Does Health Insurance Cover TRT?

TRT is not only a daunting endeavor but can be pretty costly depending on where you are. Does health insurance cover TRT - and if so, how much?

If you are experiencing decreased libido or sex drive or any other symptoms of low testosterone, if you have low free testosterone, you might be considering considering testosterone replacement therapy (TRT).

You may be concerned about how much you may need to pay for it. Does your health insurance provider cover it? Here’s what you need to know.

Many insurance companies will need to see a medical evidence that you need testosterone treatment before paying for it, so, the question remains, Does Health Insurance Cover TRT?

In this article, we will provide you with all the information you need. So, stay with us.

Key Takeaways

  • Testosterone is FDA-approved replacement therapy for men with low testosterone levels.
  • Health insurance company may be able to cover your testosterone therapy if your doctor can show a legitimate need for such treatment.
  • The costs of testosterone therapy vary based on the type of formulation.
  • The costs of testosterone therapy do not include only the prescribed formulation, but more include the office visits and the blood tests as well.
  • Always remeber that you need to consult with your doctor before starting, changing or stopping your treatment.

What Are the Normal Levels of Testosterone?

In young, healthy men (20 – 30 years old), the normal levels of serum testosterone are maintained within the range of 300–800 ng/dL. [1]

Testosterone Replacement Therapy

Does Health Insurance Cover TRT?

Testosterone is FDA-approved as replacement therapy only for men who have low testosterone levels due to disorders of the testicles, pituitary gland, or brain that cause called hypogonadism. [2]

With the worldwide increase in men’s life expectancy and the development of proper testosterone preparations, the interest in prescribing TRT has dramatically increased.

In the United States, the trend for prescribing TRT for men over 60 years of age has increased, from 1.32% in 2001 to 3.75% in 2011. [1]

The American Urological Association recommended the use of TRT in patients with total testosterone < 300 ng/dl. [3]

Several testosterone preparations and modes of application are available such as:

  • Oral testosterone
  • Testosterone Injections
    • Long acting IM injections such as T enanthate, T cypionate.
    • Extra long acting IM injections such as T undecanoate.
  • Transdermal
    • Transdermal testosterone preparations such as patches, gels, or solution.
  • Subdermal implants or pellets

How Does Health Insurance Cover Testosterone Therapy?

Most health insurance companies may cover the majority of the cost of testosterone therapy for men, as long as you can demonstrate a legitimate medical need.

The amount that your insurance would offer to cover, varies from provider to another, and it also varies based on your specific health plan and other variables, like your deductible.

So Now! How Should You Start?

Know Your Insurance Benefits

When you are diagnosed with low testosterone levels and you think that being on testosterone therapy would help you, you have to be aware of what is waiting for you down the road.

Testosterone replacement therapy is not only the formula that you will be on during the course of treatment. But, it includes regular and periodic blood tests, regular office visits and of course the costs for the formulation.

Therefore, you need to know your Insurance Coverage Benefits

Some insurance providers offer policies with high deductable but they include all the previously mentioned aspects of the therapy. On the other hand, some insurance companies offer policies with low deductable but the do not cover certain aspects of the therapy such as the office visits or the blood tests.

So, the bottom line here is to be aware of your benefits and the amount of money that you may need to pay out of your pocket.

Blood Tests

Recently, you have one or more symptoms of low testosterone such as anemia, depression, mood swings, fatigue, decreased lipido and sexual drive, reduced muscle mass and strength, reduced bone mass and osteoporosis, insomnia, forgetfulness, difficulty in concentration, and loss of memory.

Once you feel any of these symptoms, you need to do testosterone testing and check your testosterone levels.

According to Harvard Health, most insurance companies will cover your testosterone replacement therapy treatments when you have a documented and valid lab result of a low testosterone level of 350ng/dL with two separate blood tests done usually in the morning. [4]

Established Diagnosis by a Licensed Physician

You had your blood tests results back and you found out that your testosterone levels are low.

Now, you have to schedule an apointment with a your doctor.

Your doctor will obtain a full medical history and do a full physical examination.

Have a Prescription

Low testosterone can lead to serious complications and clinical conditions. Therefore, your doctor can easily justify your need for testosterone replacement therapy.

Also, there are a couple of clinical conditions and syndromes that may be covered by your insurance that make it easier for you to get your testosterone replacement therapy covered by your insurance such as:

  • Pituitary gland tumor.
  • Klinefelter’s Syndrome.
  • Kallman’s Syndrome.
  • Prostatectomy.

Costs of Different TRT Formulations

When you are looking for health insurance coverage of your testosterone replacement therapy, it is very important to know that the costs of testosterone replacement therapy vary according to the formulation that your doctor is recommending for you.

So, it is very important to know the costs of different formulations.

In general, Injections are the most affordable TRT option. Without insurance coverage, the cost of a single 200 mg/mL testosterone vial can range between $40 and $100 a month. [5]

Testosterone enanthate is the cheapest among all injectable testosterone while testosterone undecanoate is relatively more expensive compared to other injectable testosterone formulations.

The cost of testosterone pellet insertion varies. Typically, patients will generally pay $650-750 for a single pellet inserion procedure, depending on the dose and the number of pellets required.

Transdermal testosterone formulations such as gels and patches can cost as little as $30 to $500 a month.

What Should I Do If My Health Insurance Company Won’t Cover My TRT Costs?

Usually, your health insurance will cover your testosterone therapy if your doctor can show a legitimate need for such treatment.

However, you may be one of those who have no health insurance or your health insurance company won’t fully covered the costs of your testosterone replacement therapy and in such situation you need to pay out of pocket.

Now, you need to talk with your doctor who can provide you with different treatment plans that may fit your budget.

Also, If your insurance is not able to cover prescriptions or lab work, the best suggestion is to get in touch with a local testosterone replacement therapy clinic to see how they can help you.

These clinics work with patients like you every day and may be able to offer you payment plans, discounts, or other financing options.

Where do you even get a Prescription

The easiest way is to go through an online HRT Clinic or online TRT clinic like Marek Health or Evolve Telemed.

Yabluchanskiy, A., & Tsitouras, P. D. (2019). Is Testosterone Replacement Therapy in Older Men Effective and Safe?. Drugs & aging, 36(11), 981–989. https://doi.org/10.1007/s40266-019-00716-2

FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use.

Park HJ, Ahn ST, Moon DG. Evolution of Guidelines for Testosterone Replacement Therapy. J Clin Med. 2019 Mar 25;8(3):410. doi: 10.3390/jcm8030410. PMID: 30934591; PMCID: PMC6462962.

A new look at testosterone therapy https://www.health.harvard.edu/mens-health/a-new-look-at-testosterone-therapy

Kovac, J. R., Rajanahally, S., Smith, R. P., Coward, R. M., Lamb, D. J., & Lipshultz, L. I. (2014). Patient satisfaction with testosterone replacement therapies: the reasons behind the choices. The journal of sexual medicine, 11(2), 553–562. https://doi.org/10.1111/jsm.12369

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