Midi Health and Alloy are two of the most popular menopause telehealth services, but they are built on opposite ideas: Midi works with insurance and offers video visits, while Alloy is low-cost, cash-pay, and asynchronous. This comparison lays out the real differences so you can tell which one fits.

A note on our position: Menova is an independent publication. We sell no hormones, we are not your doctor, and we take no payment for placement. Menova may earn a commission if you use a clearly marked provider link, at no extra cost to you, and it does not change what we wrote or the order we ranked in. This is general education to help you compare, not a recommendation or medical advice.

Midi vs Alloy at a glance

The quickest way to understand the two is that they solve for different things. Midi solves for insurance coverage and a real clinical conversation. Alloy solves for low, predictable cost and simplicity.

  • Cost model: Midi bills insurance (or ~$250 first visit / ~$150 follow-up self-pay); Alloy charges a one-time ~$49.95 consult, then ~$40–$75/month for medication
  • Visit type: Midi uses live video visits; Alloy is asynchronous (questionnaire reviewed by a doctor)
  • Insurance: Midi is in-network with many PPO plans; Alloy does not bill insurance (FSA/HSA only)
  • Clinicians: Midi uses menopause-trained NPs, CNMs, MDs, and NDs; Alloy uses Menopause Society-certified physicians
  • Scope: Midi covers a broad range of symptoms plus GLP-1 and lifestyle support; Alloy focuses tightly on hormone therapy
  • Availability: both operate widely, and Midi is in all 50 states

How much do Midi and Alloy cost?

This is where the two diverge most. With Midi, if you have a participating PPO plan, you typically pay only your specialist copay, which can make it the cheapest option of the two — but your cost depends on your plan, and a high deductible can erase that advantage. Self-pay at Midi is about $250 for the first visit and $150 for follow-ups, plus medication at your pharmacy.

With Alloy, cost is flat and predictable: roughly $49.95 once for the doctor to review your intake, then about $40 a month for an estradiol pill or around $75 a month for a patch-plus-progesterone protocol, often billed quarterly. Alloy does not touch insurance, but it accepts FSA and HSA cards. For a woman paying entirely out of pocket, Alloy is usually the lower and more predictable number. For a woman with good PPO coverage, Midi can come out ahead.

Which has better doctors — Midi or Alloy?

Both are staffed by clinicians who focus on menopause, which already puts them ahead of a general practice that rarely treats it. The difference is in the type of clinician. Alloy is physician-led: your intake is reviewed by a board-certified doctor with menopause certification from The Menopause Society. Midi's care is delivered by a mix of menopause-trained nurse practitioners, nurse-midwives, physicians, and naturopathic doctors, with much of the front-line care provided by NPs.

Neither model is "better" in the abstract — menopause-trained NPs are often more current on hormone therapy than a non-specialist MD. But if you specifically want a physician reviewing your case, Alloy makes that more explicit, while Midi gives you a live video visit that Alloy does not offer by default.

Video visit vs questionnaire: which do you want?

This is the other big fork. Midi's care centers on a real video appointment — a back-and-forth conversation where you can ask questions and the clinician can probe your history. Alloy's core flow is asynchronous: you fill out a thorough questionnaire, a doctor reviews it, and a prescription follows, with ongoing questions handled by message.

If your situation is straightforward and you value convenience, Alloy's questionnaire is fast and low-friction. If your history is complicated — a history of breast cancer, blood clots, migraines with aura, or other factors that genuinely need discussion — the live conversation Midi offers is the safer starting point, because a two-way exchange catches nuance a one-way form can miss.

Midi vs Alloy: which should you choose?

Choose Midi if you have PPO insurance and want to use it, if you want a live video visit, or if your symptoms span several areas and you want one clinician looking at the whole picture. Midi is also the better pick if you are unsure and would value talking it through in real time.

Choose Alloy if you are paying out of pocket and want the lowest, most predictable cost, if you specifically prefer FDA-approved hormones prescribed by a physician, and if you are comfortable with a questionnaire-based process. Alloy rewards women who already suspect their symptoms are hormonal and just want an efficient, affordable path to treatment.

For many women it comes down to one question: do you have PPO insurance you want to use? If yes, start with Midi. If no, Alloy is usually the more economical route. Neither is a wrong choice — they are simply built for different situations.

Beyond Midi and Alloy

These two are not the only options. Evernow offers either a one-off video visit or membership with ongoing clinician messaging, and Gennev pairs menopause-trained OB-GYNs with registered dietitians for a whole-health approach. If your priorities are different again — ongoing support, or nutrition and coaching alongside hormones — one of those may fit better. We line all of these up on cost, clinician type, insurance, and treatment range on our menopause care comparison page, so you can compare them on substance rather than marketing.

Worth reading alongside: the Midi Health review, the Alloy review, Wisp versus Midi, the full telehealth comparison, and HRT cost and insurance.

Before you book, the free 2-minute Menova self-check organizes your symptom picture, the free printable visit prep sheet is what the first consultation runs on, and the free blood test sheet covers what should be checked regardless of which service you use — no account, not a diagnosis, and your answers never leave your device.

This article is general education, not medical advice, and does not endorse any specific provider. Prices, coverage, and state availability change often — verify directly with each service, and decide about hormone therapy with a licensed clinician who knows your history.

Sources: Midi Health — Pricing & Insurance, Midi Health — Clinicians, Alloy — Online HRT, Alloy — Estradiol Products, and The Menopause Society.