Does Medicare Cover Testosterone?

Christian Worstell
In this article...
  • Does Medicare cover testosterone? Here's what you need to know if you suffer from a condition that requires hormone replacement therapy and need testosterone.

Medicare Part B will only cover testosterone treatments that are administered directly by an approved physician. This means that you wouldn't be covered at the pharmacy for testosterone supplements.

However, some Medicare Advantage (Medicare Part C) plans that include prescription drug coverage can cover some brands of testosterone therapy. You may also be able to select a Medicare Part D plan that will cover these prescriptions.  

If you don't have coverage for prescription testosterone medications, you may be covered if you receive testosterone through injection at your doctor’s office. Make sure you review your plan with your doctor so that they can submit the proper documentation to get you approved. 

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Does Medicare Cover Testosterone Drugs Like Androgel? 

Some brand-name drugs might not be covered by your Medicare Part D or Medicare Advantage plan. If you have a preferred medication you would like to take, such as Androgel, you should review your plan details to see whether it's covered. It may be possible to fill a prescription for a generic version that is covered instead.  

You can compare Medicare Part D prescription drug plans online to find out if a plan offered where you live covers testosterone.

Does Insurance Cover TRT?

Traditional health insurance plans may cover testosterone replacement therapy (TRT) under the right circumstances. Medicare Advantage plans are facilitated by private insurers, so you might be able to receive coverage if you have an Advantage plan that offers coverage. Check with your health care provider and insurance company to determine if you can receive reimbursement for treatment and to learn about other payment options available.  

Is a Testosterone Test Covered by Medicare? 

Medicare Part B covers any diagnostic testing that is deemed medically necessary. Proving that there is a medical need is the primary hurdle for you to clear if you want to be covered for a test. Work with your doctor to make sure you gain prior approval from Medicare and are tested by a facility that Medicare will cover. 

How Else Might I Pay for Testosterone? 

If you're eligible for Medicaid, you may be able to receive coverage for hormone replacement therapy through your Medicaid plan instead of going through Medicare or Medicare Advantage. Some medications may be covered under prescription discount programs. You can sign up for the program and receive a card to present at the pharmacy counter. This is a way that many people routinely save money on their prescription drugs.

Christian Worstell
About the Author

Christian Worstell is a senior Medicare and health insurance writer with HelpAdivsor.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. You can find Christian’s most recent articles in our blog.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@MyHelpAdvisor.com.

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