Does Aetna Cover TRT Costs in 2025? Insurance Breakdown & What You Need to Know

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Do you feel tired, moody, or just maybe not yourself anymore? 

Testosterone Replacement Therapy (TRT) could be the solution—but before making such an important decision, it’s essential to know exactly what your health insurance plan covers, whether it be Aetna or not. Let’s just say if you’re reading this for 2025, navigating TRT insurance coverage can feel like cracking a code, with requirements around lab work, symptoms and benefits based on plan type. 

In this guide, we will walk through how Aetna has provided TRT coverage in 2025—what’s covered, how to get it approved, what types of therapy are covered, and if you’re denied—what to do next. 

What is Aetna Coverage?

With a wide range of plans, Aetna remains a major health insurer in the US. There are employer-based, individual ACA (Affordable Care Act) policies, and Medicare Advantage—all versions of Aetna health insurance. Recognizing you are using TRT for therapeutic or managing a long-term hormone condition it is important to know the structure of your policy so that you know what’s paid and what’s not paid.

Core Structure of Aetna Health Plans

Aetna provides a variety of plan types, such as PPO, EPO, and HMO. Each of these options has different rules around coverage. The main factors are as follows: 

• Network Providers: Going to a healthcare provider that accepts Aetna will save you more money. 

• Deductibles and Coinsurance: Usually you must meet a deductible before Aetna will start covering services.  

• Tiered Drug Formularies: Depending on the tier the prescription falls under with Aetna will determine what you will have to pay.

• Preventive vs. Therapeutic Care: TRT is considered therapeutic and Aetna will cover it depending on difficulty meeting medical necessity. 

Does Aetna Cover TRT in 2025?

Yes, Aetna may cover TRT in 2025—but only with strict medical criteria. Just because Aetna might cover TRT, does not mean it is guaranteed. Aetna will consider TRT medically necessary if a man has a diagnosis of hypogonadism (primary testicular failure and/or secondary due to problems with the brain-pituitary-gonadal axis).

Approval for TRT will depend on the plan type (employer, ACA, or Medicare Advantage), the clinical documentation, and lab results. Coverage will vary by employer, ACA and Medicare Advantage.

Requirements of Aetna Coverage

Usually for an Aetna policy to provide TRT coverage, patients will need to fulfill all of the following requirements:

• Below-normal testosterone levels were found in two morning testosterone blood tests.
• Formal diagnosis of hypogonadism
• Clinical signs and symptoms, similar to things like fatigue, sexual, and/or muscle loss problems.
• Rule out any secondary causes, such as thyroid disease, sleep apnea, or opioid use.

Drug coverage can also differ as well. Most generic formulations are lower tier, and therefore are more likely to get a quicker approval, while branded formulations will require more paperwork, and/or higher those co-pays.

Types of TRT Aetna May Cover

Coverage for testosterone therapy by Aetna will vary for prescribed forms of testosterone therapy, although you should know the following:

• Injectables (e.g., Testosterone Cypionate, Enanthate)

Injection testosterone is usually the form most affordable and covered. Generics have the overall lower tier category (Tier 1 and Tier 2) and is usually the 1st line therapy covered.

• Topical Gels (e.g., AndroGel, Testim, Fortesta)

Topical gels are more convenient, but are usually more costly and listed on Tier 3 of drugs. These gels will often have a prior step therapy requirement, which means you will have to start out on injectables first.

• Transdermal Patches (e.g., Androderm)

Transdermal Patches maintain stable dosing but may irritate the skin. The coverage with transdermal patches is usually restricted to cases of previous failures in treating testosterone deficiency by other means. 

• Implants (e.g., Testopel)

Implants are long-acting, surgically placed options that also gravitate the release of testosterone. Aetna typically needs proof that alternative therapies have been explored and unsuccessful. 

• Oral Capsules (e.g., Jatenzo)

Oral Capsules are a newer option, but the rate of coverage of oral testosterone is either a full pathway of alternatives to a certain plan, or may or may not be included in your specific plan. Circumvented as a higher tier option requiring "medical justification." 

Aetna’s Prior Authorization Requirements

Before TRT is approved, Aetna usually requires prior authorization, which is a review to decide if treatment meets their criteria. Below summarizes what is commonly required:

• Two testosterone lab tests in the early morning.
• Documentation of symptoms.
• A physician's clinical notes excluding alternative explanations.
• Medical necessity requirement for therapy.

Turnaround Time

After submitting everything as requested, a decision is generally made in 5–10 business days. Any piece of information missing in the documentation may delay or deny authorization.

