Does insurance cover TRT? The answer is it depends. You have to convince the insurance company that you need TRT. So, stick till the end to find out all about the topic! We’ll answer the question in detail here.
If you’re on the wrong side of 40, there’s a good chance your testosterone level has dipped below where they were during the 20s. Though it’s natural to happen, it can cause some issues.
A TRT can be an easy solution if you find out that your testosterone levels are low.
However, one of the concerns for the ones that are keen on TRT is how much the therapy costs. Now, if you have health insurance, do you really need to worry about the cost?
Table of Contents
What Is TRT?
As the name suggests, Testosterone Replacement Therapy (TRT) mainly focuses on testosterone levels. And testosterone is basically a hormone that is produced primarily in the testicles. However, unlike some of the other hormones, testosterone plays a massive role in maintaining the body condition of men.
It helps maintain fat distribution, muscle mass and strength, bone density, body and facial hair, RBC (Red Blood Cell) production, sperm production, and sex drive. But the thing is, the production of testosterone only peaks during early adulthood and adolescence. And as the body ages, the production level gradually declines.
Typically, the levels will be around 1 percent after 30 and 40. However, the decline of testosterone is not because of aging. It can happen due to a disease as well. And many older adults may confuse the deterioration with aging, whereas they might have symptomatic hypogonadism. Well, that is where TRT steps in.
Benefits and Drawbacks of TRT
There are loads of well-documented benefits of TRT. That includes increased energy levels, increased libido, beneficial effects on strength, muscle, bone density, and cardioprotective effects. Some studies have also suggested that TRT can lower heart risk. You can also read this study about managing the risks of TRT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9243576/
There are also several natural Testosterone boosters like Weider Prime that can help without the prescription.
However, along with the benefits, there are many documented side effects. Those side effects include mild fluid retention, acne or oily skin, decreased stream or frequency of urine, breast enlargement, risk of developing prostate abnormalities, and others.
Who Qualifies for TRT and Insurance Coverage?
Basically, doctors will prescribe Testosterone Replacement Therapy to males with hypogonadism. And to get a definitive diagnosis, the blood tests need to show that the male has low testosterone levels. Now, what level of testosterone is actually low?
According to American Urological Associate, a low testosterone level indicates that the testosterone level is below 300 ng/dl (nanograms per deciliter). So, how do you know that your testosterone levels are low? Well, these are some common symptoms:
- Low sex drive
- A decline in the sense of well-being
- Erectile dysfunction
- Depressed mood
- Difficulties with memory and concentration
- Loss of muscular strength
- Irritability and moodiness
Now, doctors state that it is undoubtedly possible to have a low testosterone level and not experience any symptoms. In such cases, a blood test is the only way to be sure that your testosterone level is below average.
How Much Does It Cost to Take TRT without Insurance?
Depending on the TRT type, frequency of administration, and mode, it will cost anywhere from $150 to $1500 a month. Now, when it comes to the types of TRT, there are mainly six. And getting an idea of the cost related to each, you can know how much is TRT without insurance.
Various solutions and gels are available, with different application methods for TRT. Depending on your pick, you will need to rub the testosterone solution on your skin. Usually, the gel or solution will advise you to rub it on the upper shoulder or arm or to the front and inner side of the thigh.
In this case, the body will absorb testosterone through the skin. Therefore, you will not be capable of taking a shower or bath for a couple of hours after the application. Nonetheless, the typical cost is around $112 for 75 grams of gel.
Testosterone enanthate and cypionate will be given under the skin or in a particular muscle. The dosage and the frequency of the injections will depend on the symptoms that you have. And although taking injections might sound a little worrying, a family member or you can give the injection right home.
Now, when it comes to the cost, injections can make you spend anywhere from $30 to $300.
The patch method is the most convenient way of receiving TRT. This patch will contain testosterone (Androderm), and you will need to apply it on your torso or thigh every night. That said, testosterone patches cost around $658 for a supply of 60 patches.
The gum-and-cheek method will deliver testosterone through the natural depression of your teeth. This method will rely on a putty-like substance, which you will need to place on the top position of the teeth. It will let the bloodstream absorb the testosterone, allowing the levels to get to a moderate amount.
Nevertheless, the gum-and-cheek putties will cost anywhere from $200 to $500 for a month’s supply.
You will need to pump a Natesto (testosterone gel) into your nostrils for the nasal method. This method will lower the risk of the medication transferring from one person to another through the skin. However, nasal delivery can be inconvenient compared to the other delivery method as you need to pump twice or thrice a day.
That being said, for the supply of 11 grams of Natesto, you will need to spend around $467.
As the name suggests, this method involves surgical methods through which testosterone-containing pellets will be implanted under your skin. You must carry out the surgical process every three to six months. And the cost for a supply of 10 pellets is about $1149.
Is Testosterone Testing Covered by Insurance?
Is testosterone free with insurance? The thing is, most health insurance providers will cover the majority of the cost for TRT. However, you need to show that you require TRT. Without that, the insurance providers will not pay a penny. So, basically, TRT is not free.
You can also reach out to our tested and reviewed online TRT clinics to see if they may accept your insurance.
Now, regarding how much testosterone test costs with insurance, it will depend on the insurers. For example, some will cover the expenses of the lab and the ongoing prescription cost. The exact amount will depend on several factors, including the specifics of deductibles, treatments, and health plans.
So, what about online TRT? Is online TRT covered by insurance? Well, it is 100 percent legal to purchase testosterone online.
You will still need a prescription and the same things that are applicable for regular purchases will apply online.
Read more on our current favorite online TRT clinic Marek Health if you would like to go the telehealth route.
Frequently Asked Questions
Blue Cross Blue Shield will only cover Testosterone testing when it is medically necessary. In such cases, the medical guidelines and criteria need to be met.
The needle will smoothly glide into your muscle. And during that, your muscle might twitch a little, but it will not be painful.
In the typical pharmacy benefit of Cigna, injectable testosterone is not covered. In other words, Cigna does not cover testosterone injections.
Yes, if the TRT is prescribed by your doctor, United Healthcare Insurance will cover your medications.
Yes, Aetna will also provide insurance payments for testosterone. Aetna will also require a valid doctor’s prescription for TRT medications.
So, does insurance cover TRT? Testosterone replacement therapy is generally 100 percent out-of-pocket expense. However, some insurers can cover most of the fees, while others will cover some costs. It will basically boil down to which insurance provider you are relying on.
Have you had your TRT (testosterone replacement therapy) covered by your insurance provider?
Let us know in the comments below!