About 75 million women in the United States are in perimenopause, menopause, or postmenopause at any given time, according to LifeMD. Yet despite how common this life stage is, health insurance coverage for menopause care isn’t always easy to understand. Knowing what your plan does (and doesn’t) cover is essential. This can help you get the care you need while avoiding unexpected costs.

Here are six important facts about health insurance coverage for menopause. For questions about your specific plan, contact your health insurance company directly.

1. Verify Your Coverage Before Treatment

Medical debt is a serious problem in the United States. That’s the case even though more than 90 percent of the population has some form of health insurance. Before starting menopause treatment, take the time to review your health insurance plan. Knowing what your plan covers can help you avoid unexpected medical bills and out-of-pocket costs.

If you have questions about your coverage, call your insurer. Customer service representatives can help with a range of needs. They can:

• Explain your benefits
• Outline what expenses you could be responsible for
• Clarify what your insurance covers

If your coverage is through your employer, a human resources employee or benefits navigator may also be able to guide you.

2. Coverage Varies by State

Health insurance coverage can vary by plan and provider. When it comes to menopause care in the United States, coverage can also depend on where you live. For example, someone in California may have different menopause insurance protections than someone in Georgia or New Hampshire.

In recent years, menopause care — and women’s health in general — has started receiving increased attention. To date, state representatives in 21 states have introduced dozens of bills to improve menopause care, insurance coverage, and treatment. Eight of those bills have become law.

To find out which menopause-related bills have been proposed or passed where you live, you can view this map. Take action by staying informed about potential changes that could affect your coverage.

3. Public Insurance Could Make Accessing Care More Difficult

A recent study found that more than 60 percent of women with moderate to severe menopause symptoms weren’t being treated. It also showed that women with public insurance were more likely to go untreated than women with private insurance. The study included 845 perimenopausal and postmenopausal women in Oregon.

While this was a single study conducted in one state, these findings highlight the importance of self-advocating. If you’re having menopause symptoms, schedule an appointment with your healthcare provider. Be proactive. If you have Medicare, Medicaid, or other public health insurance, accessing care may require extra effort. Speak up, ask questions, and don’t let barriers prevent you from getting the menopause care you deserve.

4. Some Telehealth Providers Accept Insurance

Telehealth became increasingly popular during the COVID-19 pandemic. Today, accessing healthcare from home is a realistic option for many people. This includes those seeking menopause treatment. In some cases, telehealth visits can be just as effective as in-person care.

Insurance coverage for telehealth care varies by provider. Some telehealth companies accept insurance, while others operate on a self-pay basis. For example:

• Alloy Women’s Health does not accept insurance.
• Carrot accepts most major insurance plans.
• Evernow accepts most major insurance plans.
• Hers does not require insurance.
• Midi is in network with most preferred provider organization (PPO) plans, but it does not currently accept Medicaid or state health insurance programs.

Even when telehealth services are covered by insurance, costs such as copays, deductibles, laboratory fees, and coinsurance can vary by plan. Before scheduling a telehealth appointment, check the provider’s website for the most up-to-date information. Also, confirm your benefits with your insurance company.

5. Some Treatments Are More Likely To Be Covered Than Others

Common menopause symptoms include hot flashes, urinary incontinence, weight gain, vaginal dryness, night sweats, and mood swings. Your menopause treatment plan will depend on the symptoms you’re experiencing. Some treatment options are more likely to be covered by insurance than others.

For insurance to cover medical care, the treatment usually must be considered medically necessary.

Menopause symptoms are typically caused by changes in hormone levels as the body produces less estrogen and progesterone in midlife. Menopause hormone therapy, also called hormone replacement therapy (HRT), helps replace these hormones and is approved by the U.S. Food and Drug Administration (FDA) as a first-line treatment for menopause. Because of this, most Medicare, Medicaid, and private insurance plans cover at least some form of hormone therapy.

Other treatments, such as pelvic floor physical therapy and acupuncture, may also help relieve menopause symptoms. But these services are often classified as lifestyle, wellness, or preventive care. This means they’re less likely to be covered by insurance or may require additional approval.

6. If Insurance Won’t Pay for Care, You Still Have Options

Some treatments that ease menopause symptoms may not be covered when they’re coded (submitted to insurance as) specifically as menopause care. But many menopause symptoms overlap with other medical conditions that are commonly covered. In these cases, coverage may depend on how your symptoms and care are documented.

This doesn’t mean asking a healthcare professional to invent a diagnosis. Instead, it means making sure your symptoms are accurately documented and treated under the medical condition they reflect. Below are examples of menopause-related treatments that may be covered when linked to a specific, qualifying diagnosis.

Pelvic Floor Physical Therapy

If you experience urinary incontinence (loss of bladder control) as a menopause symptom, pelvic floor physical therapy may help. Urinary incontinence is a recognized medical condition that’s often covered by insurance. Therefore, treatment may be covered when it’s linked to an incontinence diagnosis rather than billed as menopause care. Your provider can evaluate your symptoms and provide the documentation needed for insurance approval.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is an evidence-based form of psychotherapy. It may reduce menopause symptoms such as insomnia, anxiety, and mood changes. Under federal laws like the Affordable Care Act (ACA), most insurance plans cover CBT, though coverage levels vary.

If menopause itself isn’t a covered diagnosis with your insurance plan, CBT may still be covered. This is especially true when it’s performed for conditions such as chronic insomnia, anxiety disorders, depression, or stress-related conditions. Check your plan for details, and talk with your provider about how your symptoms are documented.

Prescription Medications

Some prescription drugs used to ease menopause symptoms are also FDA-approved to treat other medical conditions. For example, certain antidepressants and high blood pressure medications may help reduce hot flashes. In some cases, these may be covered when prescribed for a specific use, such as depression or another qualifying condition, rather than menopause alone.

These are just a few examples. No matter your symptoms, insurance coverage may depend on identifying and documenting the specific condition being treated, even if menopause is the underlying cause.