How much does Plume membership cost?

Plume membership $99/month OR $32 with eligible insurance plans. Membership includes:

  • Gender affirming healthcare by a licensed medical provider who is an expert in trans healthcare

  • Digital video appointments with your medical provider, who will review your goals for your gender journey and work with you to establish a treatment plan

  • Prescription orders for gender-affirming medications as medically appropriate sent to our delivery* pharmacy or your local pharmacy 

    • These medications may include hormones (testosterone, estradiol, progesterone), hormone blockers (spironolactone, finasteride, dutasteride), hair loss medications (finasteride/dutasteride), and sexual function support medications (sildenafil/tadalafil)

  • Ordering, analysis, and cost of all recommended labs* (done at your local Quest Diagnostics or Labcorp and ordered by your Plume provider). Please note that members using eligible insurance to reduce their cost of membership will also have their labs processed through their insurance. Self-pay members will have the cost of labs included in the cost of membership. 

    • For patients on testosterone: testosterone levels, Hemoglobin and Hematocrit (H/H)

    • For patients on estradiol: estradiol levels, Testosterone levels 

    • For patients on Spironolactone: basic metabolic panel (BMP), estradiol levels, Testosterone levels

  • Ongoing progress monitoring with quarterly evaluations and treatment adjustments to make sure you’re healthy and on track

  • Medical letters for legal name or gender marker changes

  • Medical letters of support for surgery

  • Access to a six-week series of support groups, guided by a facilitator from our community

  • Injection instruction and live injection support, to help you feel comfortable taking your medication

  • Access to your gender-affirming care team who can provide resources, guidance, and answer any questions in our app

  • Access to Member Resource Center

When will I be charged?

After you have paid $99 for your initial intake appointment, you will not be charged again until one month after your appointment day. After that, your membership fee of $99 will automatically be processed every month (members in New York, New Jersey, and Rhode Island pay $90/month, to offset their out-of-pocket costs for lab tests.) 

For example, if you signed up and paid on January 5 and scheduled an appointment for January 21, you would not be charged $99 again until February 21. The 21st of the month would become your payment date, so you would pay your membership fee every 21st of the month moving forward. If you ever want to change your payment date, just let us know the day of the month you prefer. We can easily adjust this for you!

Please note that if you miss your appointment, we will need to charge a $20 no-show fee to reschedule your appointment. This $20 fee is in addition to your $99 monthly membership fee and is in place to ensure our members are able to meet with a provider as soon as possible. 

How do I pay for my membership?

When signing up with Plume, you will be charged $99* for the initial consultation. Post consultation, if you choose to and are able to continue receiving care with Plume, you will be placed on our monthly, recurring membership plan of $99*. If you are using an eligible insurance plan to cover the costs of membership, you will pay $32 per month + copays for virtual appointments with your provider. 

The payment information you used to sign up and pay for your registration fee before you filled out your intake forms is the same form of payment that will be charged for the monthly membership fee moving forward. Your membership is automatically processed once per month. You do not have to initiate the payment yourself. 

Membership payments begin 30 days after your initial appointment, and you will continue to be charged on that day moving forward unless you request to change your payment date (just let your care team know which day between 1-28 you prefer). For example, if your appointment was February 15th, your payments will fall on the 15th of the month moving forward.

We only accept Visa, Mastercard, Discover, and American Express credit and debit cards as a form of payment. If you have an FSA-issued credit card, we can also use this as a form of payment if it is one of the four major credit card providers listed above. We do not accept cash, direct bank connections, cryptocurrency, or app-based payments.

*Except in NY/NJ/RI. Monthly membership for these states is $90 to offset the out-of-pocket cost of labs.

How do I pay my copay?

For members using eligible insurance to reduce membership cost, you will receive an automated email with a digital statement and instructions on how to pay. 

When will I need to pay my copay?

A copay will be required for all video appointments with your provider, such as your initial intake appointment and all follow-up appointments. 

I signed up for a membership with insurance. Why do I need to pay a co-pay for virtual appointments? 

