Does Medicare Cover TRT? Part B, Part D, and What You'll Pay in 2026–2027

Yes — Medicare can cover TRT when the applicable coverage rules are met. When asking “does Medicare cover TRT,” check the exact drug and who supplies it. Part B may cover qualifying clinician-supplied treatment; Part D may cover a pharmacy prescription. Your diagnosis, plan rules, and separate care bills still matter.

By TRT Provider Guide Editorial Team · Last verified: October 2026 · Editorial research; not clinically reviewed · How we verified this guide

Last updated: October 22, 2026.

The catch: three different rulebooks can decide your case, and one of them changes with your state. You need to know which one applies before you pay. This page helps you check.

Best for: U.S. Medicare members checking prescribed testosterone, a coverage change, or a denied claim. Not for: diagnosing low testosterone or applying this male-hypogonadism checklist to gender-affirming care or other populations.

Key numbers: Part D yearly cap on covered drugs: $2,100 in 2026, $2,400 in 2027. Part B deductible: $283 in 2026. Open Enrollment for 2027 plans ends December 7, 2026.

TRT Provider Guide is the independent decision resource for testosterone replacement therapy — helping U.S. adults understand how low testosterone is evaluated, compare online and local care models and providers, and choose the next step that fits their health needs, fertility plans, budget, state, and care preferences, with every material claim verified and dated.

Educational information, not medical advice. A clinician decides whether treatment is right for you. Your Medicare plan or contractor decides whether it pays. If you have chest pain, trouble breathing, signs of a stroke, or a painful, swollen leg, get emergency care.

What we actually verified — October 22, 2026
We read two Medicare contractor policies for testosterone (Noridian L36538 and Palmetto L39086), 2026 Medicare plan criteria built on them, a 2026 Part D plan's testosterone drug-list entries, Medicare.gov and CMS cost and appeal pages, FDA and HHS labeling notices, and federal telemedicine rules. From those, we built the coverage map, state table, cost tables, and coverage-check worksheet on this page. We did not file a claim, call a plan as a member, or get a personal price quote. Your own coverage decision and claim still need to be checked.

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Which part of Medicare pays for testosterone?

Medicare checks the drug and who supplies it, not just where you get the shot. If a pharmacy fills your testosterone, it is generally a Part D question. If your clinician buys the drug and gives it to you, it may be a Part B question, subject to medical-need and drug-benefit rules, including whether the drug is "usually self-administered."

That last line trips up a lot of people. Here's how it works in plain English.

Part D is your drug plan. It helps pay for covered prescriptions you pick up at a pharmacy. Each plan has its own formulary (its list of covered drugs) and its own rules.

Part B is your medical insurance. It can cover drugs your clinician supplies and gives you in the office, but only drugs that aren't "usually self-administered." Medicare's contractors decide that by looking at how most Medicare patients take a drug. If more than half give it to themselves, Part B generally won't pay for it — even when a nurse gives your dose.

So an office shot is not automatically a Part B drug. And if a pharmacy fills your testosterone and you bring it to the office for the shot, the drug is still generally billed to Part D. The office visit and administration may be billed separately.

Medicare Advantage (Part C) plans do both jobs under one card. They have a medical side and, in most plans, a drug side. Check each side separately.

Medigap (a supplement like Plan G) helps pay your share of Original Medicare bills. Medigap policies sold since 2006 don't include Part D prescription coverage. They may help with cost sharing for testosterone covered under Part B. Medicare explains the distinction here.

The Medicare TRT coverage map

We built this table so you can find your exact treatment in one place. Verified October 2026.

The Part B percentages above describe Original Medicare when the drug is covered. Medicare Advantage costs depend on the plan, and visits or procedures may have separate charges. Sources: CMS benefit rules, Part B/Part D and compound rules, drug plan rules, and Medicare laboratory coverage.

Two quick definitions you'll see again. Prior authorization means the plan must approve the drug before it pays. Step therapy means the plan wants you to try a preferred drug first.

One more rule matters here. Basic Part D coverage excludes drugs when used for sexual or erectile dysfunction. Testosterone may qualify for a medically accepted indication, such as hypogonadism, when the plan's coverage requirements are met. CMS explains these exclusions. That's why the diagnosis on your prescription matters. Never let anyone change it to "fit" a plan.

Not sure which row is you? Use the Medicare coverage-check worksheet to write down who supplies your drug, which benefit to ask, and the questions to ask before you pay. You can also explore TRT Provider Guide's Find My TRT Path tool. It's educational and doesn't confirm Medicare coverage.

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Does Medicare Part D cover testosterone?

