Medicare TRT Coverage in 2025: Costs and Plan Comparisons Explained

Coverage for Testosterone Replacement Therapy (TRT) under Medicare—including Original Medicare, Medicare Advantage (Part C), and prescription drug plans (Part D)—is limited but available under specific medical conditions.

Medicare may provide coverage for TRT when it is deemed medically necessary to treat conditions such as:

• Symptomatic hypogonadism caused by disorders affecting the testicles, pituitary gland, or brain
• Delayed puberty in individuals assigned male at birth
• Gender dysphoria requiring hormone therapy

However, TRT is not covered for cases including:

• Late-onset hypogonadism related to natural aging
• Idiopathic hypogonadism without identifiable cause or related disorders

Additionally, individuals with recent serious cardiovascular events like thrombophilia, heart attack, cardiac revascularization, or stroke within the last six months may be excluded from coverage.

Original Medicare (Part B) Coverage and Costs

Part B covers outpatient medical services such as diagnosis and treatment. If TRT is prescribed as an injection, it often requires administration in a healthcare provider's office.

In 2025, the standard Part B premium is $185 monthly, though this may increase based on income. After a deductible of $257, beneficiaries typically pay 20% coinsurance for approved services.

Medicare Advantage (Part C) Plans

Medicare Advantage plans must cover all benefits included in Original Medicare, including in-office TRT administration. Many Part C plans also bundle prescription drug coverage, which may cover self-administered TRT options.

Costs such as premiums, deductibles, copayments, and coinsurance vary by plan. Staying within the plan’s network usually reduces out-of-pocket expenses.

Prescription Drug Coverage (Part D)

Part D plans cover self-administered TRT forms like at-home injections, topical gels, and oral testosterone medications. These drugs are available in generic and brand-name versions.

Each Part D plan has its own formulary and tier system influencing coverage and cost. Medications on higher tiers generally require higher copayments.

Summary

Medicare can cover TRT for medically necessary conditions such as symptomatic hypogonadism, delayed puberty, and gender dysphoria. Coverage details and costs depend on the specific Medicare plan.

For personalized information about TRT eligibility and coverage, contact Medicare directly at 1-800-633-4227 (TTY: 1-877-486-2048).

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