Medicare covers testosterone replacement therapy for many beneficiaries, but the rules around what is covered, how much you pay, and what documentation you need have shifted in 2026. Here is what Medicare beneficiaries should understand about TRT coverage this year.
The Short Answer
Yes, Medicare generally covers TRT for beneficiaries with clinically documented low testosterone. Coverage flows mainly through Part D for prescription medications, with Part B covering some physician administered injections and lab work.
What Medicare Part D Covers
Most outpatient TRT prescriptions, including testosterone cypionate injections you administer yourself, testosterone gels, and oral testosterone capsules, are covered under Part D. Coverage requires:
A documented diagnosis of hypogonadism, typically supported by at least two morning serum testosterone tests showing levels below 300 ng/dL (UnitedHealthcare TRT policy).
A prior authorization from your plan in many cases, with paperwork submitted by your prescriber.
Use of preferred formulary drugs when available. Generic testosterone cypionate is almost always on Medicare formularies (Medicare.org, 2025).
The 2026 Part D Out of Pocket Cap
A major change for Medicare beneficiaries in recent years was the introduction of a hard cap on annual Part D out of pocket spending. The $2,000 cap that took effect in 2025 carries forward into 2026. Once you spend $2,000 out of pocket on covered prescriptions in a calendar year, your remaining covered medication costs are zero (Highland Longevity, 2026).
For TRT patients on generic injectable testosterone, the cap is mostly insurance against catastrophic spending and rarely triggered. For patients on branded oral testosterone, gels, or pellets, the cap can meaningfully reduce annual costs.
What Medicare Part B Covers
Part B covers some TRT related services:
Physician administered testosterone injections, when given in a doctor's office, are sometimes billed under Part B rather than Part D.
Office visits with primary care doctors, endocrinologists, and urologists are covered under Part B with the usual deductibles and coinsurance.
Laboratory testing, including testosterone levels, hematocrit, PSA, and related labs, is generally covered when medically necessary.
Medicare Advantage and New Evidence Based Criteria
Many Medicare beneficiaries are enrolled in Medicare Advantage plans rather than Original Medicare. For 2026, Medicare Advantage plans are increasingly using evidence based criteria to evaluate TRT requests (Highland Longevity, 2026). In practice this means:
Requests aligned with current Endocrine Society and American Urological Association guidelines are typically approved without issue.
Off label uses, including testosterone for aging related symptoms without clinical hypogonadism, may be denied.
Plans may require step therapy, starting with generic injectable testosterone before approving branded gels or oral formulations.
The shift to evidence based review is generally favorable for patients who meet clinical guidelines. If you have confirmed low testosterone, symptoms, and appropriate documentation, your odds of approval are high.
