If you want gender reassignment surgery to treat gender dysphoria, you must receive hormone therapy in preparation for surgery. This involves modifying your hormone levels so they are aligned with your gender identity. Medicare does cover hormone therapy, but you must have a Medicare Part D prescription drug plan.
Does Medicare cover gender reassignment surgery?
Aug 30, 2016 · In the absence of an NCD, coverage determinations for gender reassignment surgery, under section 1862 (a) (1) (A) of the Social Security Act (the Act) and any other relevant statutory requirements, will continue to be made by the local Medicare Administrative Contractors (MACs) on a case-by-case basis. (This policy last reviewed August 2016.)
How can hormone therapy help treat gender dysphoria?
Aug 30, 2021 · Medicare covers medically necessary gender confirmation surgery for the treatment of gender dysphoria. It does not cover cosmetic procedures. Decisions on whether a beneficiary qualifies are made on a case-by-case basis by the local Medicare Administrative Contractor. A Word From Verywell Everyone deserves to feel comfortable in their own body.
Does Medicare cover hormone therapy for transgender people?
Sep 10, 2018 · Now Medicare Administrative Contractors determine coverage of gender reassignment surgery on an individual claim basis. That means Medicare may cover gender reassignment surgery for Medicare beneficiaries with gender dysphoria whose doctors and health care providers determine there is a medical necessity for the surgery.
What are the different types of gender reassignment surgery?
Jan 19, 2022 · However, hormone therapy medications are not covered by Original Medicare at all. If Medicare covers your gender reassignment surgery, a Medicare Supplement (Medigap) plan can help pay for your gender affirmation out-of-pocket Medicare costs, such as deductibles, copays, coinsurance and more. To receive Medicare coverage for prescription medications, …
Is gender transition surgery covered by Medicare?
What insurances cover gender reassignment surgery?
- Anthem Blue Cross.
- Blue Shield.
- Aetna.
- Cigna.
- United Health Insurance.
- Anthem Blue Cross Blue Shield Medical.
Is gender affirmation surgery covered by insurance?
Is gender dysphoria treatment covered by insurance?
How much does it cost for gender reassignment surgery?
How much does GRS cost?
Is gender-affirming surgery medically necessary?
Does insurance pay for bottom surgery?
The majority of insurance companies covered “bottom” surgeries. More than 90% of companies covered penectomies (Fig. 6). This is most likely because most health-care professionals believe that genitalia is what defines an individual's sex.Dec 11, 2019
Is HRT medically necessary?
What Is Gender Reassignment Surgery?
According to the American Society of Plastic Surgeons, that goal of gender reassignment surgery is “to give transgender individuals the physical ap...
Does Medicare Cover Gender Reassignment Surgery?
Sir Harold Gillies performed the first female to male gender reassignment surgery in 1946, according to the U.S. National Library of Medicine. Howe...
Who Can Get Gender Reassignment Surgery?
According to the American Society of Plastic Surgeons (ASPS), gender reassignment surgeries have risks, such as bleeding, infection, poor healing o...
The Case That Changed It All
Denee Mallon is a 75-year-old transgender Army veteran. Assigned male at birth but identifying as female, she sought gender confirmation surgery in 2012. Medicare denied her request. 4
What Is Transgender Surgery?
Transgender surgery is not one-size-fits-all. One individual’s approach to gender expression may differ from another’s. Surgeries are often grouped into the following categories.
Gender Dysphoria and Medical Necessity
Medicare does not cover any service unless it deems it to be medically necessary. When it comes to gender confirmation surgery, a diagnosis of gender dysphoria is key.
National Coverage Determination vs. Local Coverage Determination
Medicare-covered services fall into two discrete categories, those with a national coverage determination (NCD) and those with a local coverage determination (LCD). The former states that the service is covered for all qualifying Medicare beneficiaries nationwide, while the latter allows decisions to be made on a case-by-case basis.
Requirements for Gender Confirmation Surgery
Medicare has a bare minimum for what is required for coverage of gender confirmation surgery: 5
Summary
Medicare covers medically necessary gender confirmation surgery for the treatment of gender dysphoria. It does not cover cosmetic procedures. Decisions on whether a beneficiary qualifies are made on a case-by-case basis by the local Medicare Administrative Contractor.
A Word From Verywell
Everyone deserves to feel comfortable in their own body. That has not always been easy for transgender people who want but cannot afford expensive gender confirmation surgery.
What is gender reassignment surgery?