Part D can cover testosterone, but you need to check your plan's list for the exact product and strength. Prior authorization, quantity limits, and requirements to try a preferred drug can apply. Brand products, nasal spray, and testosterone pills each need their own coverage check.

Here's one plan-published example. A 2026 CVS Caremark prior-authorization form for testosterone enanthate asks these questions for primary or hypogonadotropic hypogonadism:

• Starting treatment: Do you have at least two confirmed low morning total testosterone results?
• Already on treatment: Did you have a confirmed low morning result before you started?

That second question is a big deal if you're moving onto Medicare after paying cash somewhere. Your old pre-treatment labs can decide your approval. Get copies now.

Why the exact product matters — a real 2026 example

Plans don't just list "testosterone." They list exact products and strengths, and the rules can differ between them. In the 2026 drug list for HealthSpring Assurance Rx (PDP), updated October 1, 2026 (printed page 66):

Same active ingredient. Same tier. Different paperwork. That's why "Is testosterone covered?" isn't the right question to ask your plan. Ask about your exact prescription. (This example shows how drug lists work. It isn't a reason to switch products. That's your clinician's call.)

How to check your plan

1. Open Medicare Plan Finder or your plan's drug list.
2. Enter your exact drug, strength, and amount. Copy it from your prescription label.
3. Look for the tier and the letters next to it: PA (prior authorization), QL (quantity limit), ST (step therapy).
4. Choose 2027 when comparing next year's coverage; use 2026 for a current refill.
5. Call the plan to confirm, and write down who you talked to.

What if your testosterone isn't on the list?

You still have a move. Your prescriber can ask for an exception, which is a request for the plan to cover a drug that isn't on its list or to bend one of its rules. The plan generally decides within 72 hours of getting your prescriber's supporting statement, or 24 hours if waiting could seriously harm your health. An exception is a request, not a guarantee. CMS explains the exception process.

If you're already fighting a denial, our testosterone prior authorization guide walks through the full process.

The right TRT provider is not the same for every person — it depends on whether low testosterone has been properly evaluated, your symptoms and health history, your fertility plans, your state, your insurance or cash-pay preference, your treatment-format preference, your budget, and whether online or in-person care is the better starting point. Some situations belong with primary care, urology, endocrinology, reproductive urology, or urgent or emergency care when the symptoms warrant it. Because a general answer cannot resolve those questions for you, use the Medicare coverage-check worksheet to prepare for a call with your plan and clinician. You can also explore TRT Provider Guide's Find My TRT Path tool. The tool is educational: it doesn't diagnose, confirm Medicare coverage, or replace your clinician.

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Does Medicare Part B cover testosterone shots and pellets?

Part B can cover testosterone that your clinician supplies and gives you, like Aveed or Testopel pellets, when the medical-need and drug-benefit rules are met. Under Original Medicare, most covered Part B drugs cost up to 20% of the approved amount after the deductible, which is $283 in 2026. Part B won't pay for a drug your contractor lists as usually self-administered, even if it's given in the office.

When Part B may cover Aveed

Aveed is a long-acting testosterone shot that can only be given in a certified healthcare setting. Its FDA label carries a boxed warning for serious lung reactions called pulmonary oil microembolism and severe allergic reactions, so you must stay in the office for 30 minutes after each shot. When your clinician supplies it, Part B may cover it if the applicable coverage requirements are met. Some plans require preferred shots first. Univera Healthcare's policy, reviewed June 1, 2026, asks for at least three months of testosterone cypionate or enanthate with severe side effects or inadequate benefit before Aveed or pellets. For Medicare Advantage, this preferred-product requirement applies to patients new to therapy, not patients already established on a non-preferred product. Other applicable coverage criteria still apply. See our Aveed cost guide for prices.

Pellets have additional coverage limits

In seven Southeastern states (more on that next), the Medicare contractor's rule calls pellets a choice that "should be rare." The 2026 CVS Caremark criteria for these jurisdictions require that transdermal or oral treatment was ineffective and that those methods are not accepted or preferred for the patient. Palmetto's billing article limits coverage to no more than six pellets every three months. That is a local payment limit, not a dosing instruction. See our testosterone pellets cost guide.

A simple cost example

Say a covered Part B testosterone claim has a $100 Medicare-approved amount, and you still owe $60 of your yearly deductible. You'd pay the $60, plus 20% of the remaining $40. That's $68. If your deductible were already met, you'd pay $20. (This is math, not a price quote. Your real amount depends on the drug, the visit, and any supplement you have.)

