Does Medicare Cover Testosterone?

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  • 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. 

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.  

Is Hormone Replacement Therapy Covered by Medicare? 

Traditional Medicare plans are unlikely to cover hormone replacement therapy unless you're receiving in-person care. 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. 

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