Last checked November 2026 against 20 sources · Editorial policy
Midi vs Alloy: insurance-based visits or cash-pay HRT
Midi Health bills video visits to insurance and is in-network with most PPO plans; without coverage the first visit is $250. Alloy takes no insurance but charges a $49 one-time fee, with FDA-approved estradiol pills from $39.99 a month. Both work in all 50 states. Choose Midi if your plan covers it, Alloy if you pay cash.
Midi Health vs Alloy side by side: first-visit cost, insurance and Medicare, HRT prices, testosterone, GLP-1s, states and Trustpilot, checked November 2026.
Midi vs Alloy side by side
| Midi Health | Alloy | |
|---|---|---|
| How it works | Video visits with a clinician, billed to insurance. | Online intake; a doctor replies within 12 hours; medicines shipped. |
| To start | $250 self-pay first visit, or your copay. | $49 one-time consult fee. |
| Ongoing fees | $150 per self-pay follow-up. | None; unlimited doctor messaging. |
| Insurance | In-network with most PPO plans. | No; receipts can go to a PPO plan, HSA or FSA. |
| Medicare and Medicaid | Medicare self-pay only, no claims; no Medicaid. | Not billed: no insurance. |
| Estradiol pill | FDA-approved; billed separately, may be covered. | From $39.99 a month. |
| Estradiol patch | FDA-approved; billed separately, may be covered. | $100 a month. |
| Progesterone | Prescribed with estrogen if you have a uterus. | From $23 a month. |
| Non-hormonal hot flash drugs | Non-hormonal options; no drugs named. | Paroxetine, $34.99 a month. |
| Compounded products (not FDA-approved) | Testosterone, GLP-1s, a vaginal estradiol cream. | Semaglutide in its weight program. |
| GLP-1s | Brand-name, or compounded from $165.90 for 4 weeks. | $99 a month program plus medicine from $70. |
| Testosterone | Compounded, in 25 states, from $100 for 90 days. | Not listed. |
| Where available | All 50 states. | All 50 states and D.C. |
| Trustpilot, November 1, 2026 | 4.1 from 1,795 reviews. | 4.3 from 4,146 reviews. |
How it works
- Midi Health
- Video visits with a clinician, billed to insurance.
- Alloy
- Online intake; a doctor replies within 12 hours; medicines shipped.
To start
- Midi Health
- $250 self-pay first visit, or your copay.
- Alloy
- $49 one-time consult fee.
Ongoing fees
- Midi Health
- $150 per self-pay follow-up.
- Alloy
- None; unlimited doctor messaging.
Insurance
- Midi Health
- In-network with most PPO plans.
- Alloy
- No; receipts can go to a PPO plan, HSA or FSA.
Medicare and Medicaid
- Midi Health
- Medicare self-pay only, no claims; no Medicaid.
- Alloy
- Not billed: no insurance.
Estradiol pill
- Midi Health
- FDA-approved; billed separately, may be covered.
- Alloy
- From $39.99 a month.
Estradiol patch
- Midi Health
- FDA-approved; billed separately, may be covered.
- Alloy
- $100 a month.
Progesterone
- Midi Health
- Prescribed with estrogen if you have a uterus.
- Alloy
- From $23 a month.
Non-hormonal hot flash drugs
- Midi Health
- Non-hormonal options; no drugs named.
- Alloy
- Paroxetine, $34.99 a month.
Compounded products (not FDA-approved)
- Midi Health
- Testosterone, GLP-1s, a vaginal estradiol cream.
- Alloy
- Semaglutide in its weight program.
GLP-1s
- Midi Health
- Brand-name, or compounded from $165.90 for 4 weeks.
- Alloy
- $99 a month program plus medicine from $70.
Testosterone
- Midi Health
- Compounded, in 25 states, from $100 for 90 days.
- Alloy
- Not listed.
Where available
- Midi Health
- All 50 states.
- Alloy
- All 50 states and D.C.
Trustpilot, November 1, 2026
- Midi Health
- 4.1 from 1,795 reviews.
- Alloy
- 4.3 from 4,146 reviews.
Midi vs Alloy: expectation vs reality
What people often expect
“Midi takes insurance, so it must be the cheaper of the two”
What the evidence shows
Only if your plan covers the visits. Without coverage, a Midi first visit is $250 and each follow-up $150, and medicine is billed separately. Alloy charges $49 once, includes unlimited doctor messaging, and sells an estradiol pill from $39.99 a month. With a PPO plan Midi is usually cheaper; paying cash, Alloy usually is.
Midi vs Alloy: the differences that matter
Midi vs Alloy: two different models
Midi Health works like a doctor's office online: you book a video visit with a clinician, the visit is billed to your insurance, and prescriptions go to your pharmacy or are billed separately. Alloy works like a prescription service: you fill in an online intake, a doctor replies within 12 hours, and Alloy ships the medicine for a monthly price.
Learn more →Midi vs Alloy cost without insurance
Paying cash, a first year at Midi starts with a $250 visit and $150 for each follow-up, plus medicine at your pharmacy. At Alloy the year starts with a $49 fee, then estradiol pills from $39.99 a month or patches at $100 a month, and progesterone from $23. Generic HRT can also be cheaper at a discount pharmacy, so compare before you pick.
Learn more →Midi vs Alloy with insurance and Medicare
Midi is in-network with most PPO plans, so you pay your copay for visits. It doesn't bill Medicare, which is self-pay only, and doesn't take Medicaid. Alloy takes no insurance at all; it can give you receipts to submit to a PPO plan, HSA or FSA. If you're on Medicare, neither service is billed to it, and a local Menopause Society practitioner is usually the better route.
