Menopause and Health Insurance: What’s Covered and What’s Not

Menopause and Health Insurance: What’s Covered and What’s Not

Menopause is a natural stage of life that technically doesn’t require medical treatment. However, as our bodies change throughout this transition, many of us may benefit from certain medications, treatments, and supplemental products that can help us enjoy life to the fullest and keep us feeling our best.

Many medications that support menopause symptom management are covered by traditional health insurance plans, but others are not. Those not covered often include sex (and sexual dysfunction) related remedies, such as those used to alleviate common menopausal symptoms like vaginal dryness or decreased sexual satisfaction. 

If you have health insurance, it may come as a surprise when your insurer denies payment for a recommended menopause medication, product, supplement, or medical treatment that your healthcare provider feels you need. In other instances, prescriptions may be covered, but you may have an expensive copay that won’t be sustainable to pay out-of-pocket on a monthly basis.

When it comes to insurance and menopause treatment, understanding your options, along with what’s covered and what’s not, can save you money and help inform your choices. Here’s what you need to know about insurance coverage and what it means for your menopause symptom management.

Does Health Insurance Cover Hormone Replacement Therapy?

Hormone replacement therapy (HRT) refers to a group of prescription medications used to alleviate certain menopausal symptoms through the use of hormone regulation. These treatments can help manage hot flashes and night sweats, vaginal dryness, and painful vaginal sex. HRT can be administered in multiple ways, including pills, suppositories, patches, or creams. If your healthcare provider prescribes HRT for you, you may find that it is covered by your insurance plan, but it’s important to always check with your insurance provider first and confirm with your physician that this is the best treatment option for you.

Does Medicare Cover Menopause Treatments?

If you’re new to the world of Medicare, you may be spending a lot of time scratching your head in confusion. Medicare’s dos and don’ts can be complicated, especially when it comes to prescription coverage for menopause symptom management.

Original Medicare is comprised of two parts (Part A and Part B), which cover inpatient services, such as hospital stays, and outpatient services, such as in-office appointments or same day procedures. Except in specific circumstances, they don’t cover prescription medications.1,2

The part of Medicare that does cover prescriptions, is Part D. To many people’s surprise, signing up for Part D is voluntary rather than automatic. Part D plans are overseen by Medicare but sold by private insurance companies.3 Even if you do you sign up for a Medicare Part D prescription plan, your plan may or may not cover HRT.4 This is because Original Medicare and Part D typically only cover treatments that are classified as “medically necessary” or as “preventive”.  HRT and other menopause treatments designed to alleviate specific symptoms may be life-enhancing, but they may not be classified as “medically necessary” or “preventive” by all insurance plans.5,6

As an alternative to Original Medicare, you can also decide to choose a Medicare Advantage plan. Medicare Advantage is also known as Part C of Medicare coverage. Part C plans cover everything Original Medicare does. They also often fold in Part D and cover a selection of prescription drugs.7

Some Medicare Part C and Part D plans cover menopause treatments such as HRT, and other medications or supplements that Original Medicare won’t. Regardless, it’s important that you check with your insurance plan provider first to determine what they will and won’t pay for. When you do, it may also be a good idea to ask if a generic, covered version is available, to help you save on costs.

Does Insurance Cover Medications That Can Make My Sex Life Better During Menopause?

Menopause is earmarked by a reduction in estrogen. Less estrogen can lead to vaginal atrophy – or the thinning, drying, and inflammation of the vaginal walls. This can make sexual activity painful, and can also cause urinary symptoms, such as leakage. Dealing with consistent discomfort such as this can often also negatively affect your desire to have sex.

For women in menopause, symptoms such as vaginal atrophy and sexual dissatisfaction can make maintaining a normal sex life, challenging. Several FDA-approved, hormone-based prescriptions are available to address these symptoms, in addition to a few clinically studied, over-the-counter options. However, insurance coverage for these is spotty.

If you and your healthcare provider feel strongly that one or more of these prescription medications or over-the-counter supplements is the right treatment for you and you’re concerned about how to pay for it, you may be able to benefit from using a Health Savings Account or Flexible Spending Account.  

What Are FSA or HSA Accounts?

Flexible Spending Accounts (FSAs) are plans sometimes offered under your employer’s insurance plans that enable you set aside pre-tax dollars from your paycheck to use for health-related expenses that traditional insurance may not cover. FSA dollars typically must be used within a specific calendar year, most often by December 31st (although this could extend to 3/31 the following year, in some cases), or you lose them.8

Health Savings Accounts (HSAs) are similar to FSAs in that they are available through your employer’s insurance plans and allow you to contribute pre-tax dollars. However, with HSAs, you can roll over any contributed money you don’t use into the next calendar year. HSAs are typically available if you have a High Deductible Health Plan (HDHP) through your employer.9

Both FSA and HSA dollars can be used to pay for certain prescriptions and over-the-counter treatments, including those for menopause-related symptoms that traditional health insurance may not cover.

Can HSA or FSA Accounts Cover Bonafide Products?

Select FSA and HSA accounts can be used to pay for some prescription and over-the-counter treatments that may be beneficial for reducing menopausal symptoms, such as hot flashes and vaginal dryness.

For example, Bonafide’s line of hormone-free menopause solutions may be covered under certain FSA or HSA accounts. If you’re interested in finding out if your Bonafide purchase is covered, we’d recommend reaching out to your insurance provider as well as consulting with our FAQs.

If you’ve already confirmed that your HSA or FSA does cover Bonafide products, you can find links to some of our most commonly asked questions about FSA or HSA usage below.

To view all our HSA/FSA resources, check out our help center.

Resources

  1. https://www.medicare.gov/what-medicare-covers/what-part-a-covers
  2. https://www.medicare.gov/what-medicare-covers/what-part-b-covers
  3. https://www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans-cover
  4. https://www.medicarefaq.com/faqs/does-medicare-cover-hormone-therapy-for-menopause/
  5. https://www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans-cover
  6. https://www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans-cover
  7. https://www.anthem.com/medicare/medicare-information/what-is-medicare-part-c/
  8. https://www.healthcare.gov/glossary/flexible-spending-account-fsa/
  9. https://www.healthcare.gov/glossary/health-savings-account-hsa/
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1 comment

I’m on Medicare bart D

Pongsi Thimom

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