What Online Menopause Care Costs — and When Insurance Pays

Online menopause programs bill in one of two ways, and the two services here sit on either side of the line.

Route 1: bill your insurance (Midi Health)

Midi’s pricing page says it “is in-network with most major insurance plans nationwide” and “is in-network with most PPO plans,” and it works in all 50 states. If your plan is one of them you pay your plan’s cost-share; if it is not, the flat price sits in the same sentence: “Self-pay is $250 initial, $150 follow-up.” That buys a 30-minute first visit, or 15 minutes on a return, and medication and labs are billed separately: “The visit price does not include the cost of labs or any prescription medications.”

Route 2: pay cash for the medication (Winona)

Winona works the other way round: it “does not accept insurance at this time” and publishes no consultation fee. It prices the medication, from “From $39 per month” for progesterone capsules to “From $149 per month” for the estrogen patch, shipping included, and its policy states: “There is no long-term agreement or subscription fee associated with a Winona account.”

So this is visit fees plus a pharmacy bill against one recurring medication charge, and both publish enough to do the arithmetic first. Full detail: our Midi Health review, our Winona review and the menopause clinics hub.

Midi names five carriers: Blue Cross Blue Shield, Health Net, UnitedHealthcare, Cigna and Aetna. In-network with a carrier is not the same as covered on your plan, and Midi says so: “Coverage, deductibles, coinsurance, and copays vary by plan.”

• The average. Midi’s help center says insured patients “pay around $50 out-of-pocket per visit” on average.
• Before a deductible is met. The same article describes a deductible of up to $250 on a new patient visit and $150 on a follow-up, plus copay or coinsurance.
• Self-pay. “Self-pay is $250 initial, $150 follow-up,” repeated in the help center.
• Minnesota. For Blue Cross Blue Shield PPO plans there, Midi says “Herself Health handles billing on Midi’s behalf.”
• Government plans are out. “Medicare is out of network with Midi,” and Midi is “not able to accept Medicaid or Medi-Cal patients at this time.”
• Pre-tax money. Midi: “Your HSA or FSA can be used to pay for Midi visits and services.” Winona: “our bioidentical HRT is HSA & FSA-eligible.”

Why a prescribed hormone can still carry a copay

The visit and the prescription are two bills. Your plan decides the second from its formulary, which HealthCare.gov defines as “A list of prescription drugs covered by a prescription drug plan”. A covered hormone sits in a tier with its own copay; one that is not on the list is billed to you in full.

Hormone therapy is also not a no-cost preventive service. HealthCare.gov’s preventive list for women covers “Well-woman visits to get recommended services for all women” and “Bone density screening for all women over 65 years” — prescription hormone therapy is not on it. CMS says services graded A or B by the U.S. Preventive Services Task Force “will be covered under these rules.”

Before the prescription is sent, ask your plan which tier the product sits in and the copay there; our guide to menopause hormone therapy basics names the categories. Midi’s Custom Rx prescription products are cash-pay whatever your plan: “starting at $40/month” at the low end, $90 for a 30-day DHEA/estradiol cream, $149 for the Estriol+ face cream and $179 for a 30-day Sermorelin course. The store pages do not say whether they are compounded preparations.

Winona prices every product on one page. These are floors: what you are prescribed decides the charge.

• Progesterone Capsules — “From $39 per month”
• Estrogen Tablets — “From $54 per month”
• Estrogen Body Cream, Estrogen Body Cream (with Progesterone), Progesterone Body Cream and Vaginal Estrogen Cream — “From $89 per month” each
• Estrogen Patch — “From $149 per month”
• DHEA — “From $27 per 3-month supply” (our calculation: $27 ÷ 3 = $9 a month)
• Non-hormone items — “$150 per 3-month supply” each for the Estriol Face Cream with Tretinoin and the Minoxidil Hair Serum (our calculation: $50 a month), and Sildenafil Arousal Cream “$79 per order”

Winona’s FAQ lists 37 states plus Puerto Rico, and hormone therapy for ages 35–59.

Which of these carry FDA approval

Winona’s pages answer differently, so ask about the product you are prescribed. Its hormone therapy page names estrogen patches, tablets and progesterone capsules among the forms it calls FDA approved, and describes the body creams as patient-specific formulations “not regulated or approved by the FDA.” Its 503A pharmacy page and a help-center article say the treatments are not FDA approved, and its treatments page tags “Pills” as “Compounded.” Winona has not said which is current.

A compounded preparation is mixed for an individual patient and does not carry FDA approval; the agency does not review such drugs for safety, effectiveness or quality before they are marketed, and says many products sold as “bioidentical hormones” are compounded drugs of that kind.

Shipping, and what “no subscription fee” means

Shipping is “Free via USPS Ground Advantage (2–5 business days),” or paid and priced: “USPS Priority ($15), FedEx Ground ($25), FedEx Overnight ($50-$75).” Orders wait 24 hours, then take 1–2 business days to ship.