Learn more →Midi vs Alloy: what each prescribes
Both prescribe FDA-approved estradiol and progesterone. Midi also offers compounded testosterone in 25 states, from $100 for 90 days, a compounded vaginal estradiol cream, and GLP-1s, brand-name or compounded from $165.90 for 4 weeks. Alloy adds paroxetine for hot flashes at $34.99 a month and a GLP-1 program at $99 a month plus medicine. Compounded products aren't FDA-approved.
Learn more →Midi vs Alloy reviews
On Trustpilot on November 1, 2026, Midi had 4.1 stars from 1,795 reviews and Alloy 4.3 from 4,146. Ratings depend on how often a company invites customers to review, so treat them as a rough signal. Read the most recent low ratings for both before you decide: they show what goes wrong, which the average hides.
Learn more →Midi vs Alloy by the numbers
$250 vs $49
$39.99
25
4.1 vs 4.3
Prices were checked on each service's website on November 1, 2026.
Midi, Alloy or something else: who each one suits
Midi if you have a PPO plan
Strong evidenceVideo visits billed to insurance, FDA-approved HRT at your own pharmacy, and the widest menu of extras, from testosterone to GLP-1s. It suits women whose plan covers specialist telehealth and who want a clinician they see on video.
Related guide →Alloy if you pay cash
Strong evidenceA $49 fee once, unlimited messaging with a doctor and published monthly prices for each medicine. It suits women without coverage for telehealth who want to know the cost up front, and anyone who'd rather not book video visits.
Related guide →Evernow if you want Veozah or a membership with messaging
Some evidenceEvernow prescribes Veozah and paroxetine, bills video visits to four national insurers, and charges a membership of $35 to $49 a month that insurance doesn't cover.
Related guide →Winona if you want no visit fee
Some evidenceNo visit fee and free follow-ups, FDA-approved tablets from $54 a month, but no insurance, ages 35 to 59 only and not in every state.
Related guide →
When neither Midi nor Alloy is the right route
You're on Medicare or Medicaid
Neither service bills them. A Menopause Society certified practitioner or your own doctor is the covered route.
More →You've had breast cancer, a blood clot or a stroke
Online intake can't replace an in-person specialist for a complex history. Ask your oncologist or a menopause specialist.
More →Bleeding after menopause, or a new breast lump
Book an in-person visit; these need an exam.
Midi vs Alloy: questions women ask
Is Midi or Alloy cheaper?
With a PPO plan that covers visits, usually Midi, because you pay only your copay. Paying cash, usually Alloy: $49 once and estradiol pills from $39.99 a month, against $250 for Midi's first visit and $150 for each follow-up, before medicine.
Related →Does Alloy take insurance like Midi?
No. Alloy is cash-pay, though it gives receipts you can submit to a PPO plan, HSA or FSA. Midi is in-network with most PPO plans for its video visits, but doesn't bill Medicare or take Medicaid.
Do Midi and Alloy prescribe the same HRT?
Both prescribe FDA-approved estradiol pills and patches and progesterone. Midi adds compounded testosterone in 25 states and a compounded vaginal cream; Alloy adds paroxetine for hot flashes. Both offer GLP-1 programs.
Which has better reviews, Midi or Alloy?
On November 1, 2026, Alloy had 4.3 stars from 4,146 Trustpilot reviews and Midi 4.1 from 1,795. The gap is small, and both companies collect reviews differently.
Are Midi and Alloy available in every state?
Yes. Midi lists all 50 states, and Alloy all 50 states and D.C. Midi's compounded testosterone is the exception: it's offered in 25 states.
What about Winona or Evernow instead of Midi and Alloy?
Winona has no visit fee but takes no insurance and treats only women aged 35 to 59. Evernow bills visits to four national insurers and prescribes Veozah, with a membership of $35 to $49 a month. Our ranking compares all four.
Related →Sources
- Midi Health. Pricing & insurance (visit prices, insurance, Medicare and Medicaid, FAQ). Accessed November 1, 2026.
- Midi Health. Home page: care plans, availability, products and patient-reported results. Accessed November 1, 2026.
- Alloy. Estradiol patch (price, consult fee, timing). Accessed November 1, 2026.
- Alloy. Menopause solutions and prices. Accessed November 1, 2026.
- Alloy. FAQ: insurance, availability, doctors. Accessed November 1, 2026.
- Midi Health. Insurance-covered hormone replacement therapy. Accessed November 1, 2026.
- Mark Cuban Cost Plus Drug Company. Hormone therapy medication prices (checked September 2026).
- Midi Health. Testosterone for women, by Midi (states, price, process). Accessed November 1, 2026.
- Midi Health. Compounded vaginal estradiol cream (product page). Accessed November 1, 2026.
- Midi Health. GLP-1 pricing: compounded GLP-1 and GLP-1/GIP. Accessed November 1, 2026.
- Alloy. Compounded semaglutide and Alloy Weight Care. Accessed November 1, 2026.
- Trustpilot. Midi Health reviews (joinmidi.com): TrustScore and review count. Accessed November 1, 2026.
- Trustpilot. Alloy Health reviews (myalloy.com): TrustScore and review count. Accessed November 1, 2026.
- Evernow. Non-hormonal menopause treatment. Accessed November 1, 2026.
- Evernow. FAQ: membership prices, insurance, states, medications. Accessed November 1, 2026.
- Winona. Home page: online HRT for perimenopause and menopause, FAQ. Accessed November 1, 2026.
- Winona. All products and prices. Accessed November 1, 2026.
- Winona. Frequently asked questions: states, treatments, compounding, insurance, billing and refunds. Accessed November 1, 2026.
- The Menopause Society. How to find a certified menopause practitioner.
- Prescribing information: Vivelle-Dot (estradiol transdermal system). Sandoz, 2023. DailyMed, US National Library of Medicine.
See our editorial policy.
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