TRT/HRT & Medicare / Medicare supplement

[DFW Guy]

i would assume that Medicare does not pay for TRT/HRT. segregating the elements - provider, labs and pharma - will it pay for any of the separate elements? will any of the Medicare supplemental coverage plans pay for any of the elements?

 

[Cameron58]

It pays for all my doctor and labs. My Part D drug plan pays for the testosterone. The only thing not covered is syringes.

 

[tropicaldaze1950]

Yes. Been on Medicare w/an Advantage plan since 2013. Other than syringes, everything has been covered.

 

[DragonBits]

i would assume that Medicare does not pay for TRT/HRT. segregating the elements - provider, labs and pharma - will it pay for any of the separate elements? will any of the Medicare supplemental coverage plans pay for any of the elements?

The situation for medicare covering things like TRT revolves around just how low your total T was. And of course following all the rules about prescribing that medicare has.

I am sure they will pay for medically necessary treatment, but I am guessing for the majority of us our total T isn't low enough.

IE: Without TRT, my total T is around 350 ng/dl, not low enough to qualify, but it does make a big significant difference to my quality of life.

Aside, medical cannabis is popular, when medicare starts to cover that no doubt it will a new millennia

 

[tropicaldaze1950]

In 2013, when I was prescribed testosterone, my TT was 360 ng/dl. My Aetna Medicare Advantage plan covered it. Maybe things have changed but when I moved to Florida and changed to AARP/United Healthcare PPO, and went back to Maryland to see my urologist, no problems with tests or rx. Regarding medical weed, when the federal government legalizes medical mj, perhaps Medicare will cover it. Hell, they won't cover erectile meds and a portion of the men using them are on Medicare. Medicare should have the power to negotiate drug prices. I was told by a doctor in Maryland that BC/BS/DC pays out more in prescription meds than primary coverage. Big Pharma and generic manufacturers are getting rich.

 

[DragonBits]

In 2013, when I was prescribed testosterone, my TT was 360 ng/dl. My Aetna Medicare Advantage plan covered it. Maybe things have changed but when I moved to Florida and changed to AARP/United Healthcare PPO, and went back to Maryland to see my urologist, no problems with tests or rx. Regarding medical weed, when the federal government legalizes medical mj, perhaps Medicare will cover it. Hell, they won't cover erectile meds and a portion of the men using them are on Medicare. Medicare should have the power to negotiate drug prices. I was told by a doctor in Maryland that BC/BS/DC pays out more in prescription meds than primary coverage. Big Pharma and generic manufacturers are getting rich.

That's interesting, I think you got lucky, and it does seem to be a state by state sort of thing.

FOr the most part, it's not doctors that are a problem, it's really all caused by insurance companies and lawyers.

And often insurance companies and all big businesses use their power to influence the governments to pass regulations to increase safety, but the real reason is to make it too expensive for anyone but a big business to compete. The safety concerns are a false flag that sounds good.

A number of doctors actually personally approve of my using testosterone, but they don't want to prescribe it because the medical groups that they are a part of tell them not to unless my levels are below 279 ng/dl.

But if a doctor prescribes it as medically necessary, I think it's likely medicare will pay for it.

I think we should go to a national health care system, allow private insurance if you want it, medicare should be able to negotiate prices. But without a national health care system, that won't help everyone else that is not on medicare.

So much of the US system is so screwed up by big business I am not sure we will ever get a rational system. It's not just health care, it's any small business is getting screwed over by big business.

 

[DragonBits]

In 2013, when I was prescribed testosterone, my TT was 360 ng/dl. My Aetna Medicare Advantage plan covered it. Maybe things have changed but when I moved to Florida and changed to AARP/United Healthcare PPO, and went back to Maryland to see my urologist, no problems with tests or rx. Regarding medical weed, when the federal government legalizes medical mj, perhaps Medicare will cover it. Hell, they won't cover erectile meds and a portion of the men using them are on Medicare. Medicare should have the power to negotiate drug prices. I was told by a doctor in Maryland that BC/BS/DC pays out more in prescription meds than primary coverage. Big Pharma and generic manufacturers are getting rich.