According to the American Society of Plastic Surgeons, that goal of gender reassignment surgery is “to give transgender individuals the physical appearance and functional abilities of the gender they know themselves to be.”
Does Medicare cover gender reassignment surgery?
Sir Harold Gillies performed the first female to male gender reassignment surgery in 1946, according to the U.S. National Library of Medicine. However, gender reassignment surgeries were considered “experimental” and were banned by Medicare in 1981.
Who can get gender reassignment surgery?
According to the American Society of Plastic Surgeons (ASPS), gender reassignment surgeries have risks, such as bleeding, infection, poor healing of incisions, nerve injury and hematoma. There also risks associated with specific surgeries, such as injury to the urinary tract for transfeminine bottom surgeries.
Medicare Part D Plans May Cover Hormone Therapy Medications
The types of hormone therapy medications that may be covered by a Medicare Part D prescription drug plan may vary from one plan to the next.
Medicare May Cover Gender Reassignment Surgery in Some Cases
In 2014, Medicare lifted exclusions for gender reassignment surgery under Medicare Part A.
Medigap Plans Can Help Cover Gender Affirmation Surgery Medicare Costs
If your gender reassignment surgery is covered by Medicare, a Medicare Supplement Insurance plan can help pay for some of your out-of-pocket Medicare costs like deductibles and copays.
Does Medicare Cover Hormone Therapy?
If you want gender reassignment surgery to treat gender dysphoria, you must receive hormone therapy in preparation for surgery. This involves modifying your hormone levels so they are aligned with your gender identity.
What Will You Pay for Gender Reassignment Surgery?
Out-of-pocket costs for gender reassignment surgery vary depending on the specific Medicare plan.
Get Started With Medicare
If you’re age 65 or older and thinking about reassignment surgery, the first step is to enroll in Original Medicare or a Medicare Advantage plan with Part D benefits. If you sign up for Original Medicare, make sure you also enroll in a Medicare Part D standalone policy.
Does Medicare cover transgender people?
What Does Medicare Cover for Transgender People? Medicare covers routine preventive care regardless of gender markers. Medicare covers routine preventive care, including mammograms, pelvic and prostate exams. Medicare has to cover this type of care regardless of the gender marker in your Social Security records, ...
Does Medicare cover hormone therapy?
Medicare covers medically necessary hormone therapy . Medicare also covers medically necessary hormone therapy for transgender people. These medications are part of Medicare Part D lists of covered medications and should be covered when prescribed. Private Medicare plans should provide coverage for these prescriptions.
Does Medicare cover mammograms?
Medicare covers routine preventive care regardless of gender markers. Medicare covers routine preventive care, including mammograms, pelvic and prostate exams. Medicare has to cover this type of care regardless of the gender marker in your Social Security records, as long as the care is clinically necessary for you.
Is ancillary surgery necessary for gender dysphoria?
Certain ancillary procedures may be considered cosmetic and not medically necessary when performed as part of surgical treatment for Gender Dysphoria. Clinical review for medical necessity of ancillary procedures is conducted on a case-by-case basis.
What is the AAP policy on surgery?
In a 2018 policy statement entitled Ensuring Comprehensive Care and Support for Transgender and Gender- Diverse Children and Adolescents, the AAP states the following regarding surgery: Surgical approaches may be used to feminize or masculinize features, such as hair distribution, chest, or genitalia, and may include removal of internal organs, such as ovaries or the uterus (affecting fertility). These changes are irreversible. Although current protocols typically reserve surgical interventions for adults, they are occasionally pursued during adolescence on a case-by case basis, considering the necessity and benefit to the adolescent’s overall health and often including multidisciplinary input from medical, mental health, and surgical providers as well as from the adolescent and family.
What is a Wpath?
WPATH, formerly known as the Harry Benjamin International Gender Dysphoria Association, is an advocacy group devoted to transgender health. WPATH guidelines (2012) present eligibility and readiness criteria for transition-related treatment, as well as competencies of health care providers.
Applying for Marketplace coverage
When you apply for Marketplace coverage as a transgender person, you should use the first, middle, and last name that are on your Social Security card.
Sex-specific preventive services
Marketplace health plans must cover a set of preventive services — like shots and screening tests — at no cost to you when delivered by a doctor or other provider within your plan’s network.
Plans with transgender exclusions
Many health plans are still using exclusions such as “services related to sex change” or “sex reassignment surgery” to deny coverage to transgender people for certain health care services. Coverage varies by state.