How five states are creating insurance models for menopause treatment

If you live in New Jersey, your health insurer is now required by law to cover hormone therapy, pelvic floor physical therapy, bone density screenings, and mental health care related to menopause. If you live in most other states, none of that is guaranteed.

As of mid-2026, five states have enacted insurance mandates requiring coverage for menopause treatment, 19 states have introduced legislation, and in the rest of the country, coverage is left entirely to the discretion of individual insurers.

More state action means more women can get the treatment, care, and prescriptions that many have been paying for out of pocket or not taking at all. Each piece of legislation is a concrete model for future action.

Why It Matters

There is no federal mandate requiring health insurers to cover menopause treatment. The Affordable Care Act covers preventive services, but hormone replacement therapy is not classified as a standard preventive service under federal law. What a woman can access and what she pays depends almost entirely on her state.

The financial stakes are concrete. Without coverage, hormone therapy runs $500–$1,000 a year out of pocket. Pelvic floor physical therapy can cost $150–$300 per session. For most women, these costs land precisely during peak earning year, the average age of menopause in the U.S. is 52, when career advancement and long-term financial security are most at stake.

The access problem is compounded by a bureaucratic one. Insurers have historically required step therapy, which forces women to try cheaper drugs first and prove they failed before approving hormone therapy. Prior authorization delays can stretch weeks. For women managing disruptive symptoms, that wait is not administrative; it is personal.

Background

Until 2023, no state required health insurers to cover menopause treatment. Coverage was discretionary and almost never discussed at the point of care, leaving women to discover the gap only after receiving a bill.

The void reflected two decades of institutional inertia. The FDA’s black box warning on estrogen products — added after a 2002 study linked high-dose hormone therapy to elevated cancer risks — had chilled prescribing for years. Fewer than a third of OB-GYN residency programs included structured menopause training. And because menopause was culturally framed as something to endure rather than treat, no insurance infrastructure was created that conditions like diabetes or hypertension take for granted.

What changed was science, data, and organized advocacy. Mayo Clinic studies put a price tag on the problem: $1.8 billion a year in lost workplace productivity alone. The FDA removed the black box warning in 2025. A bipartisan network of state legislators began translating the data into bills.

Which States Require Coverage

Illinois was the first state to act. Its original 2023 law required coverage of medically necessary hormone therapy for women with surgically induced menopause from hysterectomy. Then, HB 5295, which took effect Jan. 1, 2026, expanded that mandate to all women experiencing menopause or perimenopause. All group and individual health insurance plans must cover medically necessary hormonal and non-hormonal therapy when recommended by a licensed provider and supported by peer-reviewed research.

Critically, the law requires coverage for every FDA-approved delivery method — oral pills, transdermal patches, topical gels, and vaginal rings — closing a common insurer workaround of covering some forms while denying others. The Medicaid program was expanded in parallel to cover induced menopause care (like menopause triggered by cancer treatments, hysterectomies, or other medical conditions).

Louisiana followed in 2024 with a law that went further than most. It required coverage for medically necessary menopause care and explicitly banned step therapy and prior authorization for hormone therapy, directly targeting the bureaucratic barriers that had made coverage technically available but practically inaccessible.

Oregon and Washington both enacted laws effective Jan. 1, 2026, though with narrower scope. Oregon’s HB 3064 requires state-regulated health plans to cover hormonal therapy and the prevention and treatment of osteoporosis for people in perimenopause, menopause, and postmenopause — a meaningful mandate, though it does not extend to the full spectrum covered by New Jersey or Illinois.

Washington’s HB 1971 takes a different angle: it requires plans to cover up to a 12-month supply of hormone therapy at one time, reducing the pharmacy barriers that forced women into repeated approvals for ongoing prescriptions. It applies to hormone therapy broadly, including for menopause, but is a dispensing access law rather than a comprehensive coverage mandate.

Then in January 2026, New Jersey enacted the most comprehensive menopause insurance mandate in the country. The New Jersey Menopause Coverage Act requires insurers to cover hormonal and non-hormonal therapies, pelvic floor physical therapy, bone health screenings, behavioral health care, and preventive services for associated conditions like cardiovascular disease and osteoporosis. Insurers must treat menopause at the same coverage level as any other medical condition — no special prior authorization, no tiered access.

Ohio, Massachusetts, Pennsylvania, Virginia, and New York all have bills actively advancing. Ohio’s lawmakers have specifically cited the $500–$1,000 annual out-of-pocket cost as the harm their bill addresses. California remains the cautionary case: Gov. Gavin  Newsom vetoed comprehensive mandates twice, in 2024 and 2025. While he has signaled possible budget inclusion, advocates warn that budget provisions are temporary and easily cut.

What Changes for Women

For women on state-regulated plans in mandated states, the differences are tangible. A New Jersey woman can now see a menopause specialist, get a hormone prescription, begin pelvic floor therapy, and schedule a bone density scan all at standard cost-sharing rather than full out-of-pocket. She cannot be required to fail a cheaper drug first. She cannot be denied coverage because her insurer treats hormone therapy as elective.

The limits are equally clear. State mandates apply only to state-regulated plans. Self-insured employer plans — which cover roughly 60 percent of privately insured Americans — are governed by federal ERISA law and are not bound by state mandates. A woman at a large corporation in New Jersey may have the same insurer as her neighbor and none of the same protections. The mandate governs the plan’s structure; it does not follow the patient.

Related WRDI Reporting

(Explainer) From whispered complaint to public priority: Menopause is finally a policy issue (June 26)
More state Medicaid programs cover menopause, but progress is slow (June 26)

Resources

Live Insurance News - 5 States Now Require Insurers to Cover Menopause Treatment
NJ Governor’s Office - Governor Murphy Signs the Menopause Coverage Act
NJ Assembly Democrats - Menopause Coverage Act Bill Summary
Louisiana Legislature - ACT 784 (HB 392) Full Text
FDA - Labeling Changes for Menopausal Hormone Therapy Products
Mayo Clinic - Price Tag on the Cost of Menopause Symptoms in the Workplace
Ms. Magazine - What’s Next for Menopause Legislation in Your State?
News From The States - Menopause Coverage Bills Meet Mixed Fates
The ‘Pause Life - 2026 State Summary of Menopause Bills
Meno & Money - States That Have Passed Menopause Laws
Katie Couric Media - State-by-State Menopause Legislation Tracker
healthinsurance.org - What Is Step Therapy?