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Hormone Replacement Therapy

Not Covered by Medicare

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Hormone replacement therapy is the use of medications containing estrogen and progesterone to replace the hormones the body no longer makes after menopause. It is sometimes used to treat common menopausal symptoms, including hot flashes and vaginal discomfort.

Hormone replacement therapy has also been proved to prevent bone loss and reduce fractures in postmenopausal women.

Medicare coverage is limited for hormone therapy prescriptions. Under Medicare Part A, you will have prescription drug coverage under inpatient treatment at a hospital or inpatient facility. Medicare Part B may offer coverage for certain prescription drugs for outpatient situations. Since hormone therapy for menopause is typically done at home, Medicare will not cover hormone therapy in that situation.

In order to get Medicare to cover your hormone therapy, you will need to go through Medicare Part D prescription drug coverage. Refer to your plan’s formulary list to find out what is covered for you.

Talk to your doctor and healthcare provider about your options and the risks involved before going forward with any hormone therapy treatment.

Costs

A Medicare Supplement Plan picks up coverage for deductibles, copayments, coinsurance, and other out-of-pocket costs associated with medical care.

What to Know

There are two common types of hormone replacement therapy and each has different benefits:

  1. Estrogen-Therapy only therapy (ET). The estrogen hormone provides the most relief for menopausal symptoms. Most commonly, estrogen is used for women without a uterus due to a hysterectomy.
  2. Estrogen Plus Progesterone therapy (EPT). Progesterone hormones are added to ET for women with a uterus. Progesterone works to protect women from endometrial cancer.

Your prescription will come from your provider in one of two ways as there are two forms of hormone therapy:

  1. Localized (non-systemic). With this treatment, the medication comes in a cream, tablet, or ring. The drug only affects the area it touches.
  2. Systemic. With systemic treatments, the medications come as an oral tablet, injection, emulsion spray, patch, or gel. With systemic medications, the medicine enters the bloodstream and then affects all areas of the body.

Medicare By State

Medicare is regulated by the federal government. However, private insurance companies are allowed to offer various parts of Medicare, and these plans can differ from state to state.

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