Quick Answer
Partially. Medicare Part A and Part B do not cover hormone replacement therapy (HRT) medications for menopause. However, Medicare Part D prescription drug plans and Medicare Advantage plans with drug coverage (MAPD) may cover HRT medications depending on the plan's formulary. Always verify your specific medications are covered before enrolling.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Medicare Part A & B | Not Covered | Part A and Part B do not cover outpatient prescription drugs including HRT medications |
| Medicare Part D | May Be Covered | HRT medications covered if on plan formulary; coverage varies by plan and medication |
| Medicare Advantage (MAPD) | May Be Covered | HRT medications covered when included in plan's drug formulary; same as Part D coverage |
| Medicare Supplement (Medigap) | Not Applicable | Medigap supplements Original Medicare; since Part A/B don't cover HRT, Medigap doesn't either |
Understanding Your Coverage Options
Medicare Part D (Prescription Drug Coverage)
Coverage depends on plan formularyMedicare Part D prescription drug plans may cover HRT medications for menopause when they are on the plan's formulary. Formularies vary significantly between plans - some plans cover a wide range of HRT medications, while others may cover only generics or exclude certain brand-name drugs.
Not all Part D plans cover every HRT medication. Estradiol patches, in particular, may be covered by some plans but not others - even if the plan's published formulary suggests they are. Always verify your specific medication is covered before enrolling in a Part D plan.
HRT drug costs vary significantly by plan tier. Generic estrogen and progesterone are typically Tier 1 or Tier 2 (lowest cost). Brand-name HRT medications may be Tier 3 or higher, resulting in higher copays.
What It Covers
- Estrogen therapy (ET) medications when on plan formulary
- Estrogen plus progesterone therapy (EPT) medications
- Bioidentical hormones (estrogen, progesterone, testosterone) when on formulary
- Estrace (estradiol) - covered by some plans
- Estradiol patches, gels, and oral tablets when on formulary
- Localized (non-systemic) HRT creams and rings when on formulary
What It Doesn't Cover
- HRT medications not on your plan's formulary
- Compounded bioidentical hormones not FDA-approved
- Over-the-counter hormone supplements
Generic estrogen and progesterone are typically Tier 1 or Tier 2, costing $0–$15/month. Brand-name HRT medications may be Tier 3 or higher, costing $47–$100+/month.
Medicare Advantage (MAPD) with Drug Coverage
Coverage depends on plan formularyMedicare Advantage plans with drug coverage (MAPD) are the most common way Medicare beneficiaries get HRT coverage. These plans combine Parts A, B, and D into a single plan, so HRT medications are covered when they are on the plan's formulary.
Some MAPD plans leave you with zero out-of-pocket costs for HRT, while others may require copays or coinsurance. Compare plans during Annual Enrollment (October 15 – December 7) to find the best coverage for your HRT medications.
What It Covers
- All HRT medications included in the plan's drug formulary
- Bioidentical hormones (estrogen, progesterone, testosterone) when on formulary
- Estrace and estradiol products when on formulary
- May include additional women's health benefits not in Original Medicare
What It Doesn't Cover
- HRT medications not on your plan's formulary
- Compounded bioidentical hormones not FDA-approved
- Cosmetic hormone treatments
Some MAPD plans cover HRT at $0 out of pocket, while others require copays or coinsurance. Compare plans carefully to find the best coverage for your specific medications.
Compare Plans during Annual Enrollment
If your current plan does not cover your HRT medications or the costs are too high, you can switch to a plan with better formulary coverage during the Annual Enrollment Period (October 15 – December 7) each year.
Original Medicare (Parts a & B)
HRT medications not covered under Part A or Part BOriginal Medicare does not cover outpatient prescription drugs, including HRT medications for menopause. Part A covers inpatient hospital care, and Part B covers outpatient medical services - neither covers self-administered prescription drugs.
While Original Medicare does not cover HRT medications, it does cover the doctor visits and lab tests needed to diagnose and monitor menopause-related conditions. You need a separate Part D plan or a Medicare Advantage plan with drug coverage for HRT medications.
What It Covers
- Doctor visits to discuss menopause symptoms and HRT options
- Lab tests to evaluate hormone levels
- Bone density screenings (osteoporosis is a risk factor with menopause)
- Mental health services for depression related to menopause
What It Doesn't Cover
- HRT medications - not covered under Part A or Part B
- Outpatient prescription drugs of any kind
Doctor visits for menopause-related care are covered under Part B at 20% coinsurance after your deductible. Annual wellness visits are covered at $0.
Common HRT Medications and Medicare Part D Coverage
| Medication | Type | Generic Available | Typical Part D Tier | Estimated Monthly Cost |
|---|---|---|---|---|
| Estradiol (oral tablet) | Estrogen therapy | Yes | Tier 1–2 | $0–$15/month |
| Estradiol patch (Vivelle-Dot) | Estrogen therapy | Yes (generic available) | Tier 2–3 | $15–$47/month |
| Progesterone (oral) | Estrogen + progesterone | Yes | Tier 1–2 | $0–$15/month |
| Estrace (brand estradiol) | Estrogen therapy | Generic available | Tier 2–3 | $15–$47/month |
| Premarin (conjugated estrogens) | Estrogen therapy | No generic | Tier 3–4 | $47–$100+/month |
✦ Important Rules for HRT Coverage under Medicare
Formulary Verification Required
Not all Part D or Medicare Advantage plans cover every HRT medication. Before enrolling in a plan, verify that your specific HRT medications are on the plan's formulary. Formularies can change annually, so review your plan's formulary each year during Annual Enrollment (October 15 – December 7).
Compounded Bioidentical Hormones
Medicare Part D does not cover compounded bioidentical hormones that are not FDA-approved. If your doctor prescribes a compounded HRT formulation, it is unlikely to be covered by Medicare. FDA-approved bioidentical hormones (like estradiol and progesterone) may be covered if they are on your plan's formulary.
Annual Enrollment Period
You can change your Part D or Medicare Advantage plan during the Annual Enrollment Period (October 15 – December 7) each year. If your current plan does not cover your HRT medications, this is the time to switch to a plan that does.
Transgender HRT Coverage
Medicare covers hormone therapy for transgender beneficiaries the same way it would for any other beneficiary when it is medically necessary. Hormone therapy medications are covered under Part D and Medicare Advantage plans with drug coverage.
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is the Chief Technology Officer and Co-Founder of Elite Insurance Partners and MedicareFAQ.com. He is a member and regular contributor to Forbes Finance Council.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare. She trains agents on CMS compliance guidelines.