Exclusions and Limitations in Aetna’s TRT Policy

Aetna covers TRT under certain conditions, but also explicitly excludes situations that include:

• Low testosterone from aging alone
• Bodybuilding or performance related TRT
• Non-FDA approved testosterone or compounded creams
• Over the counter testosterone supplements
• Labwork or clinical evaluation incomplete

Requests that do not include a full workup or try to circumvent certain treatment protocols may also be rejected.

What If Aetna Denies Your Claim?

A denial is frequently only a speed bump and is not the end. Aetna has a clear appeals process. With good documentation and your doctor on board, many initial decisions can be improved.

Common Reasons Aetna Denies TRT Claims

The level of testosterone is not low enough or the test was done at the wrong time of day

• Missing clinical notes or labwork
• No prior authorization has been submitted
• The request is for cosmetic purposes or age-related

Understanding the exact reason that your claim was denied will help you focus on your next steps.

Step-by-Step: What to Do After a Denial

• Review the Explanation of Benefits (EOB)

Search for denial codes or explanations like 'lack of necessity' or ‘incomplete documentation’.

• Contact Your Provider’s Billing Office

Crucial for most treatment, many providers are hoc complete with resubmitting claims once they have clean documentation to send to Aetna. 

• File an Internal Appeal with Aetna

Provide the following documentation: a cover letter, new lab reports, updated clinical notes, and a medical necessity letter from the provider.

• Request a Peer-to-Peer Review

A peer-to-peer review gives your provider the chance to speak directly to Aetna's reviewing provider - sometimes more effective than an appeal based on paperwork alone.

• File an External Review (if needed)

If all these fail and the insurance process was followed correctly, request a third party (external) appeal based on state laws surrounding health insurance. 

• Ask About Coverage Alternatives

If Aetna denied one type of TRT (gel), they may still allow injectables. They may have just changed the 'allowed methods'.

How to Increase Your Chances of Approval

Want an easier time going forward? Consider these expert tips:

• Work With a TRT Specialist

Hormones clinics and/or endocrinologists are better trained to meet Aetna's criteria for care.

• Get Early Morning Blood Tests

Remember testosterone levels can fluctuate based on the time of day so make sure that both labs are taken between 7 –10am.

• Provide Detailed Symptom Notes

Make sure the medical record documents low libido, fatigue, 

• Rule Out Other Causes

Your doctor needs to confirm that your low testosterone level isn't caused by lifestyle, stress, or sleep disorders.

Average Out-of-Pocket Costs with Aetna

You may probably incur some out-of-pocket expenses, depending on your coverage. For instance:

Expense	Estimated Cost
Initial Doctor Visit	$25–$100 (depending on plan)
Lab Tests (if not fully covered)	$50–$150
Testosterone Injection (monthly)	$10–$50
Topical Gels	$40–$100
Telemedicine Follow-ups	$15–$50 per visit

Note: If you are on a high-deductible plan, you could need to meet the full deductible prior to any coverage.*

Alternative Ways to Afford TRT Without Insurance

You don't have to put up with insurance delays and denials. Consider these options:

• Cash Pay Clinics

Some clinics have begun to offer "all-in-one" pricing based on a monthly subscription model, which bundles labs, consults, and medication, and is often significantly cheaper than copays.

• Discount Pharmacies

Prescription savings apps such as GoodRx or SingleCare can help you save on testosterone prescriptions.

• Mail-Order TRT Services

There are subscription-based services that provide at-home testing, prescriptions, and consultation—without insurance headaches.

Insurance vs Cash Pay: Key Differences 

Factor	Aetna Insurance	Cash Pay (Subscription)
Approval Speed	5–10 days with paperwork	1–2 days or same day
Coverage Certainty	Limited by criteria and plan	Guaranteed if you meet their own criteria
Monthly Cost	Varies based on plan	Transparent fixed fees
Flexibility	Limited by formulary and policy	More freedom and customization
Ease of Use	High paperwork burden	Seamless and user-friendly

Final Thoughts

Navigating Aetna’s policies on TRT can be tricky—but not impossible. If you meet their criteria and can organize the paperwork you can be covered—but if the bureaucracy is too much or the approvals are slow you can take a route to wellness through alternative options like TheKIF.

Here’s what TheKIF has to offer:-

Free consultation – $0 with certified providers

New Patient TRT Plan – only $249

Monthly subscription that includes doctor consult + medication

Refill packages – $149/month

Don't wait for paperwork—take action now.

Book your free consultation with TheKIF and reclaim your sense of energy and vibrancy—on your terms.