Medigap tip: Standard Medigap Plan G generally picks up that 20% for covered Part B care after you meet the Part B deductible. High-deductible Plan G has a separate deductible. Neither provides Part D pharmacy coverage. Compare Medigap benefits.

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Does Medicare cover TRT in my state?

For testosterone your clinician supplies under Original Medicare, the rules depend on which Medicare contractor governs the claim. Palmetto GBA's policy for Alabama, Georgia, Tennessee, North Carolina, South Carolina, Virginia, and West Virginia excludes low testosterone due to aging. Noridian's policy for its listed Western and other jurisdictions can cover age-related symptomatic deficiency when its requirements are met.

You'll read that "Medicare won't cover TRT for age-related low T." That's true in some states. It isn't a national rule.

Medicare hires regional companies called Medicare Administrative Contractors to process claims. Some of them publish a Local Coverage Determination (LCD), which is a written rule for one type of treatment in their region. We compared two current testosterone LCDs.

Sources: Noridian L36538, Palmetto L39086, and the 2026 CVS Caremark Jurisdiction E and J/M criteria. Verified October 2026. This is a summary; each policy has additional documentation and coverage requirements.

A few plain definitions:

• LH and FSH are signals your brain sends to the testicles. They help show why testosterone is low — a testicle problem or a brain (pituitary) problem.
• PSA (prostate-specific antigen) is a blood test used to watch the prostate.
• Hematocrit is the share of your blood made of red blood cells. Testosterone can raise it, and too high can be risky.

If your care is outside these jurisdictions: Ask your clinician's billing office which Medicare coverage and drug-billing rules govern your claim. These two examples are not a complete list of every policy that could apply.

Important: These state rules apply to testosterone your clinician supplies under Original Medicare. If you fill your testosterone at a pharmacy, your Part D plan's rules decide — not these LCDs. Medicare Advantage plans must follow applicable Medicare coverage rules. They may use prior authorization and permitted step therapy, and may use public, evidence-based coverage criteria where Medicare's criteria are not fully established. Federal rules limit that authority.

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Does Medicare cover TRT if my low testosterone is from aging?

Sometimes. Palmetto's Part B rule for its seven listed states excludes it, Noridian's rule can cover it when its requirements are met, and Part D plans set their own criteria. In June 2026, HHS and the FDA asked drugmakers to remove label language saying testosterone's safety and effectiveness aren't established for age-related low testosterone — but that request doesn't automatically change any Medicare rule.

Here's the timeline, because it's moving.

• February 28, 2025: The FDA required label updates for all testosterone products. It added results from the large TRAVERSE heart-safety trial and removed language about heart risk from the boxed warning. It added blood-pressure warnings. It kept the line about age-related low testosterone.
• June 18, 2026: HHS and the FDA requested new label changes. These include removing the age-related limitation, narrowing the prostate cancer warning to men with cancer that has spread, and revising the warning about enlarged prostates. The announcement alone doesn't tell you whether the label for your exact product has changed. Read the HHS announcement.

What it means for you right now: Medicare contractors and drug plans update their rules on their own schedules. Some plan forms still quote the old label language. If you're turned down because your low T is "age-related," your clinician can document the full workup — LH or FSH, and checks for pituitary or other causes. That's the honest path. Don't let anyone change your diagnosis code to get around a rule.

A label change doesn't replace a diagnosis: The Endocrine Society guideline calls for symptoms or signs plus consistently low testosterone, confirmed with repeat morning fasting total-testosterone testing using accurate tests. A clinician may also assess free testosterone when indicated and evaluate the cause. Read the clinical guideline. Learn more in how low testosterone is diagnosed.

Tell your clinician if you want children

Testosterone from outside your body can suppress sperm production, sometimes to zero. If you might want to father a child, say so before treatment. The Endocrine Society guideline recommends against testosterone therapy for men planning fertility in the near term. Palmetto's Medicare rule excludes men who want to have children. A urologist who focuses on fertility (a reproductive urologist) is often the better first stop. See does TRT affect fertility.

Does this sound like you — symptoms, and not sure Medicare will see it as medical? Use the Medicare coverage-check worksheet and take those questions to your next appointment.

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Does Medicare cover testosterone blood tests?

Medicare can cover medically necessary clinical lab tests ordered by an eligible treating clinician. Under Original Medicare, you usually pay nothing for covered tests. Testosterone, LH, FSH, PSA, and blood-count tests each need to meet the relevant coverage and testing-frequency rules.

