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Will Medicaid Pay For Hormone Replacement Therapy For Older Men?

Menopausal women are not the only ones who can benefit from hormone replacement therapy. This treatment also helps older men who experience symptoms of hormone imbalance like erectile dysfunction due to changes in testosterone hormone levels. In addition, transgender individuals with gender dysphoria and who are undergoing gender reassignment also need to take hormone therapy to aid in their transition. However, the price to pay for hormone treatment can be restrictive and may get you to think twice.

So is testosterone replacement therapy covered by Medicaid? Medicaid has one of the largest insurance coverages, providing health care to low-income children, families, and seniors. Coverage for HRT as prescribed by a doctor will depend on your provider. In the case of Medicaid, they can provide coverage for prescription drugs that are needed for testosterone treatment. Still, it’s best practice to check with your provider before availing of the treatment.

How Much Does Hormone Replacement Therapy Cost?

Hormone replacement therapy, or testosterone therapy, is an essential treatment to correct hormonal imbalance and low testosterone in older men. Some prostate cancer patients may also receive testosterone hormone replacement treatment to suppress testosterone level and inhibit cancer cells from growing.

For a transgender man, they may also receive testosterone hormone therapy as part of their transition related care and can be taken in combination with a gender reassignment surgery. Receiving testosterone hormones is said to help introduce physical changes to match your body with your assumed gender identity.  Hormone therapy for a transgender person can also reduce feelings of anxiety, depression, and distress from a gender identity disorder.

Hormone replacement therapy can usually come in the form of pills, injectables, pellets, and topical or transdermal medications like creams, gels, and patches. Factors like what type of hormone medication you’ll get and the frequency of times that you’ll be taking them can affect the overall cost of your hormone treatment. To have a better picture of how much you may be spending annually for HRT, here’s how much each form of hormone medication may cost:

  • Pills - Oral hormone medications may average about $130 to $240 per month. The good thing is that most insurance providers can pay for HRT pills so patients only need to pay the prescription co-pay costs which is around $30 each month.
  • Injectables - This type of hormone therapy includes testosterone injections for men, it may cost $288 - $1440 if you are insured and $480 - $4,880 if uninsured. It’s usually one of the more expensive treatment options since you may need more than one testosterone shot.
  • Pellets - Hormone pellet therapy is usually done on a cash basis and not all health insurance companies may cover this. The average cost of pellet treatment for men may cost anywhere between $1,400 to $2,100.
  • Creams, gels, and patches - Through this type of treatment, the hormones are absorbed by the skin directly through the bloodstream. Some patients may prefer these medications since they have lesser side effects. It may cost around $60 to $360 if you have insurance or $120 to $1,020 if not insured.

Aside from the necessary prescription drugs, your doctor may also run some lab tests and order blood work to check the hormone levels. This may incur additional costs which average about $80 to $500 if you don’t have an insurance.

Some doctors may prescribe taking bioidentical hormone replacement therapy. It differs from traditional hormone replacement therapy because it uses compounded bioidentical hormones that are made from natural plant sources. Many manufacturers claim that these products are a safer alternative since they are almost identical in structure and composition to the hormones produced by the body.

The average cost of bioidentical hormones is roughly between $200 to $500 monthly. The price already covers the hormone medications, a customized hormone treatment plan, and maintenance checkups with your provider. The coverage for bioidentical hormonal therapy will largely depend on your provider since not all insurance may cover compounded medications.

The best way to know is to contact your health care provider and ask if they will cover the cost of bioidentical hormones. If it states that your insurance does not cover “holistic” or “natural” therapies, then it will most not likely include bioidentical hormone replacement.

Is Hormone Therapy For Older Men Included In Insurance Coverage?

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A universal health plan gives everyone access to health services, medical treatments, and surgical procedures that they will need. In the United States, there are three ways that residents can avail themselves of health insurance: individual plans, employer-sponsored health plans, and government-based programs like Medicare and Medicaid.

Medicare is the primary health insurance program for persons with disabilities and for citizens who are 65 years of age and above. On the other hand, Medicaid coverage has no age limit and is open to all low-income individuals with limited means to fund their health care and medical needs.

In terms of long-term care for older women and men, the benefits of Medicare coverage may be limited. Medicare offers four different insurance programs: hospitalization coverage (Part A), medical insurance (Part B), Medicare Advantage (Part C), and prescription drug (Part D).

While Part A and Part B can provide coverage for the necessary gender affirmation surgery and other medical procedures, they may not pay for the costs of your hormone medications. You may opt to subscribe to the Medicare Advantage Plan Part C or Medicare Part D to get coverage for prescription drugs needed for hormone therapy.  

For Medicaid, which is a state-run health insurance, the benefits of the program may vary among each state. Some state Medicaid programs offer coverage for hormone replacement therapy for men and women while others still don’t offer it. In addition, there’s a new Medicaid expansion which includes new advantages and expands on the services that are already covered through traditional Medicaid.

Some of the essential health benefits under Medicaid expansion are emergency services, preventive and wellness services, chronic disease management, rehabilitative services, mental health treatments, and prescription drugs. If you have Medicaid, you should check if your plan includes coverage for the medications that you will need for hormone therapy. 

