The symptoms were more than annoying – they were debilitating. For men with low-T, it can mean chronic fatigue, decreased passion, loss of muscle mass, hair loss – the list goes on and on. For women with low estrogen, it can mean mood swings, hot flashes, depression, and other symptoms.
After diagnostic tests, your physician diagnosed you with low hormone levels and recommended hormone replacement therapy.
When your healthcare provider recommends hormone replacement therapy to help alleviate your symptoms, the question for a lot of people that comes up is, “will my health insurance cover treatment?” And without a doubt, it’s a fair question.
The answer is, it depends.
Like any other medical treatment, individual insurance plans have their unique and exclusive inclusions and restrictions when it comes to health coverage. While one plan may cover hormone replacement therapy, another plan may not.
Even more disconcerting is that the same insurance plan may cover some individuals while excluding others. It’s all based on the type of coverage you have and what agreement you or your employer has with the insurance provider. After all, hormone replacement therapy is a medication. Every insurance company has a formulary regarding which medications are covered. Each plan is negotiated separately, and the medications covered will vary with the coverage selected.
Medically necessary treatment
Patients often wonder if HRT is considered “medically necessary.” The truth is hormone replacement therapy isn’t a life or death proposition like cancer medications might be. But if your physician prescribes the therapy, you should be entitled to it being covered.
What do you get for your money?
There are several different costs involved. First, there are visits to your physician and/or specialist. There will be blood tests as well. Usually, diagnostic tests are covered by insurance, as are diagnostic doctor visits. If insurance doesn’t cover the lab work, you can pay out-of-pocket.
Surprisingly, there are some hormone replacement therapies available over the counter without a prescription. These include micronized progesterone, DHEA, and pregnenolone. While the upfront costs can add up, the long-term benefits are considerable.
Many people with low hormone levels can experience depression, and long-term effects of low levels of hormones can lead to other diseases like osteoporosis. Those treatment costs can be considerable compared to hormone replacement therapy. In the long run, it is far more cost-effective to treat the low hormone levels.