HRT in Maryland: 2026 Prices, Online Providers and What CareFirst or Medicaid Will Pay

Updated October 12, 2026. We read Maryland's telehealth and nursing rules, CareFirst's 2026 drug list and the Maryland Medicaid drug list that day. Each price comes from the provider's own listing in the past three weeks.

In a hurry? Find your situation below, then look up that provider in the table above.

• Cheapest start: Winona, from about $40 a month for one product, with no consult fee.
• A fee that halves: Inner Balance, about $100 a month from month seven.
• A CareFirst, Aetna, Cigna or UnitedHealthcare plan: Midi Health, which bills your plan for the visit.
• A low-cost membership with messaging: Evernow, about $35 a month on a prepaid year, with medicine extra.
• A Menopause Society-certified doctor: Alloy, from about $40 a month after a one-time $49 consult.
• Already have a prescriber: coupon generics, or The HRT Club.
• On Maryland Medicaid: a clinician who accepts your HealthChoice plan, since none of these online services takes Medicaid.

What does hormone replacement therapy cost in Maryland, and which online services serve the state?

Maryland doesn't change what these services charge. It shapes two other things: who may treat you, and what CareFirst or Maryland Medicaid must cover.

You can pay in three ways. A subscription bundles the visit and the medicine into one charge. A membership or insurance-billing service charges for care and sends the prescription to a pharmacy. A coupon generic costs least once you already have a prescriber.

Winona: best for a low first bill and no bloodwork

Maryland is one of the 37 states on Winona's list, along with Puerto Rico. You pay per product, with no consult fee and no bloodwork. Progesterone capsules alone cost about $40 a month. The estradiol patch costs the most, at about $150.

The patch, tablets and capsules are FDA-approved. The creams are compounded, meaning mixed to order, in pharmacies Winona owns. You can pay with an HSA or FSA card, the tax-free health accounts many employers offer. Winona doesn't take insurance.

Winona rates 4.6 on Trustpilot from about 8,600 reviews. Most complaints are about automatic refills and cancelling. It offers no video visit and no testosterone. Our Winona review explains how to cancel cleanly.

Inner Balance: best for a fee that halves after six months

Inner Balance charges about $200 a month for the first six months. That covers the evaluation and Oestra, its only treatment. Oestra is one compounded cream that holds estradiol and progesterone. You apply it vaginally, and it acts on the whole body. From month seven, the fee drops to about $100. Labs are optional.

Its review record is thin, at 2.3 on Trustpilot from 32 reviews. Most complaints are about cancelling, and a dose change may cost extra. Read the two-deadline refund terms in our Inner Balance review before you pay.

Alloy: best for Menopause Society-certified doctors

Alloy treats menopause in all 50 states and DC. You pay a one-time $49 consult, then a price for each product, with no membership. Every prescribing doctor is certified by The Menopause Society, the main US medical group for menopause care.

The estradiol pill costs least, at about $40 a month. Patches ship and bill every three months, so the charge lands once a quarter. On a first order, code PILL25 takes 25 percent off the pill, and HRT25 does the same for Evamist spray.

Care runs by message, with no video and no labs. Alloy rates 4.3 on Trustpilot from about 3,990 reviews. Our Alloy review has the full picture.

Midi Health: best if you want CareFirst or another plan to pay for visits

A PPO, or preferred provider organization, is a plan that lets you see specialists without a referral. Midi says it's in-network with most PPO plans. In network, you pay your specialist copay, a set fee per visit. You also pay any deductible left, the amount you owe each year before your plan starts paying.

Midi's Maryland page names four carriers. They are CareFirst BlueCross BlueShield, Aetna PPO and HMO plans, Cigna PPO and Open Access Plus plans, and UnitedHealthcare. Out of network or uninsured, the first visit costs $250 and each follow-up costs $150.

All four Maryland clinicians Midi shows are nurse practitioners. Visits are by video, prescriptions go to your local pharmacy, and labs are billed separately. Midi rates 4.1 on Trustpilot from about 1,700 reviews. Midi Health and insurance goes plan by plan.

