Why is hormone therapy not covered by insurance?

Because this is a cash procedure, health insurance usually doesn't cover hormone pills and the patient would have to bear the full cost on their own. A common concern among people seeking hormone replacement therapy is how they are going to pay for it. This often raises the question of whether insurance covers hormone replacement therapy (HRT). In short, the answer is: “it depends.

Factors such as the type of therapy and the type of insurance plan can affect the coverage of the treatment you seek. The only way to find out is to contact your insurance company directly. If you choose a treatment with bioidentical hormone pills, be sure to choose a brand created by a pharmaceutical company and approved by the FDA. Otherwise, insurance may not cover your hormone therapy with granules.

Original Medicare (Part A and Part B) only covers limited prescription drugs. Medicare Part A may cover prescription drugs you receive as an inpatient during a stay in the hospital or other hospital facility. Medicare Part B may cover certain prescription drugs you receive as an outpatient, such as infusions and injections. Because you take most hormone therapy medications at home, Medicare Part A and Part B generally don't cover menopausal hormone therapy.

Barriers to insurance coverage combine with other structural barriers to care to limit access to gender-affirming hormones. However, the positive results could be explained by historical and current racism and prejudice, and by the decline in trust in the health system, which, together with reduced access to health professionals, aggravate other barriers to care and encourage the obtaining of alternative sources of gender-affirming hormones. It's also important to have regular checkups with your doctor, especially when you're undergoing granular hormone therapy. The content and quality of hormones accessed from an unauthorized source may not be controlled, and they may differ from those recommended in terms of formulation and dosage.

According to the Food and Drug Administration (FDA), hormone therapy can come in the form of a pill, patch, gel, vaginal cream, vaginal insert, skin spray, skin cream, or injection. Women, on the other hand, experience a decrease in female hormones, such as estrogen and progesterone, when they are between 40 and 50 years old. We conducted a study to evaluate associations between barriers to insurance coverage for gender-affirming hormones (whether lack of insurance or denial of claims) and patterns of hormone use among transgender adults. If your insurance company only covers certain types of hormone replacement therapy, we recommend that you get the list of covered items and carry it with you to your first consultation.

Your doctor will consider your medical history, risk factors and preferences to determine if hormone therapy is right for you. According to the FDA, hormone therapy carries some risks, such as the possibility of blood clots, heart attacks, strokes, and breast cancer. Table 3 shows the associations between the denial of insurance claims and the use of over-the-counter hormones and the general use of hormones. Bioidentical hormones are plant-based hormones that closely resemble those that occur naturally in the body.

Table 1 shows a summary of the demographic statistics of the respondents, as well as hormone use and insurance coverage.