Medicare may cover hormone replacement therapy (HRT) for menopause when considered medically necessary.

That said, coverage depends on the specific Medicare part or plan, and Medicare may refuse coverage if it considers your treatment experimental.

Original Medicare includes Part A and Part B. Part B might cover doctor visits and treatments related to hormone therapy. That said, due to HRT’s continued experimental reputation for menopause treatment, Medicare might deny coverage in some cases.

Even if Part B does cover the above-mentioned services, it won’t cover the hormones themselves. That’s because prescription drugs are covered under Part D. In addition, these plans are administered privately, and the drugs they cover vary.

You also have the option to enroll in Medicare Advantage (Part C), which is an alternative to Original Medicare and has to offer the same benefits. Some plans may include more extensive benefits. Like Part D, these plans are managed privately.

If Medicare approves your HRT, any services you get under Part B would be subject to meeting the $257 deductible. Afterward, Medicare will pay 80% of your treatment costs. In addition, you have to pay a monthly premium of $185 to maintain coverage.

Regarding Part D, you’ll have to select a plan that covers hormones. In addition, even if your chosen plan does cover HRT drugs, how much you’ll pay out of pocket depends on what tier it places the drug within its formulary.

For Part D and Part C, your premium, deductible, and copay will depend on your specific plan. You also have the option to select a Part C plan with drug coverage, in which case you don’t need to enroll in Part D.

You can verify your specific costs and what each plan covers for both Part C and Part on Medicare.gov by entering your ZIP code.

Is 65 too old for hormone replacement therapy?

A 2024 study shows health effects depend on the type, method, and dosage of HRT, aligning with the North American Menopause Society’s 2022 statement that there’s no universal guideline for stopping hormone therapy in women 65 and older.

How much does menopausal hormone therapy cost?

According to Optum Perks, one box of generic estradiol costs between $31 and $57. In addition, 30 tablets of Premarin (conjugated estrogens) cost between $228 and $246.