What If Medicaid or Medicare Stops Covering Gender-Affirming Hormone Therapy?"
How to Stay on HRT Without Insurance

How to Afford Gender-Affirming Hormone Therapy Without Insurance: Transparent HRT Costs & Sustainable Options

Worried that Medicaid, Medicare, or private insurance might stop covering transgender HRT? Be Well Berlin offers low-cost, judgment-free hormone therapy options for trans people in California and Alaska—including membership and refill-only models.

What Happens If Insurance Stops Covering Transgender Care?
We’ve been hearing this fear more and more:
“What happens if the government bans gender-affirming care?”
“Will my Medicaid or Medicare plan drop coverage for hormones?”
“If my insurance changes or gets canceled, can I still get my testosterone or estradiol?”
Unfortunately, these aren’t hypothetical concerns. Across the U.S., laws are shifting rapidly. Transgender healthcare is being politicized. Some states have passed bans. Others are pushing restrictions on what Medicaid or private insurance will cover.

We want you to know:
Even if the system fails—you still have options.

At Be Well Berlin, we believe your right to hormone therapy isn’t negotiable. That’s why we’ve built care models that work even if your insurance doesn’t... 

 

Estimated Cash Pricing of Gender Affirming HRT, provider Visits, and Labs at Be Well Berlin

Estimated Cash Pricing of Masculinization Treatment at Be Well Berlin
Affordable Testosterone Therapy Without Insurance
Transparent pricing for transmasculine, nonbinary, and gender-diverse patients seeking masculinization care. This estimate includes provider visits, medication (testosterone), lab monitoring, and injection supplies. Most patients pay $1,229–$1,619 in the first year, and $679–$1,069 annually once stable.
Transparent pricing for feminizing hormone therapy at be well berlin with cash cost estimates for the first year and ongoing gender affirming care including cost of provider visit medication and labs

Affordable Estrogen Therapy Without Insurance


Cost estimates for transfeminine, nonbinary, and gender-expansive patients starting or continuing feminization care. Includes provider visits, medication (estradiol and spironolactone), and labs. Most patients pay $1,217–$1,367 the first year, and $477–$702 per year after that with stable dosing.
Smiling primary care provider in blue scrubs at be well berlin clinic offering personalized health services

Isaac Berlin, FNP-C – Committed to Accessible Trans Care

As a queer clinician and member of the LGBTQIA+ community, I’ve been fighting for health equity since 2012—and I’ve been providing gender-affirming care since 2017. At every organization I’ve worked with, I’ve helped launch or lead LGBTQ+ health initiatives—training providers, writing care protocols, and advocating for better systems.

This work is deeply personal. My brother’s experience as a young trans person showed me how broken the healthcare system can be—and how urgent the need for affirming care really is.

That’s why I started Be Well Berlin: to make hormone therapy, primary care, and mental health support more affordable, inclusive, and respectful—especially for trans, nonbinary, and Two-Spirit patients.

What If the Only Provider You Can See Charges $300/Visit?

For some patients—especially those in rural areas, or navigating insurance that refuses to cover nurse practitioners—your only option may be a private doctor who charges $300 per visit. If that provider requires you to be seen every three months and still expects regular lab work, the cost can feel overwhelming.


But even in that scenario, gender-affirming hormone therapy may still be within reach—especially if you know where to look for savings.

Medication: You don’t need insurance to access affordable prescriptions. Sites like GoodRx and CostPlus Drugs offer transparent, low-cost pricing on medications like estradiol, spironolactone, and testosterone. Most patients pay under $25/month for their hormones.

Lab Testing: Through LaboratoryAssist.com, you can access common HRT labs—like CBC, CMP, and hormone levels—at significantly reduced rates. You’ll still go to LabCorp or Quest for your blood draw, but you’ll pay a fraction of what you'd be charged out-of-pocket at the lab counter.

By combining low-cost labs and medication with careful budgeting—even care from a high-fee provider may be manageable.
 

Feminizing HRT – High-Cost Provider Estimate

  • 4 visits/year @ $300 = $1,200
  • 4 labs/year @ $100 = $400
  • Estradiol + spironolactone: ~$21/month = $252/year
  • Supplies (if needed): ~$40/year

Estimated Annual Total: $1,892
Monthly Equivalent: ~$158/month
 

Masculinizing HRT – High-Cost Provider Estimate

  • 4 visits/year @ $300 = $1,200
  • 4 labs/year @ $64 = $256
  • Testosterone: ~$40/month = $480/year
  • Injection supplies: ~$40/year

Estimated Annual Total: $1,976
Monthly Equivalent: ~$165/month

Even if you're stuck paying out-of-pocket to a $300/visit provider, your total yearly cost is still under $2,000 in most cases. That’s roughly the cost of one Starbucks coffee per day—and often worth budgeting for if affirming care is otherwise out of reach.
 

What About Injection Supplies?


If you’re using injectable testosterone or estradiol, you’ll also need a reliable, safe source for syringes, needles, alcohol pads, and sharps disposal. These don’t have to break the bank either—but it’s important to source them safely.
 

Best Option: ShopMedVet.com

ShopMedVet.com is a trusted medical and veterinary supply store that many patients use to order sterile injection supplies affordably. You don’t need a prescription in most states, and shipping is fast. Many patients get everything they need for under $40–50/year.
 

