Does Cigna Cover TRT in 2025? Insurance Coverage Explained

Reading Time: 6 minutes

Have you been feeling fatigued, foggy, or not yourself lately? You are not alone. Low testosterone (also known as hypogonadism) is something that affects millions of men, and it can greatly affect energy, mood, strength, and sexual intimacy, for example. Testosterone Replacement Therapy (TRT) has emerged as a vital medical intervention that is effective at restoring hormonal balance and quality of life.

However, prior to committing to this life-enhancing therapy, there is one essential question you need answered: does Cigna cover TRT in 2025? In this guide, we’re going to explain to you what you will need to know about Cigna’s policies, eligibility criteria, covered treatments, what to do if you are denied coverage, and financial options if insurance is short.

Does Cigna Cover TRT in 2025?

In 2025, Cigna does provide coverage for TRT, but only if the treatment meets its definition of medical necessity. Not all cases of low testosterone are automatically eligible, especially the cases that are related to aging or performance enhancement.

• In general, Cigna requires that patients meet the following coverage guidelines:
• A confirmation from a clinician that there is clinical hypogonadism
• At least 2-morning blood tests indicating low testosterone
• Symptoms that have been documented, like depression, poor libido, or exhaustion
• A treatment plan that is provided and monitored by a licensed physician.

Cigna covers testosterone replacement therapy that is medically indicated and not for bodybuilding, anti-aging or non-specific fatigue.

Types of TRT Covered by Cigna

Cigna covers multiple FDA-approved testosterone therapies; each has its unique advantages, and potential coverage will depend on clinical necessity, personal tolerance, and insurance plan characteristics.

Intramuscular Injections

Intramuscular injections are the most classic and most commonly prescribed form of testosterone replacement therapy. Intramuscular injections are given as testosterone enanthate or testosterone cypionate, both of which are well-studied compounds that come in a very affordable generic formulation.

Key Features:

• Administered every 1–2 weeks
• Administered into the gluteal muscle
• Administration causes an initial peak and gradual then decline in hormones

Insurance Consideration:

Cigna will usually pay for an intramuscular injection if you provide laboratory and clinical documentation from your physician; if you need to adjust the dosage, make sure there is a new clinical indication.

Pros:

Affordable, well-studied and effective

Has been used as a clinical treatment for decades

Most patients have a good tolerability

Cons:

Hormonal highs and lows can induce fluctuation in mood and behavior

Anxiety about needles or discomfort at the injection site

Transdermal Patches

Testosterone patches are applied once daily. Patches offer a more stable delivery system for testosterone and serve patients who prefer a non-invasive routine.

Key Features:

• Worn nightly on the thighs or upper arms
• Mimics the body's natural testosterone rhythm.
• Delivers stable hormone levels

Insurance Consideration:

Patches can be used off-label but will be prescribed if injections are not appropriate. Cigna may ask for documentation of negative side effects with other methods. 

Pros:

• Easy to use
• Non-invasive
• Reduces the peaking of hormones 

Cons:

• Irritated skin can occur
• Being skinny can result in sweaty or oily skin and not adherence
• Need to apply every day 

Topical Gels and Creams

Topical treatments such as AndroGel or Testim have become popular because they embody an everyday routine and provide steady testosterone absorption. 

Key Features:

• Apply medicine to the abdomen, shoulders, or upper arms.
• Absorbs quickly through the skin
• Using it daily will maintain testosterone-consistent levels

Insurance Consideration:

Gels is considered a drug company to cover under Cigna, and patient-focused plans almost always cover the generic forms of drugs. However, very few plans with restrictions may require the patient to "fail" on injection first.

Pros:

• Painless and easy to apply.
• Will have testosterone-consistent levels.
• They are not popular on the gay market.

Cons:

• Risk of transfer to others. 
• It could be cost-prohibitive without insurance. 
• It could cause dry or irritated skin. 

Buccal Tablets

The buccal method is the small tablet you place between your tooth and the inside of your lip allowing the testosterone to be absorbed through the oral tissues. 

Key Features:

• Use a buccal tablet 2 times daily. 
• It is easy to put on and discreet. 
• Testosterone avoids liver metabolism. 

Insurance Consideration:

Buccal is usually covered unless the patient is unable to tolerate skins or injection-based therapies. If your patient has tried to use patches or injections - the doctor needs to document in detail "tolerance" as the patient will access buccal. 

Pros:

• Includes no skin or needle contact
• Will have testosterone-consistent levels.
• Simple use on-the-go.

Cons:

• Potential discomfort in gums
• Can hinder eating or speaking
• Less common and widely available

Subcutaneous Pellets (Testopel)

These long-acting implants gradually release testosterone over several months and are implanted through a simple in-office procedure.

Key Features:

• Subcutaneously implanted every three to six months.
• Provides constant hormone supply.
• No daily or regular maintenance.

