Health insurance testosterone

Health insurance testosterone refers to coverage for testosterone therapy or medications under a health insurance policy. Most major US insurers, including UnitedHealthcare and Aetna, cover testosterone therapy if medically necessary with documented low testosterone levels (below 300 ng/dL).

Insurers require lab results and physician diagnoses before approving coverage for testosterone prescriptions such as AndroGel or Depo-Testosterone. Plans often exclude coverage for testosterone used solely for bodybuilding or athletic enhancement.

Prior authorization is mandatory in most states, with Blue Cross Blue Shield reporting over 80% of claims requiring medical review. Out-of-pocket costs vary; generic injectable testosterone may cost $30–$100 per month without insurance, while branded gels can exceed $500 monthly.

Coverage differs by plan type–employer-sponsored plans typically offer broader benefits than individual marketplace policies according to Kaiser Family Foundation data from 2023. Transgender men seeking hormone therapy face variable insurer requirements, with some Medicaid programs covering treatment and others excluding it entirely as reported by the Movement Advancement Project in 2024.

Appeals are possible if initial claims are denied; success rates reach up to 39% after formal appeal based on National Association of Insurance Commissioners statistics, as mentioned by YourInsurance.info (Your Insurance Info).