The 17 states are: California, Colorado, Connecticut, Maine, Maryland, Massachusetts, Minnesota, Montana, Nevada, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and Wisconsin.
Full Answer
Does Medicare cover gender reassignment surgery?
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.
Does Medicaid cover sexual reassignment treatment?
Iowa recently enacted a law denying coverage for transition services, and Medicaid policies in eight states exclude sexual reassignment treatment, according to the Movement Advancement Project, a nonprofit group based in Colorado.
Does Iowa have to pay for sex reassignment surgery?
In Iowa, the state Supreme Court unanimously ruled in March that excluding sex reassignment surgeries, like the one Zingler sought, violates the state’s Civil Rights Act. But in the waning days of its session, Iowa’s Republican legislature amended the budget to say that the state doesn’t have to pay for procedures related to sex reassignment.
Can states deny coverage of reassignment surgery?
Courts in several cases have ruled against states that have denied coverage of reassignment surgeries. Last year, a federal judge in Wisconsin issued a preliminary injunction requiring the state Medicaid agency to cover surgeries for four transgender patients.
Does Medicare cover reassignment surgery?
Medicare provides coverage for gender reassignment surgery, although it needs to be deemed as medically necessary. A person can appeal the decision if surgery is denied.
Does Medicare cover gender affirming surgery?
Medicare covers gender affirmation procedures when they're deemed medically necessary. Procedures covered by Medicare may include hormone therapy, gender affirmation surgeries, and counseling before and after surgery.
How much does gender reassignment surgery cost in the US?
Gender reassignment surgeries are expensive. Bottom surgeries can cost about $25,000 and top (breast surgeries) from $7,800 to $10,000. Facial and body contouring are also costly. More employer insurance policies, and those sold under the Affordable Care Act, now cover at least some gender reassignment surgeries.
Does Medicare pay for top surgery?
Medicare covers 1) routine preventive care regardless of gender markers; 2) medically necessary hormone therapy; and 3) medically necessary sex reassignment surgery. If Medicare denies to cover your Top Surgery, you have every right to appeal the decision — and you should.
How do I change my gender with Medicare?
To change your gender status on formal documentation in NSW, you will need to:Complete the 'Record a Change of Sex Application' form on the Registry website.Have two statutory declarations from two medical practitioners verifying you have undergone “sex affirmation” procedure.More items...•
Does Medicare cover hormone therapy?
Medicare covers medically necessary hormone therapy. 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.
How much is gender reassignment surgery in Canada?
According to the 1996 British Columbia law reform project on human rights and the transgendered community, male to female sex reassignment surgery ranges from between $5,000 and $10,000. Female to male sex reassignment surgery costs considerably more, ranging from $20,000 to more than $60,000.
How much is bottom surgery in Texas?
How much does bottom surgery cost?SurgeryCost runs from:vaginoplasty$10,000-$30,000metoidioplasty$6,000-$30,000phalloplasty$20,000-$50,000, or even as high as $150,000
How long does it take to transition from female to male?
Some of the physical changes begin in as little as a month, though it may take as long as 5 years to see the maximum effect.
Is Top surgery considered medically necessary?
Not every person with gender dysphoria has the need to undergo surgery, but for those who do, Top Surgery is medically necessary and has been scientifically proven to be effective at treating gender dysphoria and improving quality of life, in both adults and minors.
Can you get skin removal surgery on Medicare?
Now Medicare only covers abdominoplasty procedures if they are related to significant weight loss if it is deemed as a medical necessity.
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...
Why do transgender people need surgery?
Many transgender people seek further surgery to make their outer appearance match more closely with their internal gender. For example, a transgender woman may want facial feminization surgery to reduce the size of her chin and nose.
What is Medicare Part B?
Medicare Part B covers outpatient services. If you’re hospitalized for your surgery, Part A pays for it.
What is covered by Part B?
Part B covers doctor visits, and lab work. Your Part D drug plan should cover the hormones. But, your doctor may need extra authorization or information before your benefits can be approved.
Does Medigap pay if Medicare denies?
Medigap follows Medicare’s rules. If Medicare covers, then your plan will too. But, if Medicare denies your claim, Medigap won’t pay it either .
Does Medicare pay for gender dysphoria surgery?
For Medicare to pay for your surgery, your doctor must diagnose you with gender dysphoria or gender identity disorder. Also, your doctor must confirm that the operation is necessary. You may have to show counseling and hormone therapy before coverage approval.
Does Medicare cover gender reassignment surgery?
Medicare covers necessary gender reassignment surgery. It also pays for doctor visits and lab work as you go through the transition process. Also, prescription plans usually cover hormone treatments for transgender people. Yet, Medicare won’t pay for surgery to make your physical features more masculine or feminine.
