Is Bioidentical Hormone Therapy Covered By Insurance?

by admin

Are you looking into bioidentical hormone replacement therapy (BHRT)? If you are, you want to know how much it will cost. A myriad of factors determines the cost.

If your healthcare provider prescribes BHRT, your insurance will likely cover the costs. Did you select an alternative specialist outside of your insurance network?

If so, much of the cost will be out-of-pocket. A looming question is this, “Is bioidentical hormone therapy covered by insurance?” The short answer is, yes, sometimes. Read on to find out more.

What is Bioidentical Hormone Replacement Therapy?

A hormone is a medication prescribed by a doctor. You can take hormone medications as a pill, injection, or applied to the skin using a patch or gel.

Doctors prescribe Hormone Replacement Therapy (HRT) to treat hormone imbalances, such as menopause and thyroid. Men also can also receive hormone therapy for andropause (more about that later).

Bioidentical Hormones

Bioidentical hormones have hormones that are chemically identical to the hormones in your body. Many bioidentical hormones sold by non-FDA approved companies have natural and organic products.

They also differ from mainstream hormone drugs in that you may be able to get a custom dose made for you.

Though, many FDA-approved, traditional hormone therapies contain natural hormones as well. Your healthcare provider most likely prescribes these routinely.

Some of the products you may have heard of are Climara, Estrace, and Vivelle-Dot. Those three contain estrogens. Another is Prometrium, which is natural progesterone. These are all natural hormones derived from plants.

Natural Does Not Mean Bioidentical

If a hormone replacement is “Natural,” it means the hormones come from plant or animal sources. They aren’t synthetic and created in a lab.

Understand, though, that these natural products still need processing to become bioidentical hormones. This includes any organic products as well.

Is Bioidentical Hormone Therapy Covered By Insurance?

The answer varies depending on your health insurance. Some policies cover more than others. Insurance covers certain prescription hormone therapy costs. Many of these are bioidentical.

If you are a candidate for hormone replacement therapy, check with your insurance provider. Even if HRT is a medical necessity, your plan may not cover the medications.

Many times, insurance does not cover holistic or progressive treatment plans. It doesn’t cover bioidentical hormone replacement therapy in these cases.

Does Insurance Pay for Bioidentical Hormone Replacement for Men?

As men age, they have a gradual loss of hormones, especially testosterone. While not as well-known as female menopause, there is such a thing as andropause for men. Andropause interferes with a man’s health and lifestyle.

Symptoms in men include weight gain, muscle loss, and fatigue. Other troubling symptoms include hair loss, urinary problems, and erectile dysfunction. Bioidentical hormone replacement therapy can help restore balance.

Here again, check with your insurance provider to see if it covers HRT. If you are looking for bioidentical hormone treatment, in particular, verify which hormones your policy covers.

Likewise, check to see what types of practitioners the plan includes and excludes.

Are Bioidentical Hormones Covered by Insurance for Women?

Menopause begins after a woman has her last menstrual cycle. The average age for women entering menopause is 51. Even before that last cycle, menopause changes the hormone balance in a woman’s body.

Progesterone, estrogen, and even testosterone levels begin to drop. The result is symptoms like mood swings, hot flashes, and thinning of the vaginal lining.

A doctor may prescribe hormone therapy to relieve these symptoms. Hormone therapy also treats some of the long-term effects of menopause like bone loss.

The same coverage guidelines apply here as they do for men. Your policy may cover traditional hormone therapy but not bioidentical hormones. Also, most insurance carriers don’t cover testosterone when prescribed for women.

Are Bioidentical Hormones Covered by Medicare?

Original Medicare (Part A and Part B) has limited prescription drug coverage. It doesn’t cover hormone therapy medications at all, even those for menopause.

If you need coverage for HRT, you’ll need a Medicare Part D Prescription Drug Plan. You can opt for a private insurance company. Or, you can add a stand-alone Part D Prescription Drug Plan to your original Medicare.

Another avenue is a Medicare Advantage (Medicare Part C) Prescription Drug. This plan covers prescription drugs, including those for hormone therapy.

For a list of covered medications, see the plan’s formulary. A formulary is a list of covered medications. If your doctor prescribes a drug that’s not on the formulary, you can request a substitute.

How Much Does Bioidentical Hormone Replacement Therapy Cost?

How much bioidentical hormones cost depends on your insurance coverage. If your insurance covers the prescriptions, you’ll pay the set copay. Likewise, if your practitioner is a preferred provider, you’ll pay your regular copay.

If your insurance doesn’t cover your prescriptions, you will pay out-of-pocket for them. If your healthcare provider is not in your insurance network, then you will pay per the plan rules.

Hormones Available Over-the-counter

Some hormones are available without a prescription. Examples are DEA, micronized progesterone, and pregnenolone. You buy these over-the-counter.

Insurance does not cover them even with a prescription. The costs for these vary by brand and can become a bit costly.

Ways to Lower Costs

If you choose a private HRT clinic, you’ll pay out-of-pocket for their services. Though, there are ways to reduce some of the cost.

You may be able to file a claim for the tests ordered by the HRT clinic. You can also check to see if you can go to a provider site to have those tests done. Your insurance may cover that in this case.

Also, ask your HRT provider if they offer payment plans or interest-free financing.

Finally, inquire about discounts from your HRT provider. For example, you may be able to receive a discount on orders in larger quantities, such as a six-month supply.

Begin Feeling Better

Is bioidentical hormone therapy covered by insurance? If it is, don’t waste any time getting yourself to a health care provider who can help you. Please contact us with questions or if you wish to find a practitioner near you.