Evernow: best for a low-cost membership with messaging

Evernow treats menopause only and says it serves all 50 states plus DC. The membership costs $49 month to month, $129 for three months, or $420 for a year paid upfront. That last plan works out to about $35 a month.

The membership covers round-the-clock messaging with a clinician, prescriptions and refills. Video visits cost extra. Evernow bills them to the insurers it names nationally: Blue Cross Blue Shield, Anthem, UnitedHealthcare and Aetna. Otherwise a visit costs $150, and medicine is billed separately.

Its estradiol patches and vaginal estradiol cream are FDA-approved. That cream is free on the 3- or 12-month plan if you qualify. Some products, such as a facial estriol cream, are compounded. The Trustpilot profile is small and unclaimed, at 2.0 from 15 reviews, and its terms set out no general refund policy. Our Midi Health vs Evernow comparison sets the two side by side.

The HRT Club: best if a doctor already prescribes for you

The HRT Club is not a clinic. It's a mail-order pharmacy membership with a free directory of prescribers. The basic tier costs nothing. Membership costs $12 a month or $99 a year.

Members pay $15 for 30 capsules of generic progesterone, against $135 for guests. It suits you if a Maryland doctor already writes your prescription and you pay cash to fill it.

The weak spots are no refunds, an annual plan you can't end early, and no Trustpilot reviews yet. Our HRT Club review lists what gets discounted.

Generic estradiol and progesterone at a Maryland pharmacy

With a prescription in hand, a generic with a coupon card usually costs least. The coupon row shows GoodRx national prices, not a quote for a Baltimore or Frederick ZIP code. Your pharmacy's price may be a little higher or lower.

At those prices, 30 estradiol tablets cost about $15. A month of patches costs about $35. A month of micronized progesterone, the body-identical form of the hormone, costs about $15, against about $50 without the coupon.

If you have insurance, compare the coupon price with your plan's copay and pay whichever is lower. The HRT savings guide explains how the cards work.

A year of HRT in Maryland

• Winona, estrogen and progesterone cream: about $1,070 a year. The patch with a progesterone capsule comes to about $2,255.
• Inner Balance: about $1,790 in year one, then about $1,195 a year.
• Alloy, patch and progesterone: about $1,525 in year one with the consult, then about $1,475. The pill with progesterone comes to about $805 in year one.
• Evernow: about $570 for a prepaid year plus one self-pay visit, or about $740 paying monthly. Medicine is extra.
• Midi Health: your specialist copay per visit if you're in network. Paying cash, a first visit and three follow-ups cost $700, with medicine extra.
• Your own prescriber and coupon generics: about $360 a year with tablets and progesterone, up to about $600 with patches, plus your prescriber's visit fees. The HRT Club adds $99 a year if you fill through it.

Is HRT online legal in Maryland, and who can prescribe it?

Yes. Maryland's telehealth law starts at section 1-1001 of the Health Occupations Article. It covers live video and asynchronous care, where you send your history and a clinician reviews it later.

A clinician can start treating you through either kind of visit. First, they must confirm who you are and give you their name, contact details and license type. They also need your spoken or written consent.

No general rule requires an office visit first. The Board of Physicians holds telehealth to the same standard of care as an office visit. If something can only be checked in person, the clinician should see you in person.

Phone visits count too. The Preserve Telehealth Access Act of 2021 let insurers and Medicaid treat a covered phone-only visit as telehealth, at first for a limited time. A 2025 law made that permanent from June 1, 2025.

The same 2025 law kept payment parity for good. That means plans and Medicaid pay the same rate for a telehealth visit as for the same visit in an office.

Midi Health and Evernow use video visits. Winona and Alloy start with a written health history that a doctor reviews later, then follow up by message. Each one sends an electronic prescription.

A DC or Virginia doctor treating you in Maryland

Many Maryland women work in DC or Northern Virginia and see a doctor near the office. The Board of Physicians says a doctor must be licensed in Maryland to treat patients in Maryland, including by telehealth.