Medicaid Coverage For Gender Affirming and Transition Related Care 

Transgender individuals also have the right to access universal health care and insurance programs. Most federal and state law suggests that is illegal for your health care provider to deny you insurance access and refuse to reimburse medically needed gender affirming surgery for transgender individuals.

Medicaid is one of the essential insurance providers for many low-income individuals, families, seniors, and even persons part of the LGBTQ community. According to a report published in 2019, at least eighteen states include full coverage for gender affirming care under Medicaid health insurance plans.

Gender-affirming care relates to medical treatments, surgical procedures like genital surgery and bilateral mastectomy, and mental health services and consultations which are designed to help transgender, nonbinary, gender non-conforming persons. Medical care for individuals seeking gender reassignment can include routine health checkups, hormone replacement therapy, and other transition related care.

Gender affirming care is also necessary to treat the symptoms of gender dysphoria. Gender dysphoria is a medical condition where a transgender patient experiences feelings of distress, discomfort, and mental health issues. It’s usually triggered by a conflict between one’s assigned gender marker at birth and their gender identity. Gender identity is different from sexual orientation which is more about who you are attracted to emotionally and romantically.

If you’re applying for Medicaid coverage for any gender affirming care, it’s necessary to show a doctor’s diagnosis of your gender dysphoria. It’s also important to have a doctor’s authorization notice at hand to inform that the medical treatment that you are seeking is mandatory. When it comes to hormone drugs and medications, a prescription note will be required to be able to avail of them.   

Any individual availing of hormone therapy or any medical or surgical intervention must also have informed consent. As with any treatment or procedure, it’s important to schedule an initial consultation first to discuss your goals and intended outcome from the hormone therapy. Before proceeding with the hormone treatment, you should have full understanding of what to expect from the therapy, its benefits, and its potential risks. It’s also important that you have a social circle that can offer support as you go through the transition.

Some of the common side effects that you may expect out of testosterone therapy are acne breakouts or oily skin, disturbed breathing while sleeping, mood swings, breast enlargement, sleep apnea, tiredness or fatigue, and weight gain.

Testosterone hormone treatment may also increase your production of red blood cells which can increase chances for blood clots, deep vein thrombosis, or pulmonary embolism. Hypertension, type 2 diabetes, stroke, heart attack, cardiovascular diseases, and higher levels of cholesterol are also some of the other complications from hormone replacement therapy.

Older men and transgender men receiving hormone replacement therapy are advised to schedule regular checkups and consultation with their doctor to assess how their body is responding to the treatment. If you’re experiencing some discomfort from hormone therapy, your doctor may change your prescription or lower your dose to manage your symptoms and proceed with the treatment smoothly.

Tips To Lower Costs of Hormone Therapy 

Mature man reading a book on the sofa.

It’s unavoidable for men to experience symptoms of hormonal imbalance or andropause (male menopause) since testosterone levels naturally begin to decline each year once they reach the age of 30. The signs of low testosterone are often uncomfortable and can drastically affect your quality of life. Likewise, hormone therapy is a vital treatment for transgender individuals to complete their transition.

As a patient, you have the right to access health insurance plans that can help with your hormone treatment plans. However, you also have the responsibility to be informed and inquire with your provider beforehand if they will be to cover your hormone therapy. To avoid the stress from thinking about payments, here are a few tips that can help keep your hormone replacement therapy costs at a minimum:

  • Check your insurance pamphlet or booklet about partner health clinics or sites where you may be able to get the necessary hormone treatments tests at a covered cost. It is highly likely that you will pay for your own expenses if you go to a private clinic.
  • Directly ask your hormone therapy provider if they are offering flexible payment plans or financing options that will save you from paying the full cost of the treatment upfront. They may also be offering discounts on large quantity orders or packages from which you can benefit.
  • Consider your options and do your research to find the best treatment for you. There are many factors that may affect the total price of hormone therapy. You want to be sure that you’re getting the most out of what you’re paying so you should thoroughly talk with your doctor and insurance provider to know if the treatment is right for you.

If your insurance provider does not cover hormone therapy or if you’re not eligible for the treatment itself, the best thing older men can do to manage the symptoms of low testosterone is to keep a healthy and active lifestyle. 

Diet changes, doing regular exercise, quitting smoking, and taking supplements can go a long way to ensure that you have good health. Consult with your doctor about possible alternative therapies and other ways you can naturally balance your hormones.

Affordable and Customized Hormone Therapy Plans At Revitalize You MD

Hormone replacement therapy is an effective treatment for older men experiencing hormone changes, as well as for transgender patients who are seeking transition-related care. And for some, getting HRT is a long-term commitment and the treatment costs may become too overwhelming if you don’t have Medicaid or other insurance plans.

At RevitalizeYou MD, we offer safe and high-quality hormone treatments for your needs. Consult with any one of our doctors and expert staff about finding the right and cost-effective hormone therapy plan to address your needs and symptoms. Book an appointment or call us today to learn more about our services.


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