Does Insurance Cover Hormone Replacement Therapy


In order to alleviate some of the symptoms and side effects caused by menopause and removal of the ovaries, many women turn to hormone replacement therapy. The ovaries produce hormones that are important to help women balance their body. When menopause begins, the ovaries slow down and eventually stop production of these hormones.

The same happens when the ovaries are surgically removed, except the production stops suddenly. When the body does not have access to these hormones that are natural to the body, a woman can experience all kinds of unpleasant side effects including night sweats, mood swings, and hot flashes.

Many doctors prescribe hormone replacement therapy to help a woman cope with the far-reaching changes happening within her body. This type of therapy is the use of synthetic hormones that work exactly like those produced by the ovaries. Replacement hormones can help relieve the symptoms experienced during menopause.

Most women on hormone replacement therapy report an overall healthier feeling after beginning hormone replacement.

Hormone replacement prescriptions and initial doctor visits are not cheap. Women who do not have insurance can expect to pay quite a bit for these prescriptions and medical care. Before prescribing any hormone replacements, a doctor will probably want to conduct thorough a health history and exam.

This is usually to rule out uterine cancer and certain forms of breast cancer. HRT has been shown to give women an increased risk for these types of cancers, so the doctor will want to be certain that this is not the case before giving therapy. Initial doctor visits can range in price and those without insurance can expect to pay anywhere from $200 and up. Most insurance companies will pay for all aspects of hormone replacement therapy, including the initial medical exams, prescriptions and follow up appointments.

  • If you do have insurance, it is always a good idea to check with your health insurance provider to see what may or may not be covered. Some insurance plans are very thorough and will pay for everything, minus the co-payment. Many insurance plans that include prescriptions in their coverage, will pay benefits to women on hormone replacement therapy. With these plans, hormone replacement prescriptions will only cost a co-payment that usually ranges from ten to 35 dollars.
  • For women without insurance, the cost of hormone replacement therapy can be cost-prohibitive. After the initial medical exam with the doctor, there will also be the cost of the prescriptions. Many of these must be refilled on a monthly basis. There will also be additional costs of follow up medical appointments.

Women on HRT usually visit their doctor every three to six months. This is important because doctors will carefully monitor women taking hormone replacement drugs. These drugs can have serious side effects in some women including elevated risks of some forms of breast cancer and uterine or endometrial cancer.

Cost per year for hormone medications can vary. Estrogen oral pills are the least expensive, usually costing around $500 per year. Skin patches can cost around $580 per year. Estrogen and progestin creams are the most expensive, costing over $1000 per year.


Last Updated on October 31, 2022