Does Medicare cover phalloplasty?
Medicare will cover phalloplasty if it is necessary to treat gender dysphoria. But, Medicare makes decisions on a case-by-case basis. If you believe your procedure should be covered and Medicare denied your claim, you can go through the Medicare appeals process.
Does Medicare cover hormone therapy?
Hormone Therapy. In preparation for gender reassignment surgery, Medicare will cover hormone therapy through Part D prescription drug coverage. If you have Original Medicare, you will need to be enrolled in a stand-alone Prescription Drug Plan (PDP). Many Medicare Advantage plans include prescription drug coverage.
Does Medicare cover transgender people?
Routine preventive care and transition-related services are vitally important to prepare for gender reassignment surgery, but there can be some confusion about Medicare coverage for transgender individuals. Medicare is a federal program that provides health insurance for individuals 65 years of age or older, and some people under the age ...
Does Medicare Advantage cover prescriptions?
Many Medicare Advantage plans include prescription drug coverage. If coverage is initially denied due to inconsistency with Social Security gender records, an appeal can be made to provide a Medicare recipient with access to medications they require to meet their specific needs.
Does Medicare cover gender reassignment surgery?
The Centers for Medicare & Medicaid Services has not issued a national coverage determination on gender reassignment surgery, and therefore, leaves coverage determination up to local Medicare Administrative Contractors (MACs). According to CMS, coverage will be based on whether the surgery is considered “reasonable and necessary for the individual beneficiary after considering the individual’s specific circumstances. For Medicare beneficiaries enrolled in Medicare Advantage (MA) plans, the initial determination of whether or not surgery is reasonable and necessary will be made by the MA plans.”
What are the exclusions for transgender people?
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. Before you enroll in a plan, you should always look at the complete terms ...
Where to file a complaint against a Medicare plan?
If you believe a plan unlawfully discriminates, you can file complaints of discrimination with your state’s Department of Insurance, or report the issue to the Centers for Medicare & Medicaid Services by email to market[email protected].
Is transgender health insurance discriminatory?
These transgender health insurance exclusions may be unlawful sex discrimination . The health care law prohibits discrimination on the basis of sex, among other bases, in certain health programs and activities.
Where to file a civil rights complaint?
You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.
Can insurance companies limit sex-specific preventive services?
Your health insurance company can’t limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender — for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear.
When did transsexualism come out?
At that time, they were referred to as transsexualism. The term evolved to gender identity disorder in the 1994 DSM-4 and to gender dysphoria in the most recent version, DSM-5, released in 2013.
What is MAC in Medicare?
Local coverage determinations require that a Medicare Administrative Contractor (MAC) review each case individually. MACs will vary regionally and may have different requirements. It is important to understand what the MAC in your area requires if you are interested in pursuing gender confirmation surgery.
How many letters do you need to confirm a mental health diagnosis?
You provide a letter from a mental health professional that confirms 2–5.
Is being transgender a mental illness?
Being transgender is not a mental condition. Not everyone who is transgender has gender dysphoria, and not everyone with gender dysphoria will want to undergo gender confirmation surgery.
Is transgender surgery covered by Medicare?
In 1981, Medicare considered transgender surgery to be experimental and excluded it from coverage outright. Simply put, it had neither an LCD nor NCD.
Is transgender surgery one size fits all?
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.
Can transgender people have a lower voice pitch?
Voice surgery procedures may change the pitch of someone’s voice. While a trans man may experience a deeper voice with testosterone, a trans woman is likely to maintain a low pitch while on estrogen therapy.
Which states have enforcing a prohibition against gender identity discrimination?
Federal judges in Minnesota and California issued rulings enforcing a prohibition against gender identity discrimination.
How many states exclude transition services from health benefits?
Twelve states also specifically exclude transition-related services from health benefits for state employees.
What is gender dysphoria?
Gender dysphoria is a conflict between a person’s physical gender and the gender with which one identifies. The American Psychiatric Association says it is often accompanied by extreme distress, which can interfere with the ability to function normally.
Can mastectomies be denied?
Services deemed medically necessary for some patients, such as mastectomies for women with breast cancer, cannot be denied to others, such as transitioning transgender patients with gender dysphoria. The same is true of other transition medical services, such as hormone treatment and facial feminization surgery.
Is gender reassignment surgery cosmetic?
Lesbian, gay, bisexual, transgender and queer and/or questioning groups strongly dispute the notion that gender reassignment surgery is cosmetic, akin to elective plastic surgery.
Which states exclude transition services?