A few limits:

• The test has to be ordered for a medical reason by an eligible treating clinician who is enrolled in Medicare or has validly opted out. Don't assume a home kit or a test you buy on your own is covered; check the order, lab, and billing arrangement before paying. See the lab-ordering rule.
• The lab matters. Use one that accepts Medicare.
• Medicare Advantage plans may charge a lab copay and require in-network labs.
• A free test doesn't make the visit free. Office visits still have Part B cost-sharing.

Already on TRT from a cash clinic? Ask that clinic for every lab result, especially anything from before you started. Your drug plan may ask for them. Our testosterone blood test cost guide covers prices if you pay out of pocket.

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How much does TRT cost with Medicare?

With Original Medicare and a Part D plan, covered testosterone from a pharmacy costs your plan's copay or coinsurance after a deductible of up to $615 in 2026 or $700 in 2027. Your covered-drug spending is capped at $2,100 in 2026 and $2,400 in 2027. Under Original Medicare, most covered Part B drugs cost up to 20% of the Medicare-approved amount after the deductible; administration and procedure charges may be separate.

The numbers that matter, by year

Sources: Medicare drug costs, CMS's 2026 Part B figures, and CMS's final 2027 benefit parameters. Verified October 22, 2026. We'll add 2027 Part B amounts when CMS releases them.

What the cap does — and doesn't — cover

The Part D cap is a big deal, but it only counts covered Part D drugs. It does not include:

• Your Part D or Part B premiums
• Office visits, shots, or pellets billed to Part B
• Drugs your plan doesn't cover
• Anything you buy with a discount card outside your plan
• Cash program fees

Also: Original Medicare has no yearly cap on what you pay for Part B care unless you have Medigap or other coverage. Medicare Advantage plans do have a yearly limit on medical costs. That limit is separate from the Part D cap.

When paying cash looks cheaper

A discount-card price for generic testosterone cypionate can sometimes be lower than your plan's price, especially before you've met your Part D deductible. Ask your pharmacist to compare prices for the same strength, vial size, and quantity.

The trade-off: Medicare says discount-card purchases made outside your plan don't count toward your Part D deductible or yearly cap. If you take other expensive drugs, keeping your testosterone inside your plan may save you more over the year. Ask your pharmacist to run it both ways. Medicare explains the discount-card trade-off.

Your first-year cost, four ways

Help paying

• Extra Help lowers drug costs for people with limited income and savings. In 2026, most enrollees pay no more than $5.10 for a generic and $12.65 for a brand-name drug, with no deductible. Check eligibility on Medicare.gov.
• The Medicare Prescription Payment Plan spreads your drug costs into monthly payments. It doesn't lower your total. It may help when a big bill lands at once. See how the payment option works.
• Your State Health Insurance Assistance Program (SHIP) gives free, one-on-one Medicare counseling.

Want every number in one place? Fill in the budget lines in the coverage-check worksheet below. It keeps drug, visit, lab, and program costs in separate boxes so nothing gets counted twice.

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Does Medicare Advantage cover TRT differently?

Medicare Advantage plans must cover the services Original Medicare covers under applicable Medicare rules. Your plan may require prior authorization, permitted step therapy for new Part B drug treatment, network providers, or lab copays. Advantage plans also have a yearly limit on covered medical costs that Original Medicare itself doesn't have.

Here's how the two paths compare for someone on TRT.

For 2027: Check whether your plan's service area, benefits, or costs are changing. Read your Annual Notice of Change, the notice your plan should have sent for receipt by September 30. Check whether your testosterone, your clinician, and your lab are still covered. Compare Medicare options and review the notice requirements.

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What should I do during Open Enrollment?

If you take testosterone or plan to start, check your exact drug and strength in Medicare Plan Finder for 2027 before December 7, 2026. Compare tier, prior authorization, quantity limits, and estimated yearly cost. A lower premium can cost you more if your testosterone isn't covered.

Open Enrollment runs October 15 through December 7, 2026. Changes start January 1, 2027.

1. Find your Annual Notice of Change. Look for your testosterone by name.
2. Write down your exact drug, strength, and monthly amount.
3. Enter it in Plan Finder under the 2027 plan year.
4. Compare available plans on total yearly cost, not just premium. Include all your drugs, clinicians, and labs.
5. Call your top choice. Ask if your testosterone needs prior authorization, and whether last year's approval carries over. Don't assume it does.
6. Ask about a transition fill — a temporary supply you may qualify for when new coverage begins and an existing drug faces certain coverage restrictions. It isn't guaranteed.
7. If you decide to switch, make sure the new plan receives your enrollment request by December 7.

Turning 65 while on cash TRT? Gather your first low testosterone results, your current prescription, and a list of your symptoms before your first Medicare visit. Those records can help your clinician and drug plan assess the request. If you're considering a change between Original Medicare and Medicare Advantage, check drug coverage and Medigap enrollment rights before switching. Medicare explains the enrollment choices.

