Testosterone is a critical hormone in the human body for both men and women. Levels of testosterone are higher in men, but can start to lessen with age. Testosterone pellets are small, and when placed under the skin, they can slowly deliver testosterone into the body over a prolonged period of time. They are used primarily for men with primary hypogonadism, which is the inability produce a normal amount of testosterone.
Low testosterone levels can cause erectile dysfunction, reduced bone mass, reduced muscle and bone development, and more. There are a number of specific requirements that must be met for this medication to be deemed medically necessary, but if it is, Medicare benefits should cover the costs of testosterone pellets.
How Do Testosterone Pellets Work?
Testosterone pellets are small in size, measuring less than a centimeter in length and only about three millimeters wide, similar to a grain of rice. These pellets contain crystallized testosterone, which can dissolve slowly in the body. This allows an individual to get a steady dose of testosterone for up to six months without having to take daily pills or supplements.
These pellets are placed just under a patient’s skin by their physician. The most common spots for placement include the hips and the buttocks. The procedure to insert the pellets is noninvasive and can simply be done in a doctor’s office. A local anesthetic is applied to the skin to ease any discomfort, and a tool known as a trocar is used to insert around five to 10 pellets under the skin.
Testosterone pellets are quite effective, and many users indicate that they are satisfied with their use. While other forms of testosterone therapy can also be effective, one of the biggest benefits of using pellets is the ease of use as daily pills are not required.
One of the more difficult parts of using testosterone pellet therapy is getting the correct dosage. With other products, like gels, creams, or tablets, testosterone levels can be measured and the medication doses altered depending on whether levels are high or low. This is more difficult with pellets as another procedure must be done to insert extra pellets or remove them.
Because of this, it is common for individuals to attempt another form of therapy first to ensure that the results of testosterone therapy are beneficial and to pinpoint the required dosage. This allows the pellets to be much more effective and reduces potential issues with improper dosing.
Can Medicare Recipients Get Coverage for Testosterone Pellets?
Medicare recipients who suffer from low testosterone levels that are a result of a medical condition may qualify for coverage. The most common conditions causing low testosterone include primary hypogonadism and hypogonadotropic hypogonadism. Both of these conditions require that testosterone replacement therapy be initiated.
In order for Medicare benefits to cover testosterone pellets, certain requirements must be met. Some of these can include your testosterone levels being below a certain level, having a confirmed medical diagnosis that is causing the low levels, and not taking other supplements that may also boost or lower testosterone levels. In addition to these, an individual must be suffering additional effects from the low testosterone. These can include significant weight loss, osteoporosis, decreased bone density, or decreased sex drive.
Once you are approved for initial therapy and the pellets are inserted, you must then continue to meet certain conditions for therapy to be continued. This can include testosterone level testing to ensure the therapy is effective, another confirmation of a disease causing the low testosterone levels, and more.
If you do qualify for testosterone pellet therapy, there is a good chance that it will be covered by Medicare. However, it is important to check your specific policy to see the exact costs associated. It is also important to know that Medicare places a cap on the maximal number of pellets that can be inserted, being six, but that this cap can be increased if it is deemed medically necessary after an appeal is filed.
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