The Policy Blind Spot Around Menopause Care in the United States
- Shriya Mehta
- Jan 5
- 2 min read
Health care policies determine whether women can access needed medical care at different stages of their lives, shaping their health outcomes and financial stability. Yet in the United States, menopause, which is an investable biological transition affecting more than half the population, remains largely invisible in health care policies.
Despite its association with increased risks of osteoporosis, cardiovascular disease, sleep disorders, and depression, menopause care is frequently treated as discretionary or nonessential within most US insurance companies.
These gaps stem from how federal preventative care policy, Medicare benefits, and state-level Medicaid rules are designed. As the postmenopausal period now spans decades for many women, these limitations have lasting implications for women’s health.
A main source of this gap is due to the design of preventative services coverage under the Affordable Care Act (ACA) . Section 2713 of the Public Health Service Act requires private insurers to cover preventative services without ghost-sharing only if those services receive an “A” or “B” recommendation from the U.S. Preventative Services Task Force (USOSTF). While this framework expanded access to contraception, cancer screening, and well-women visits, it excludes menopause symptom management by design. The USPSTF recommends against the use of menopausal hormone therapy for the primary prevention of chronic disease (Grade D), and it does not issue coverage-triggering recommendations for hormone therapy used to treat vasomotor symptoms such as hot flashes or night sweats. As a result, insurers are under no legal obligation to cover menopause treatments without cost-sharing even when they are clinically indicated.
The distinction between prevention and symptom management directly impacts coverage of hormone therapy. Although major medical organizations recognize hormone therapy as the most effective treatment for moderate to severe menopausal symptoms, inquirers frequently use many utilization management tactics to prevent the use of this therapy. Some of these tactics include placing these medications on non-preferred formularies or requiring prior authorizations. Because menopause care is not included in the ACA’s women’s preventative-service mandate, coverage decisions are left to individual plans which results in wide variation in access and substantial out of pocket costs. Newer non-hormonal therapies approved for menopausal symptoms face similar barriers, reinforcing the idea that menopause treatments are optional instead of medically necessary.
Medicare and Medicaid policies further reinforce these gaps in menopause care. Traditional medicare (Parts A and B) does not cover outpatient prescription drugs, including hormone therapy, requiring beneficiaries to enroll in Part D or Medicare advantage plans for coverage. Although Medicare covers bond-density screening, routine no-cost DEXA scans are generally limited to women aged 65 and older, even though menopause -related bone loss often begins earlier. Medicaid coverage is even more fragmented, as states retain broad discretion over whether menopause-related treatments are included in their formularies and under what conditions, resulting in a lot of variation in access and cost-burden actress states.
These coverage gaps have clear consequences. Women without access to menopause care face higher risks of osteoporosis, sleep disturbance and cardiometabolic disease. Barriers are greater for low-income women and women of color who are less likely to receive counseling or treatment. Untreated symptoms are also linked to missed work and earlier exits from the labor force. Despite this, menopause is rarely addressed in federal insurance or workplace policy.
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