Twelve states also specifically exclude transition-related services from health benefits for state employees. On the other hand, Maine announced last month that it would begin covering transition services under Medicaid, and judges in Wisconsin, Minnesota and California recently ruled that health-care providers in those states can’t discriminate ...
Is being transgender a biological imperative?
Sprigg said being transgender is a lifestyle choice, not a biological imperative — a view at odds with that of medical professional organizations, such as the AMA, the American Psychiatric Association and the American Psychological Association.
Description Information
Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
National Coverage Analyses (NCAs)
This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.
How many states have gender affirming care?
have chosen to specifically include coverage for gender-affirming care under their Medicaid programs or are in the process of extending coverage. The 17 states are: California, Colorado, Connecticut, Maine, Maryland, Massachusetts, Minnesota, Montana, Nevada, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and Wisconsin. One additional state, Illinois, is currently developing an administrative policy that will expressly state that Medicaid covers gender-affirming care. All of these policies have been adopted within the past six years, with California being the first state to issue this type of policy in 2013. The policies ensure that transgender Medicaid beneficiaries have access to a range of gender-affirming care, including gender-affirming surgery and hormone treatment, though there may be some forms of gender-affirming treatment that are not included in the policies.
How many transgender people are on medicaid?
Using the best available data, we estimate that 152,000 transgender adults in the U.S. are enrolled in Medicaid. Fewer than half of transgender Medicaid beneficiaries (69,000) have guaranteed access to coverage for gender-affirming care under express policies in state law. For around 51,000 transgender Medicaid beneficiaries, coverage is uncertain because they live in states where the laws are silent on Medicaid coverage for gender-affirming care. An estimated 32,000 transgender Medicaid beneficiaries live in states with express bans that deny access to covered gender-affirming care.
What is Medicaid funded by?
Medicaid is a federally mandated program, implemented by states, which ensures access to health care for those low-income adults and children who qualify.1The program is funded with a combination of federal and state funds.2States must implement their Medicaid programs consistent with federal law, though they retain some flexibility in the design and administration of their programs, including setting eligibility criteria.3
Does Medicaid cover gender affirming care?
Federal law does not expressly direct states to either include or exclude coverage for gender-affirming care under their state Medicaid programs.4Some states have chosen to specifically include coverage for gender-affirming care under their Medicaid programs, while other states exclude such care or have not expressly addressed coverage, creating a patchwork of policies affecting transgender Medicaid beneficiaries across the U.S.
Does Medicaid cover transgender people?
Medicaid beneficiaries who are transgender face a patchwork of policies across the U.S. that leave many of them without access to coverage for gender-affirming care. Eighteen states and D.C. have chosen to specifically include coverage for gender-affirming care under their Medicaid programs or are in the process of extending coverage, while 12 states exclude coverage for such care and 20 states have not expressly addressed coverage. Gender-affirming care includes a range of services, such as surgical procedures, hormone therapy, and other forms of treatment related to gender transition. The Williams Institute estimates that: • 1.4 million adults in the U.S. identify as transgender and approximately 152,000 of them are enrolled in Medicaid. • Fewer than half (69,000) of transgender Medicaid beneficiaries have affirmative access to coverage for gender-affirming care under express policies in state law. • For 51,000 transgender Medicaid beneficiaries, coverage is uncertain because they live in states where the laws are silent on coverage for gender-affirming care. • An estimated 32,000 transgender Medicaid beneficiaries live in states with express bans that deny access to covered gender-affirming care. Although regulations issued by the U.S. Department of Health & Human Services in 2016 bar Medicaid programs from categorically excluding insurance coverage for all types of gender-affirming care, the Department has recently proposed to eliminate these provisions. Nonetheless, a number of laws and policies continue to support access to gender-affirming care through Medicaid programs, including the Affordable Care Act, the Social Security Act, and the U.S. Constitution. Bans have been successfully challenged in court under these laws in several states, resulting in changes to Medicaid policies that have increased care and coverage for transgender beneficiaries. Additional policy changes in states that still have bans or lack clear language addressing coverage would ensure that transgender Medicaid beneficiaries have access to coverage for necessary medical care no matter where they live. In addition, more transgender people could benefit from Medicaid covered services if all states adopted Medicaid expansion and if barriers to accessing public benefits, such as requirements pertaining to identity documents, were removed.
Does New Jersey require gender affirming care?
New Jersey. In 2017, the legislature of New Jersey enacted a statute requiring Medicaid coverage for gender-affirming care .20
Does the Affordable Care Act prohibit discrimination based on gender?
explaining that federal regulations implementing the Affordable Care Act prohibit discrimination based on gender identity in health care, including in state Medicaid programs.6