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Can I use Medicare at an online TRT clinic?

Medicare may cover eligible telehealth care and separately covered prescriptions, but a private TRT membership is a different charge. Ask the clinic what it bills to Medicare and which services you must pay for yourself. Testosterone prescribing also follows separate federal and state rules; the current temporary federal extension runs through December 31, 2026.

Can I pay cash if I'm on Medicare?

Yes, you can choose to. Here's what to know so you're not surprised:

• Clinicians who are enrolled in Medicare generally have to bill Medicare for services it covers.
• Clinicians who have formally opted out of Medicare have you sign a private contract. Neither of you bills Medicare for those privately contracted services, and you pay their fee.
• A non-participating clinician is still enrolled in Medicare and may accept assignment case by case. They generally must submit claims for covered services and may charge more when they don't accept assignment.

Ask any clinic: "Are you participating in Medicare, non-participating, or opted out? What will you bill to Medicare, and what will you bill to me?" Medicare explains those statuses.

Can an online prescription go through my Part D plan?

Sometimes. If the prescription is for an FDA-approved testosterone your plan covers, it goes to an in-network pharmacy, and it meets your plan's prior authorization rules, Part D may pay. A prescriber who opted out of Medicare can still write Part D prescriptions, as long as they aren't on CMS's preclusion list. Ask the program whether its prescriber will provide the records and prior-authorization support your plan requires. CMS explains the prescriber rule.

Compounded testosterone is a different thing

A compounded drug is made by combining or altering ingredients to meet a patient's needs. It isn't FDA-approved, and it isn't the same as an FDA-approved generic. Cash programs often use compounded creams, troches (dissolving tablets), or capsules. Part D can cover eligible drug ingredients in some compounds, but bulk active ingredients used for compounding aren't Part D drugs. Ask your plan about the exact preparation; amounts paid outside covered Part D benefits don't count toward its cap. Sources: FDA compounding information and CMS ingredient rules.

The online prescribing deadline

Testosterone is a Schedule III controlled substance. That means it needs a valid prescription and has extra federal rules. Since 2020, temporary DEA rules have let qualifying DEA-registered clinicians prescribe it through an audio-video visit without an in-person visit first, subject to federal and state law. The current extension runs through December 31, 2026. We did not verify a later extension as of October 22, 2026. Read the current DEA rule announcement.

Medicare's own telehealth payment rules are separate. Many of its temporary flexibilities, including receiving eligible non-behavioral telehealth care at home, were extended through December 31, 2027. CMS explains the covered-service rules. If your prescriber is online-only, ask what changes for your refills in 2027.

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What should I do if Medicare denies my TRT?

First, find out whether the problem is missing paperwork, a prior authorization step, or a formal denial. Your next move depends on whether Original Medicare, a Medicare Advantage medical plan, or a Part D drug plan made the decision. Keep the written notice and follow its deadline.

A pharmacy "no" isn't always a denial

If the pharmacy says your plan rejected the claim, that often means the plan needs prior authorization or more information. It may not be the formal denial that starts an appeal clock. Ask the plan for a coverage determination, which is its formal written decision. Your prescriber can send the supporting records.

Match your appeal to who said no

For an appeal seeking drug coverage before you obtain it, a Part D plan generally decides within 7 calendar days, or 72 hours for an expedited appeal when waiting could seriously harm your health. A Medicare Advantage appeal seeking coverage of a Part B drug follows the same timing. Appeals about reimbursement use different deadlines. Sources: Original Medicare appeals, Part D appeals, and Medicare Advantage appeals.

If your office hands you an "ABN"

An Advance Beneficiary Notice is a form warning that Original Medicare may not pay. It isn't a denial. The box you check affects whether the claim gets sent to Medicare, and whether you can appeal later. Ask the office to explain your choices before you sign. Medicare explains the ABN options.

Want a person to walk through your notice with you? Get free help from your State Health Insurance Assistance Program — trained counselors, no cost, no sales pitch. For the full denial-and-appeal playbook, see our testosterone prior authorization guide.

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Before you pay: your Medicare TRT coverage check

Use this worksheet when you call your plan, your pharmacy, and your clinician's billing office. It turns "Is TRT covered?" into the specific answers that decide your bill. Keep your Medicare number and other personal details off any shared copy.