Insurance Consideration:

Often classified as elective or non-essential due to the cost to the insurance company. Coverage may occur after the failure of other modalities.

Pros:

• Long-lasting and easy.
• Great option for patients who want less frequent dosing.
• High satisfaction.

Cons:

• Minor surgical procedure.
• Pellet extrusion or infection is a risk.
• It may not be covered without a strong clinical rationale.

What Happens If Cigna Denies Your TRT Claim?

Don't worry—TRT denials regularly happen, but most can be addressed with some extra effort.

Understand the Reason for Denial

Always carefully examine your Explanation of Benefits (EOB) or denial letter.

Common Denial Reasons Include:

• Incomplete lab work or wrong date ranges
• Inadequate documentation of symptoms
• Prior authorization was not submitted
• Treatments outside of FDA approval

What You Should Do:

• Call your doctor's office for clarifying details.
• Request a full copy of the insurance application.
• Confirm labs and notes are complete and in compliance with date ranges.

File an Appeal

If you find that your denial is wrong or incomplete, you are entitled to an appeal.

Steps to File an Appeal:

• Have your physician write a detailed letter of medical necessity
• Include lab results, symptoms, and methods attempted for treatment
• Resubmit with supporting literature if necessary

Helpful Tips:

• Stay organized & maintain duplicates.
• Be persistent in following up routinely.
• Ask your doctor to help the appeal with current medical research.

Consider Paying Out-of-Pocket

If time or bureaucracy is an obstacle, you can opt to simply continue without insurance.

Why Many Choose This Route:

• Access therapy immediately.
• Choice in method of treatment.
• No prior authorizations.

Out-of-Pocket Options Include:

• Subscription-based telemedicine services
• Direct-pay TRT clinics with transparent pricing
• Discount cards or manufacturer rebates

Some TRT clinics offer subscription models that loop labs, prescriptions, and virtual visits into a flat fee.

Typical Monthly Costs (Without Insurance)

• Initial consultation: $0 - $249
• Monthly TRT medication + follow up: $149 - $249

Limitations and Exclusions in Cigna’s TRT Coverage

Knowing what Cigna does not cover will help to avoid some surprises.

Non-Covered Situations Include:

• TRT for aesthetic or athletic purposes
• TRT without a clinical diagnosis
• Age-based decline in testosterone
• Use of compounded or non-FDA-approved formulations
• Deficiencies in diagnostic testing

Coverage Duration Limits

• There is a limit to the time Cigna will approve treatment.
• There are ongoing visits and lab updates required.
• You must show measurable improvement to continue treatment.

Cost Breakdown: With vs. Without Insurance

Here’s what you’ll spend based on usage with insurance:

With Cigna Insurance

• Doctor Appointments: $20-50 co-pay.
• Lab Work: Usually no or little cost. 
• Medication: $20-75 a month.

Without Insurance

• Consultation & Lab: $150-300.
• Medication: 150-400 a month.
• Subscription Clinics: $149–249 a month. 

For many this is consistent pricing and faster access to care, particularly for consumers that don’t have plans to cover your costs.

Is Using Cigna for TRT Worth It?

Whether you prefer to save costs or have convenience generally is going to control the decision.

Pros of Going Through Insurance:

• Cost reductions
• Connections to primary care
• Retail pharmacy options

Cons of Going Through Insurance:

• Longer approval processes (but potentially more out-of-pocket costs)
• More paperwork/authorizations
• Limited access to newer therapies

Alternative Financial Options for TRT in 2025

If you are denied coverage by Cigna, don't fret - you can still get care:

1. TRT Subscription Clinics

These clinics have all-inclusive plans that cover:

• Consults
• Testing
• Therapy

Monthly packages can range from $149-$249 with a very simple and fast enrollment process.

2. Manufacturer Coupons and Rebates

There may be savings cards or patient assistance programs for topical and injectable testosterone medications as well.

Examples may include AndroGel and Testim discount offers. 

3. Use Health Savings Accounts (HSA/FSA)

TRT usually qualifies for funds from HSA/FSA which is probably the most tax-efficient way to pay for your TRT costs.

Conclusion

In 2025, Cigna will be covering TRT—however, it will be very restricted to those defined clinical criteria. You must have the correct diagnosis, appropriate lab tests, and solid documentation for approval. While working with insurance can be complex, there are alternatives and support out there – especially from a world-class TRT provider. 

Looking for a simpler and easier option? Check out The KIF - a leading authority in testosterone therapy that removes the burden of managing your care. 

The KIF Offers: 

• $0 Initial Consultation
• Complete TRT Start Program: $249 
• Monthly Subscription (Telehealth + Medication): $149 
• No Insurance Hassles 

Visit TheKIF.com/TRT today to schedule your free consult and begin the process of restoring your energy, confidence, and wellness.