What counts is where you are during the visit. A doctor without a Maryland license can't keep prescribing by video while you're home in Bethesda or Silver Spring. Take the call from your desk in DC, and DC's rules apply instead.

Getting that license is easier than in some states. Maryland joined the Interstate Medical Licensure Compact on July 1, 2019. The compact is a faster licensing route for doctors already licensed in another member state.

Nurse practitioners prescribe without a supervising doctor

A 2015 law, Chapter 468, ended the rule that Maryland nurse practitioners file a collaboration agreement with a physician. It took effect on October 1, 2015. Since then, they practice and prescribe on their own license.

One condition applies to brand-new nurse practitioners. Under Board of Nursing rules, a nurse practitioner certified for the first time names a mentor for 18 months. The mentor is a nurse practitioner or Maryland doctor with three years of practice, available for advice as needed.

Estradiol and progesterone fit easily within that authority. All four Maryland clinicians Midi shows are nurse practitioners, so a nurse-led online visit is fully legitimate here.

Testosterone follows tighter rules

Testosterone is a Schedule III drug, a federal class of controlled medicines with extra prescribing rules. Prescribing it by telemedicine with no prior in-person exam relies on temporary federal rules that run through December 31, 2026.

Maryland adds two steps for the prescriber. They need a state Controlled Dangerous Substances registration from the Office of Controlled Substances Administration. Before getting it, they must sign up for the state's prescription drug monitoring program through CRISP, Maryland's health information exchange.

No testosterone product is FDA-approved for women. The evidence supports it mainly for low sexual desire after menopause. Midi lists Maryland among the states for its compounded testosterone, which starts with a video visit and labs.

Will CareFirst, Maryland Medicaid or Medicare pay for HRT?

For the medicine, usually yes. For a telehealth membership, no plan pays. Midi and Evernow are the exceptions for visits, because they bill some plans.

Maryland's coverage rule sits in section 15-139 of the Insurance Article. A state-regulated plan can't refuse a covered service just because it's delivered by telehealth. It must pay on the same basis and at the same rate as in person.

Self-funded employer plans, common at large companies, fall under a federal law called ERISA instead. Your HR team can tell you which kind you have.

CareFirst BlueCross BlueShield

Every plan publishes a formulary, its list of covered drugs sorted into price tiers. On CareFirst's lists, tier 1 holds generic drugs, the cheapest tier for most medicines.

CareFirst's 2026 Formulary 2 serves self-insured employer groups with 51 or more workers. It puts generic estradiol tablets, gel and weekly or twice-weekly patches on tier 1. Generic progesterone capsules sit on tier 1 as well.

None of those generics needs prior authorization, meaning advance approval from the plan. Brands cost more. Estrace tablets and EstroGel sit on tier 3, for non-preferred brands, so the generic is the cheaper covered route.

Your plan may use a different CareFirst list, so search yours for estradiol and progesterone in your online account. Midi's Maryland page names CareFirst among its carriers. Our HRT insurance guide explains how to read a formulary and appeal a denial.

Maryland Medicaid

Maryland expanded Medicaid under the Affordable Care Act. So a woman in her 40s or 50s can qualify on income alone, with no child or disability required.

Adults under 65 qualify with income up to 138 percent of the federal poverty level, or FPL, a yearly income line set by the federal government. In 2026, that's about $1,835 a month for one person.

Medicaid's Preferred Drug List doesn't include estrogens or progestins as a class. The list says classes it doesn't name stay covered as they always have. So generic estradiol and progesterone remain covered drugs.

Most members get care through a HealthChoice managed care plan. Since May 1, 2024, these plans charge $1 for a generic prescription. A pharmacy can't turn you away if you can't pay that copay. Each plan may set its own preferred list, so check yours.

None of the online services on this page takes Maryland Medicaid. You'll need a clinician who accepts your HealthChoice plan.

Medicare

Part D drug plans usually cover generic estradiol and progesterone. In 2026, your out-of-pocket costs for covered drugs are capped at $2,100.