Budget lines for the next 12 months: visits ______ · labs ______ · medication ______ · shot or procedure fees ______ · supplies or shipping ______ · membership or other cash charges ______ · total ______ · premiums (keep separate) ______. If your 12 months cross January 1, estimate each plan year on its own. Include deductibles within the relevant cost lines, and don't add them twice. A phone estimate helps you plan; ask for a formal coverage decision when needed.

What to say

To your plan or pharmacy:

"I want to check my testosterone prescription for [year]. It's [name, strength, form, amount], filled at [pharmacy]. Is it covered for my diagnosis? Does it need prior authorization, step therapy, or a quantity limit? Has an approval been received? What will I pay now, and will that change later in the year? How do I get a written coverage decision if I need one?"

To your clinician's billing office:

"Who supplies my testosterone, and which part of Medicare will you bill? Please list the drug, the shot or procedure, visits, facility fees, and lab tests separately. Are you enrolled in Medicare, or in my Advantage plan's network? If you expect Medicare won't pay for something, what notice and estimate will I get?"

If your prescription is denied:

"The notice says [exact reason]. Can your office check whether records are missing, and whether a coverage request, exception, or appeal makes sense? Who will send it, and when should I follow up?"

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If Medicare won't pay — or you'd rather skip the paperwork

If your plan covers generic testosterone, compare your Medicare costs with an itemized cash quote before choosing. Paying cash can avoid an insurer's approval process for those private charges, but it does not remove clinical testing, monitoring, or prescribing requirements. Check your remaining coverage and appeal options before committing to a program.

Who this section is for:

• The applicable medical-benefit policy excludes your situation, and you've checked whether a different covered treatment format is clinically appropriate.
• Your plan has denied or limited your testosterone, and you want to compare an itemized cash option after reviewing the reason and appeal choices.
• You want to compare the actual testing, visit schedule, and clinician availability of a private program.

Who should resolve clinical or Medicare questions first:

• Your plan covers your testosterone; confirm approval and your complete costs before paying for a private program.
• You get Extra Help.
• You want to father a child soon. Start with a reproductive urologist instead. Read how TRT affects fertility before choosing a program.
• You've had a heart attack or stroke in the past six months, have prostate or breast cancer history, have a very high hematocrit, or have untreated severe sleep apnea. Start with your doctor, urologist, or endocrinologist.

Male Excel

Medicare fit: Male Excel's terms direct people with government coverage to a participating provider. It is not a Medicare-billing option.

Male Excel does not bill Medicare or work with your Part D plan. If having Medicare pay is your priority, your own Medicare doctor and Part D plan is the better route. Its current terms also prohibit you, its medical group, lab, and pharmacies from submitting program charges for reimbursement. Male Excel says you order an online consultation with a U.S.-licensed provider, and it comes with an at-home hormone test; that does not establish a diagnosis or guarantee treatment.

What to know before you start:

• States: As of October 22, 2026, Male Excel's site says its providers don't prescribe in Alabama, Alaska, Arkansas, Connecticut, Hawaii, Idaho, Louisiana, Minnesota, Mississippi, New Hampshire, or Rhode Island.
• Medication: Male Excel's terms say it doesn't send prescriptions to outside pharmacies. Its FAQ identifies the cream as compounded, and its injection page identifies compounded testosterone cypionate. Neither is an FDA-approved product. These are provider-stated policies, checked October 22, 2026. See its terms, FAQ, and our Male Excel insurance guide.
• Your Medicare cap: Nothing you pay counts toward your Part D deductible or yearly cap.
• Price: Get the full cost — test, visits, medication, and renewal pricing — in writing before you pay. Its pricing page lists the required membership separately from medication and adds shipping. Ask about repeat testing, follow-up labs, cancellation timing, refunds, and how to obtain your medical records before committing.

Before you pay, read Male Excel's Medicare and payment restrictions.

Hone Health

Pharmacy option: Hone says it can send eligible prescriptions to a local pharmacy, but this does not confirm Medicare participation or payment.

Hone's current pharmacy policy, checked October 22, 2026, says it doesn't assist with prior authorizations or insurance processing, but it can send eligible prescriptions to your pharmacy. In that case, your Part D plan could still pay for the drug if the prescription meets the plan's rules. The membership itself is cash. Ask Hone, before you join, whether it serves Medicare members in your state and what it charges. Its membership FAQ says medications and confirmatory tests cost extra, monthly charges continue even if you skip medication, and cancellation takes effect at the end of the current billing period.

If keeping your pharmacy matters to you, read Hone's pharmacy-transfer and prior-authorization policy before paying for membership.

Still weighing local care against online care? Compare TRT providers that take insurance.

