TRT has comparatively little coverage under Original Medicare, Medicare Advantage, and prescription medication (Part D).

If TRT is deemed medically essential, Medicare may pay for it. This may involve ailments like:

• symptoms of hypogonadism brought on by a pituitary, brain, or testicular condition
• delayed puberty in people assigned male at birth
• gender dysphoria

In the following situations, TRT is not deemed medically required by Medicare and is not covered:

• age-related hypogonadism is known as late-onset hypogonadism.
• idiopathic hypogonadism is characterized by an unclear origin or by a condition that is not brought on by a pituitary, brain, or testicular issue.

You may also not be covered if you have certain conditions. For instance, if you have experienced thrombophilia, myocardial infarction (heart attack), cardiac revascularization, or stroke within the last six months, Medicare might not pay for TRT.

Part B coverage and costs

Medical insurance is covered under Part B. It involves medical condition diagnosis, treatment, and prevention in outpatient settings.

If your doctor recommends injected TRT, they could ask you to visit their office so they can give you the treatment.

The majority of consumers will pay a $185 monthly premium in 2025. Your income may determine how much your premium is.

You will typically pay 20% of all Medicare-approved expenditures for covered procedures after paying a $257 deductible.

Part C coverage and costs

The in-office administration of TRT is one of the fundamental treatments that Medicare Advantage, sometimes referred to as Part C, insurers are required to provide.

Prescription drug (Part D) coverage is a feature of many Part C plans. In certain situations, self-administered TRT might also be covered under Part C.

Costs and coverage quantities are specific to each Part C plan. Your selected plan will determine your premiums, deductibles, copayments, and coinsurance amounts.

It is typically less expensive to stay in the network than to go out of the network, which entails receiving care from a list of authorized medical providers and institutions.

Part D coverage and costs

Self-administered TRT, such as oral drugs, topical TRT, and at-home injections, is covered in Part D. There are brand-name and generic versions of testosterone.

Costs and coverage quantities are specific to each Part D plan. Each plan’s formulary and tier structure determine how much coverage it offers. Generally speaking, the cost of the prescription increases with tier.

The bottom line

TRT may be covered by Medicare for the treatment of gender dysphoria, delayed puberty, and symptomatic hypogonadism.

For inquiries concerning your TRT eligibility, contact Medicare at 1-800-633-4227 (TTY: 1-877-486-2048).

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