Does Health Insurance Cover Testosterone Therapy?
Because testosterone replacement therapy is sometimes considered a “new” therapy, many patients ask us this question, “Does health insurance cover testosterone therapy for me?”
Most health insurance providers will cover the majority of the cost of testosterone replacement therapy for men, as long as you can demonstrate a need.
Of course, the amount that your insurance covers varies from provider to provider, and it also varies based on your specific health plan and other variables, like your deductible.
Though we cannot guarantee that your insurance will cover the cost of your testosterone replacement therapy, we can at least help you get the process started with a free consultation or with a simple call to your insurance carrier.
Your health insurance company may have already approved you for testosterone replacement therapy if you have certain medical conditions or diagnoses from a physician. Depending on the insurance company, these conditions can include the following:
- A pituitary tumor
- Klinefelter’s Syndrome
- Kallman’s Syndrome
Other conditions, like having had a prostatectomy, may also preclude you from needing tests to prove low testosterone.
For Men—How Does Health Insurance Cover Testosterone Therapy?
We will make sure we check your insurance benefits with your health insurance company to see if insurance will cover the cost of your therapy.
Unfortunately, we cannot guarantee during your free consultation that insurance will cover the cost, and coverage can vary from provider to provider and from one insurance plan to another.
The main purpose of the consultation is to evaluate you for low testosterone and to answer all of your questions.
Most insurance companies need you to demonstrate a need for therapy. In fact, many health insurance companies require you to meet several standards before paying for therapy.
Commonly, health insurance companies want you to take two blood samples, each of which indicate low total OR free testosterone levels, on two separate days, before 10:00 AM. What constitutes low testosterone may vary between insurance companies.
One of the services we provide is testosterone testing. We help establish the criteria that your health insurance requires through several simple blood tests, the first of which costs only $25.
Once we get the results back from both blood tests, we can pass the information on to your insurance company.
You may also have a low testosterone diagnosis from your primary care physician or a specialist—we can work with that too, but we always make sure to do our own blood tests and confirm the work of others.
Does Health Insurance Cover Testosterone Therapy for Women?
Again, it all depends on your health insurance company, but insurance usually only covers testosterone for women who have specific medical diagnoses.
Why does health insurance sometimes cover testosterone therapy for men but not for women?
The answer lies with the FDA.
Unfortunately, the FDA does not currently consider low testosterone to be a diagnosable condition for women in and of itself.
However, health insurance often covers the cost of testosterone replacement therapy for you if you’ve been previously treated for certain types of breast or mammary cancer, and there may be other instances where your specific insurance plan will cover the cost.
So, does health insurance cover testosterone therapy for women? Usually, it depends on your plan.
We will check with your health insurance provider to find out exactly what is and is not covered.
Does Health Insurance Cover Testosterone Therapy? Generally, Yes. But What If it Doesn’t?
Usually, your health insurance does cover testosterone therapy if your medical care provider can show a need.
However, not everyone has health insurance.
And sometimes, even when you have health insurance, you may be stuck paying out of pocket for one reason or another. For instance, your hormone levels may not be technically low enough to demonstrate a need to your health insurance company, but you may still be experiencing symptoms.
Fortunately, the cost of testosterone replacement therapy is very reasonable, even when paying out of pocket.
Generally, $299 a month is enough to cover the cost of weekly testosterone injections, injections that you can get quickly and easily, without a long wait. We also offer flexible hours and multiple locations, giving you the ability to get therapy when and where it best suits you.
Most of our patients who pay out of pocket find that the benefits of feeling happy, healthy, and like themselves again far outweigh the costs—they see the value in therapy.
To find out if testosterone replacement therapy is right for you, schedule a free consultation with us today.