What sort of prices are you paying for those two advantage plans? I am curious since they keep advertising zero pay advantage plans.

But one of the big reasons I didn't want to get any sort of plan outside of regular medicare is because I like being able to go any doctor that accepts medicare, I don't need a referral to go to any specialist, though sometimes the specialist will want for a doctor to refer me to eliminate patients that don't know what they are doing. The other reason I am generally pretty healthy and don't really need to see a doctor on a regular basis.

 

[tropicaldaze1950]

In Florida, a number of the plans on the official Medicare site don't charge premiums. The reason why, as I understand it, is that the Florida market is so competitive and the insurance plans are getting thousands a month from Medicare to provide care for each new patient, so they're raking in the $$$ and we get to choose from many plans.

Previously, when living in Maryland and Aetna pulled out of the market, I bought an AARP supplement plan(one of the lower priced ones) and it served me well, but I did have problems finding a psychiatrist. I have bipolar and several related issues. My cousin near Fort Lauderdale told me that he paid nothing for his Medicare plan. When my wife and I moved to Florida in 2017, I searched the Medicare site and found an AARP/United Healthcare PPO plan that had statewide and national coverage, plus I could go out of network if need be. She's retired federal and gets her BC/BS PPO through the government system for current and retired federal employees.

I agree on a national healthcare system. A couple of my doctors tell me what a mess it is dealing with the different insurance companies. Right now, I'm in the process of setting up a virtual consult with an internationally known psychiatrist and researcher who is in Colorado. He doesn't take Medicare and I'm paying cash. I don't have much but he's my last hope. I don't respond to any medications. Been sick for 15 years. My life just fell apart. Poor sleep, can't handle stress, can't hold a job and my johnson, even with testosterone, rarely works. Just telling my story. We've all got stuff we're dealing with.

 

[DFW Guy]

the business of healthcare is indeed a mess. i occasionally read that only a single payer system will clean it up.

i am in Texas and blessed to be healthy. however, i do not take this for granted. i am not retired and own/operate several small businesses and plan to do so into my early 70s minimum. i will be 65 later this year and i am assessing enrollment options. my initial assessment is that i can obtain equal or better coverage, on a dollar-for-dollar basis, under MediCare with supplements than i can today under a private plan and even adding back any employer subsidy. i am still researching this but pleasantly surprised.

 

[AdelPetersen]

While I'm not an expert on Medicare, I did find some information on their website that may help answer your question. It looks like Medicare covers testosterone replacement therapy (TRT) if your doctor deems it medically necessary. However, coverage can vary depending on the specific plan and services needed. I'd recommend contacting Medicare or your supplemental coverage plan directly to get more information about your situation. Additionally, consider speaking with a financial advisor or insurance specialist who can help guide you through the options available to you. Hope this helps! And if you're interested, here's a link to a financial planning firm: http://www.thefinitygroup.com.

 

[Systemlord]

i would assume that Medicare does not pay for TRT/HRT.

Medicare is paying for my very expensive Jatenzo prescription. A medical exception goes a long way to getting stuff covered.

 

[tropicaldaze1950]

While I'm not an expert on Medicare, I did find some information on their website that may help answer your question. It looks like Medicare covers testosterone replacement therapy (TRT) if your doctor deems it medically necessary.

When I began TRT 9 years ago, I had a Medicare Advantage Plan. Still do. I was even covered when, for awhile, I had an AARP Medicare supplement plan.

 

[jobshopper]

It pays for all my doctor and labs. My Part D drug plan pays for the testosterone. The only thing not covered is syringes.

I have the Standard Part D. They pay for the doctor and the labs. The Test C is cheaper if I go through GoodRx as is generally the case with most of my prescribed drugs.