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What Medicare won't cover (and other edge cases)

Basic Part D excludes drugs used for sexual or erectile dysfunction or to promote fertility, and treatment must meet the applicable coverage rules. A contractor's medical exclusions and a compound's ingredients also need separate checks. This guide's male-hypogonadism checklist does not decide coverage for women or gender-affirming care, and it covers U.S. Medicare only.

• Erectile dysfunction alone: Basic Part D excludes drugs when used for sexual or erectile dysfunction. Testosterone may qualify for a medically accepted indication such as hypogonadism when the plan's requirements are met. See TRT and erectile dysfunction.
• After prostate cancer: Palmetto's rule blocks coverage unless you've had a radical prostatectomy and been disease-free for at least two years. The June 2026 FDA request proposed narrowing the label contraindication to cancer that has spread; it did not itself change this local Medicare policy. Your urologist or oncologist needs to lead this decision.
• Fertility drugs: Medications like clomiphene or hCG are not TRT. They work differently, and Medicare drug plans generally don't pay for drugs used to promote fertility. Clomiphene use in men is off-label (not FDA-approved for that use); Pregnyl, an hCG product, has an approved use in selected cases of male hypogonadism caused by pituitary deficiency. See the prescribing information for clomiphene and Pregnyl.
• Women and PCOS: This guide covers men with low testosterone. Testosterone use in women follows different evidence and coverage rules, and PCOS often involves high androgen levels or signs of androgen excess. NIH explains PCOS here. Talk with your gynecologist or endocrinologist.
• Gender-affirming care: Some Medicare policies list it as a separate covered use with its own criteria. This guide's testing rules don't apply to it.
• Canada: Canadian "Medicare" is provincial and works differently. This guide covers U.S. Medicare only.
• Medicaid: Medicaid is run by each state, often through private plans, so coverage and rules vary. Call your state Medicaid plan.

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How we verified this guide

We read Medicare and CMS rules, the two testosterone contractor policies compared here, 2026 Medicare plan criteria and a drug list, FDA and HHS labeling notices, and federal telemedicine rules. Then we organized them by treatment format, state, and cost. This is editorial research, not a medical review or a test of anyone's claim.

Our method follows How We Review TRT Providers. We keep four kinds of information separate: facts we verified, facts a provider or plan states about itself, customer experiences, and our own editorial conclusions. We calculate complete costs instead of repeating teaser prices.

What we checked (October 22, 2026):

• Medicare.gov pages on outpatient drugs, drug plan rules, Medigap, costs for drug coverage, lab tests, appeals protections, help with drug costs, Open Enrollment, and provider payment status
• CMS benefit manuals on self-administered drugs and pharmacy-supplied drugs
• Noridian LCD L36538 (revision effective October 16, 2025) and Palmetto LCD L39086 (revision effective May 5, 2022), plus 2026 CVS Caremark Medicare Part B criteria built on them
• A 2026 CVS Caremark Medicare Part D testosterone prior authorization form
• HealthSpring Assurance Rx (PDP) 2026 drug list and prior authorization requirements, updated October 1, 2026
• A 2026 Univera Healthcare Medicare Advantage testosterone policy
• FDA's February 2025 testosterone labeling changes and HHS's June 18, 2026 labeling request
• Aveed's FDA prescribing information
• DEA telemedicine extension through December 31, 2026, and Medicare telehealth extensions through 2027
• Male Excel's current FAQ, terms, and pricing disclosures, plus Hone Health's current pharmacy and membership policies

What we could not confirm: your plan's 2027 tier and rules for your exact prescription; 2027 Part B premium and deductible (not announced as of October 22, 2026); your personal acceptance and full first-year quote from an online program. Get your plan's coverage decision in writing; you can appeal a denial.

Found something outdated? Report a correction, and we'll recheck it. Include the page URL and a supporting source; don't send personal health or insurance information.

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What else should I know about Medicare TRT coverage?

Medicare testosterone coverage depends on the exact treatment, benefit, and plan rules. These answers help you identify what to check; they do not replace your own coverage decision.

Does Medicare cover TRT injections?

Medicare can cover them. For generic testosterone injections filled at a pharmacy, check your Part D plan's coverage and prior authorization rules. Injections your clinician supplies may be covered under Part B, depending on your contractor's rules.

Is a testosterone shot covered by Medicare Part B?

Part B may cover it when the clinician-supply, medical-need, and drug-benefit requirements are met, including the "usually self-administered" rule. Aveed must be given in a certified setting, but its coverage still needs to be checked.

Does Medicare cover testosterone gel?

Part D can cover testosterone gel, with prior authorization or quantity limits depending on the exact plan and product. Rules can differ even between strengths of the same gel.