No subscription fee means no platform charge on top of the medication: the price you see is the whole recurring bill. It does not mean a single charge — refills run automatically “every 28 days (30-day supply) or every 84 days (90-day supply),” and each is a new charge, though you can pause for 30, 60 or 90 days. One exception: “A $50 monthly platform fee applies if patients use outside pharmacies instead of Winona’s compounding services.”

Lab tests, and who pays

Midi’s process page says clinicians “may order labs to understand the full picture,” naming a “metabolic panel, thyroid testing, and insulin sensitivity markers.” Those sit outside the visit fee, and whether the charge reaches your insurer is not stated on the pages we read — ask before the draw.

Winona requires none: “Winona does not require any type of bloodwork or hormone testing,” a position it attributes to The Menopause Society and ACOG, with its homepage repeating “No lab work needed.” So the lab line is $0 unless you choose to test.

Follow-up visits

Midi’s returning visits cost your plan’s cost-share or $150 self-pay, and you can follow up “as often as you need,” so the number of visits sets the yearly bill. Winona advertises “Free, unlimited follow-ups” through its portal; it offers no phone or video calls, so those are messages, not appointments, and add nothing to the monthly price.

The Good Faith Estimate you can ask for

Paying cash on either route, you are entitled to a written estimate of the charges. CMS: “A good faith estimate shows the list of expected charges for items or services from your provider or facility.” Self-pay and uninsured patients get one when scheduling care or on request, covering the primary service plus “Any other items or services you’re reasonably expected to get as part of the primary item or service for that period of care.”

Point at that clause when a program quotes a visit fee but not the labs and medication around it.

Every figure below is our calculation from the prices above, with the maths shown.

Midi: a year of visit fees

• Self-pay, one initial visit and two follow-ups — our calculation: $250 + (2 × $150) = $550.
• Self-pay, one initial and three follow-ups — our calculation: $250 + (3 × $150) = $700.
• Insured, three visits at Midi’s stated $50 average — our calculation: 3 × $50 = $150.
• Insured with an unmet deductible, three visits — our calculation: up to $250 + $150 + $150 = $550, matching self-pay until the deductible is met.

Labs and medication sit on top of all four.

Winona: a year of medication

Start with the refill clock: a 30-day supply refills every 28 days, so our calculation is 365 ÷ 28 = 13 charges a year.

• Progesterone capsules at $39 — our calculation: $39 × 13 = $507 ($468 on twelve charges).
• Estrogen tablets at $54 — our calculation: $54 × 13 = $702.
• Any of the $89 creams — our calculation: $89 × 13 = $1,157.
• Estrogen patch at $149 — our calculation: $149 × 13 = $1,937.
• DHEA at $27 per 3-month supply, refilled every 84 days — our calculation: 365 ÷ 84 = 4 refills, 4 × $27 = $108.

Standard shipping adds nothing. Two products bill as two lines — our calculation: ($89 + $39) × 13 = $1,664 — while Winona sells an Estrogen Body Cream (with Progesterone) as one item at “From $89 per month.”

Read together: Midi is $150 to $700 a year in visit fees plus whatever the hormones cost through your plan or pharmacy; Winona is $507 to $1,937 a year for the hormones, with no visit fee. Which wins turns on the figure neither company can give you — what your plan pays for the prescription.

Midi runs two clocks

Midi’s platform terms say your card is “automatically charged at regular intervals” until you cancel, and that a subscription renews “unless you cancel at least two (2) days before the applicable renewal processing date.” You can cancel by email, by phone on 1-888-731-8994, or in your account. The supplement shop is a separate document with a different deadline — “at least three (3) business days prior to the shipment date” — so holding both means tracking two dates.

On refunds, the platform terms say “We do not offer refunds for partially used subscription periods”; the shop refunds a first purchase in full within 30 days of delivery, though supplements cannot be returned.

Winona runs a 24-hour window

Winona’s terms say your card is charged “unless and until you cancel,” and that “charges are non-refundable once incurred.” A full refund is available “within the 24-hour window only” after an order, because once the pharmacy has prepared a patient-specific medication it “cannot be refunded, returned, or re-dispensed to another patient.” Refunds take up to seven business days, and cancelling runs through the portal, under “Manage Prescription” for one order and “Your Account” for the plan.

What federal law requires of both

The Restore Online Shoppers’ Confidence Act (ROSCA) covers any automatically renewing online plan. It requires a seller to disclose “all material terms of the transaction before obtaining the consumer’s billing information,” to obtain “express informed consent” before charging, and to provide “simple mechanisms for a consumer to stop recurring charges.”

The FTC’s stronger 2024 “click-to-cancel” rule is not in force: the Eighth Circuit found the Commission’s failure to issue a preliminary regulatory analysis “procedurally insufficient” and vacated it, and the FTC’s final rule of February 12, 2026 restores the Negative Option Rule “in the form it existed before the 2024 Rule became effective.” Its rule page lists an advance notice of proposed rulemaking dated March 11, 2026; nothing later was in force on September 18, 2026.

Before the first charge, write down the date of the second and the deadline for stopping it. Then compare the services in full: Midi Health, Winona, or the menopause clinics hub.