Copayments are common with managed care plans, such as HMOs. Insurance companies offering these plans have contracts with health-care providers (like Plume) that let insurance companies pay fixed fees for essential services while requiring consumers (i.e. patients) to pay a portion of the service costs. This makes it easier to predict overall costs and to offer a cost sharing structure to consumers. Economically, it’s set to protect insurance companies from over-utilization. 

We are not able to apply the membership fee to the appointment as it’s not structured in a fee for service (pay per appointment) approach. The membership fee covers non-medical costs associated with care (patient education, community support, etc.).

Is the cost of medication included in my membership?

No, the price of your medications is not included in the cost of membership. Insurance or GoodRx coupons can help reduce the cost. You can reach out to your private insurance company to learn more about what they will cover. You can view the price list for medications from our delivery pharmacy here.

How much will my medication cost?

Most medications vary in cost, depending on your pharmacy, which prescriptions you want to fill, whether you have insurance or a prescription savings card, and many other factors. Estimating these costs can be challenging, so we recommend that you contact your pharmacy directly. Ask them to estimate your prescription costs, based on the name of the medication and dose. To get this information, you can refer to the messages you received from your provider after your appointment. Your care plan will include a list of your medications. If your prescription order was already sent to your pharmacy, it is easy for the pharmacist to  look up pricing information for you. If you want to use our delivery pharmacy, we created a calculator that includes shipping fees and makes it easy to estimate your monthly medication costs. You can review the price list here.

Is financial support available?

The HRT Access Fund, which is administered by trans organization Point of Pride, offers scholarships and financial support to people who need gender-affirming healthcare and other gender-specific support. The fund provides 12 months of free gender-affirming hormone therapy and medications via Plume to people who are selected to receive financial aid. Learn more and apply here.

What payment methods do you accept?

You may use any valid Visa, Mastercard, American Express and Discover debit or credit card. We are unable to directly link bank accounts or accept ACH payments, checks, or wire payments. 

What happens if I miss a payment?

If you miss a payment, you can always make up that payment before your next invoice processes. This means no late charges! If you know your payment date is coming up and you don’t think you’ll be able to make a payment, you can reschedule your payment for a later date. Let your Care Coordinator ahead of time and we will change the date you are charged for your membership. We cancel all accounts after 30 days of no payment.

How do I update my credit card?

We are committed to keeping your payment information secure. To update your credit card, please message your Care Coordinator in Spruce. We will need your new card number, expiration date, three digit code, and billing zip code. Also, let us know if your billing address has changed.

We are able to manually add cards to your payment profile by sending over a picture of the front and back of your payment method, or typing in the payment details in your secure message thread in Spruce. However, we do understand this can make some members uncomfortable, so our best recommendation for additional security would be to use something like a "virtual card" that you'd manually add money to, in order to better anonymize your payment information. You could also use something like a prepaid Visa card. Cash App ( offers a free virtual card, and you could set this up to only add the amount needed for your membership at a time, that way there is no risk of access to your whole account—the benefit also being that you can change the card number easily if fraud is detected.

How do I sign into my account?

To sign in, open the Spruce App on your phone and enter the email address and password you used during sign up to login. Your email address is your username. You may also log into your account on a computer at

How do I update my account settings?

To update your name and pronouns on your Spruce profile: 

  1. Go to “Settings” in Spruce 

  2. Select “About Me”

  3. Update your account settings.

Please clarify to your Care Team if you have legally* updated your name/documents or if you are updating your profile with your preferred name/pronouns. To update your gender, address, or payment method, please message your Care Coordinator in Spruce.

NOTE: If you have updated your name legally, we ask for you to send us a picture of your new photo ID and (if applicable). your updated insurance card to process any prior authorizations for your medication. Since the name on your labs and medication must match your photo ID, we will update the information for you once we receive these documents.

How do I cancel or suspend my membership?

Plume memberships can be canceled at any time. To cancel your membership, please message your Care Coordinator with your request. You can suspend your membership for up to six months. After six months, you will need to initiate and pay for a new intake appointment. This ensures your health information is current and accurate.