Midi treats Medicare as out of network, so you'd pay its self-pay rate for the visit. Evernow doesn't support Medicare coverage either.

Bioidentical hormones and pellets in Maryland

Search for bioidentical hormones in Maryland and many results are cash-pay clinics selling creams or pellets. Bioidentical means a hormone shaped exactly like the one your body makes. It doesn't mean compounded.

The estradiol patch and micronized progesterone most services ship are bioidentical and FDA-approved. Compounded hormones are mixed by a pharmacy for one patient and never go through FDA approval.

In Maryland, the Board of Pharmacy licenses pharmacies, including those that compound. A pharmacy in another state that mails prescriptions to Maryland patients needs a Maryland nonresident pharmacy permit. That covers the mail-order pharmacies behind national telehealth brands.

Maryland tightened its rules after the 2012 national meningitis outbreak, which came from contaminated compounded steroid shots. A 2013 state law created a Board permit for sterile compounding.

Pellets are small compounded implants placed under the skin every few months. Pellet franchises such as Biote list certified providers in the Baltimore area. Pellets aren't FDA-approved, so expect to pay cash. Ask any pellet clinic for a written quote covering the pellets, insertion and labs.

The FDA asked the National Academies to review compounded bioidentical hormones. Their 2020 report found no strong evidence that they're safe or effective. ACOG and The Menopause Society both favor FDA-approved hormone therapy whenever an approved product exists.

FDA-approved products also carry updated safety labels. In February 2026, the FDA approved the first labels that drop breast cancer, heart disease and dementia statements from the boxed warning, its most prominent caution.

On this page, Alloy's core protocol, Midi's default treatments, Evernow's patches and vaginal cream, and the coupon generics are FDA-approved. Winona offers both kinds, and Inner Balance's Oestra cream is compounded. If you want compounded hormones on purpose, compounded HRT: where to get it covers what to check.

Finding a menopause doctor or specialist in person in Maryland

Start with The Menopause Society's online Find a Menopause Practitioner directory. You can search by ZIP code, or by state for clinicians who offer telehealth. It lists Society members and Menopause Society Certified Practitioners, often shortened to MSCP.

Johns Hopkins runs the Center for Menopause and Midlife Health, formerly its Women's Wellness and Healthy Aging Program. Specialists in women's heart health, bone health, sexual health and psychiatry work together there. A patient navigator arranges the right consultations.

The Johns Hopkins menopause clinic sees patients at Green Spring Station in Lutherville, by referral only. Hopkins says telemedicine may be available to Maryland residents.

Downtown, the University of Maryland School of Medicine runs a Menopause Program within its OB-GYN department. Its clinic meets on alternate Fridays on Redwood Street in Baltimore.

From the Eastern Shore or Western Maryland, those programs can be a long drive. Midi's Maryland page names Salisbury and Hagerstown among the cities it serves by video.

A local visit adds a physical exam, which no online service on this page offers. Our guide to finding perimenopause care explains how to vet a local clinician. HRT near me covers when an online clinician beats the nearest office.

Starting HRT in Maryland: timing, labs and the questions to ask

Many women hear they're too young for hormones. The Menopause Society's 2022 position statement finds the benefits outweigh the risks for most healthy women with symptoms. That applies to women under 60, or within ten years of menopause.

Perimenopause comes before that last period, so it sits inside the window. You usually don't need blood tests to start, because hormone levels swing too much to confirm it. Winona and Alloy prescribe on symptoms, with no labs. Perimenopause labs explains what a panel can and can't show.

Before you commit, ask any Maryland prescriber these four questions, online or in an office.

• Training: Are you Menopause Society certified, or trained in menopause care?
• First choice: Do you start with FDA-approved estradiol and micronized progesterone before anything compounded?
• License: Do you hold a Maryland license, even if your office is in DC or Virginia?
• Coverage: Can you send the prescription to a pharmacy in my CareFirst network, or one my HealthChoice plan accepts?

How your dose gets settled after you start is covered in our HRT dosage guide.