered at home will NOT be covered under Medicare Part B.

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However, if your testosterone therapy is a shot that is administered by a qualified healthcare professional in a Medicare-certified facility, your Medicare Part B coverage may help with the cost. Certain out-of-pocket expenses, such as copays or deductibles, will apply.

Prescription drug plan

The Medicare benefits available with a stand-alone Part D Prescription Drug plan or a Medicare Advantage (MA) plan with prescription drug coverage may cover the costs of testosterone therapy depending on your formulary and the plan you are enrolled in. Since the plans are offered through private insurers, each formulary may be different and beneficiaries should check with their insurer to find out if their testosterone therapy preference is covered.

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