HRT Therapy Out-of-Pocket Gap
HRT pricing varies wildly between retail pharmacies, compounding labs, and concierge clinics. Enter the monthly medication price and your coverage percent to understand what insurance pays, then add recurring clinic fees or manufacturer support to expose the true out-of-pocket gap.
For budgeting only—verify coverage rules with your insurer and endocrinologist.
Examples
- $1,050 monthly medication cost, 60% coverage, $55 clinic fee, and $150 copay card ⇒ Monthly out-of-pocket: $325.00 USD • Annual cash requirement: $3,900.00 USD • Insurer covers $630.00 USD per month (60.00% of the drug cost) • Copay support applied: $150.00 USD per month.
- $680 medication price with 30% coverage and default optional inputs ⇒ Monthly out-of-pocket: $516.00 USD • Annual cash requirement: $6,192.00 USD • Insurer covers $204.00 USD per month (30.00% of the drug cost) • Copay support applied: $0.00 USD per month.
FAQ
Should I include lab fees separately?
Yes. Add any standing lab panels or shipping charges to the clinic/program fee input so the recurring total reflects every bill.
What if I pay cash and submit for reimbursement?
Use the expected reimbursement percentage as the coverage input so you can see how much cash floats before claims are paid.
Does the calculator handle pellet procedures?
Pellet therapy often bills quarterly. Divide the procedure amount by three to convert it into an equivalent monthly price before entering it.
Additional Information
- Result unit: U.S. dollars per month plus the 12-month projection.
- Copay assistance is capped at what you still owe after insurance so the calculator never drives the medication portion negative.
- Clinic fees default to $40/month to cover routine labs or membership plans common in concierge hormone clinics.