Local Pharmacy Tip

Some local pharmacies offer out-of-pocket discounts for syringes and injection supplies. If you let them know you’re paying cash and ask if they have any discount programs or PBM coupons, they may be able to match or beat online prices.
 

What About Amazon?

While I don’t specifically recommend purchasing syringes or needles from Amazon, several of my patients have shared that they’ve successfully ordered sterile injection kits via Amazon for under $50 per year. If you go this route, make sure the seller is reputable and the product comes from a recognized medical brand (like BD or Monoject).

Always confirm your injection supply details with your provider to make sure you're using the correct syringe size, needle gauge, and technique for your medication.

Additional Care Options At Be Well Berlin for Accessible & Affordable Care

💡 Starting Transgender Hormone Therapy Without Insurance
You don’t need a monthly subscription to start. If our $100/month membership is too expensive, you can still start on a pay-per-visit basis.

Visit Fees:
  • Initial gender-affirming consult: $250
  • Follow-up appointments: $125–$175
    (Pricing depends on visit length and complexity. We do not offer sliding scale due to insurance contracts.)

Feminizing HRT – First-Year Costs
Labs: CBC, CMP, Estradiol, Total T – ~$100/panel
(Optional minimal labs: ~$40)

Meds:
  • Estradiol: ~$10/month
  • Spironolactone: ~$11/month
  • Total meds: ~$21/month or ~$252/year

Estimated Total:
  • $1,217–$1,367/year
  • $101–$114/month

Masculinizing HRT – First-Year Costs

Labs: CBC, CMP, Total T – ~$64/panel
(Optional minimal labs: ~$40)
Note: Testosterone is a controlled medication. Federal law requires in-person or telehealth follow-up at least every 120 days (3x/year minimum).

Meds:
  • Testosterone (200 mg vial): ~$20–40/month
  • Injection supplies: ~$40/year
Estimated Total:
  • $1,229–$1,619/year
  • $102–$135/month

🔁 Maintenance HRT for Transgender Patients (After First Year)
Once you’re stable on treatment / current dosage for >12 months with appropriate medical records, your costs and visit frequency can often decrease.

Feminizing HRT (Stable Plan)
  • 1–2 visits/year
  • Annual labs: ~$100
  • Meds: ~$21/month ($252/year)

Estimated Total: $477–$702/year
Monthly Equivalent: ~$40–$59

Masculinizing HRT (Stable Plan)
  • 3 visits/year (every 120 days)
  • Annual labs: ~$64
  • Meds: ~$40/month = $480/year
  • Supplies: ~$40
Estimated Total: $679–$1,069/year
Monthly Equivalent: ~$57–$89

My Ultra-Affordable Refill Option for Stable Patients
For patients who are doing well on treatment, have been stable on their current dosage for >12 months, with appropriate medical records and labs to validate, and just need safe, ongoing access:

Feminizing HRT – Refill-Only Model
  • 1-2 visit/year: $125–$350
  • Annual labs: ~$100 (or $40 if minimal)
  • Meds: ~$21/month = ~$252/year

Total: $477–$840/year
Monthly Equivalent: ~$40–$70

Masculinizing HRT – Refill-Only Model
  • 3 visits/year (required): $375–$525
  • Annual labs: ~$100
  • Meds: ~$480/year
  • Supplies: ~$40

Total: $959–$1,145/year
Monthly Equivalent: ~$82–$96
⚠️ Due to DEA regulations, testosterone cannot be prescribed for more than 120 days at a time—even for stable patients.

🌿 $100/Month HRT Membership for Ongoing Access
For patients who want regular access to a medical provider, monthly check-ins, or support with other issues like anxiety, depression, general primary care, etc—our $100/month membership is ideal.

What’s Included:
  • Monthly Provider Visist
  • Medication management for HRT, mental health, PrEP, and more
  • Labs ordered as needed
  • Cancel anytime—no commitment required

Many patients choose this plan for trans hormone care and mental health care in one place—especially when managing anxiety, insomnia, or emotional stress during transition.

📊 Transparent Cost Summary
Feminizing HRT (First Year): $1,217–$1,367
Feminizing HRT (Maintenance): $477–$702
Masculinizing HRT (First Year): $1,229–$1,619
Masculinizing HRT (Maintenance): $679–$1,069
Refill Model: $40–$93/month
Membership: $100/month

This page is here to support patients looking for things like:
HRT without insurance, transgender HRT in California or Alaska, cash-pay hormone therapy, how to afford testosterone or estradiol without coverage, refill-only trans hormone options, low-cost hormone therapy FTM, low-cost hormone therapy MTF, and what to do if Medicaid or Medicare stops covering gender-affirming care.

💜 Final Thoughts
If you’re scared, you’re not overreacting.
If you’re exhausted, you’re not alone.
And if you’re preparing for the worst while hoping for the best—we’ve got your back.
At Be Well Berlin, we offer judgment-free, accessible hormone therapy for trans people across California and Alaska—whether or not you have insurance.
Ready to Start HRT or Stay On It?
→ Book a visit now
→ Explore trans hormone therapy options

Serving patients across California and Alaska—including Los Angeles, San Diego, West Hollywood, San Francisco, Sacramento, Anchorage, and Juneau—via telehealth or in-person.