Does Medicare cover testosterone pellets?

Sometimes, under Part B or your Medicare Advantage plan's medical side. Some policies require other forms to be tried first or limit how many pellets they cover.

Is a testosterone blood test covered by Medicare?

Medicare can cover a medically necessary test ordered by an eligible treating clinician. Under Original Medicare, you usually pay $0 for covered diagnostic lab tests.

Is TRT covered under Medicare Part B or Part D?

It depends on who supplies the drug. Pharmacy-filled testosterone for home use is generally checked under Part D. Testosterone your clinician supplies and gives you may be covered by Part B if its coverage requirements are met.

Does Medicare cover TRT for low testosterone from aging?

It depends on the policy that applies and how you get it. Palmetto's Part B rule for seven Southeastern states excludes it. Noridian's rule can cover it when its requirements are met. Part D plans set their own criteria.

Does Medigap Plan G cover my testosterone prescription?

Plan G may help with cost sharing for testosterone covered under Original Medicare Part B. It doesn't provide Part D coverage for pharmacy prescriptions.

What is the Medicare Part D cap for 2027?

$2,400 for covered drugs, up from $2,100 in 2026. The maximum deductible rises from $615 to $700.

Will last year's approval carry over to a new plan?

Don't assume it will. A new plan can require its own prior authorization. Ask about a transition fill and start the paperwork early.

Can I use my Medicare card at an online TRT clinic?

Ask whether the clinic bills Medicare or charges you privately. Some can send an eligible prescription to your own pharmacy, where your Part D plan might pay for the drug.

Does Medicare cover compounded testosterone cream?

Don't assume it is covered. Compounded products aren't FDA-approved, but Part D has ingredient-specific coverage rules. Bulk active ingredients used for compounding aren't covered Part D drugs; ask the plan and pharmacy about the exact preparation.

If my testosterone isn't on my plan's list, is cash my only option?

No. Your prescriber can request an exception. The plan generally decides within 72 hours of the prescriber's statement, or 24 hours if your health can't wait.

Does Medicaid cover TRT?

Each state runs its own Medicaid program, so coverage varies. Ask whether your plan requires prior authorization. Call your state Medicaid plan for its rules.

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Still not sure which TRT care route fits you? Use our free Find My TRT Path tool. It's educational and non-diagnostic, and it doesn't confirm Medicare coverage or guarantee a prescription.

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Sources

• Medicare.gov — Prescription drugs (outpatient) · Drug plan rules · Costs for Medicare drug coverage · Diagnostic laboratory tests · What Medigap covers · Compare Original Medicare and Medicare Advantage · Help with drug costs · Medicare Prescription Payment Plan · Open Enrollment · Your protections (ABN) · Does your provider accept Medicare as full payment?
• CMS — 2026 Medicare Parts A & B premiums and deductibles · Medicare Benefit Policy Manual, Chapter 15 · Medicare Prescription Drug Benefit Manual, Chapter 6 · LCD L36538 (Noridian) · LCD L39086 (Palmetto) · Billing and Coding A58828 · Coverage determinations · Exceptions · Part D redetermination · Original Medicare redetermination · Medicare Advantage reconsideration
• CVS Caremark 2026 Medicare Part B testosterone criteria — Jurisdiction E · Jurisdictions J and M · 2026 Part D testosterone enanthate PA form
• HealthSpring — 2026 Assurance Rx (PDP) formulary · 2026 Assurance Rx (PDP) prior authorization requirements
• Univera Healthcare — Testosterone, Testopel, Aveed, and Azmiro policy
• FDA — Class-wide labeling changes for testosterone products (Feb. 28, 2025) · Testosterone information · Compounding and the FDA · Aveed FDA prescribing information
• HHS — FDA requests updates to testosterone therapy labeling (June 18, 2026) · Part D and erectile dysfunction drugs guidance
• Endocrine Society — Testosterone therapy guideline resources
• DEA — Telemedicine flexibilities extended through 2026 · Controlled substance schedules
• CMS — Telehealth FAQ, updated October 8, 2026 · HHS — Telehealth policy updates
• CMS — Final 2027 Medicare Advantage and Part D benefit parameters, Table V-2
• Federal rules — Medicare Advantage basic benefits · Part B step therapy · Eligible lab-ordering clinicians · Annual Notice of Change requirements
• Male Excel — FAQ · Terms and conditions · Pricing disclosures
• Hone Health — Pharmacy and prior-authorization policy · Membership, extra testing costs, and cancellation
• CMS — Preclusion List FAQ
• Medicare — Compare Medigap benefits