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?
Also, your doctor must confirm that the operation is necessary. You may have to show counseling and hormone therapy before coverage approval. Medicare covers necessary surgery to change primary sex characteristics from one gender to the other. Medicare Part B covers outpatient services.
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 pay for gender reassignment surgery?
Does Medicare cover gender 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. While Medicare coverage is nationwide, there may be state variations in policies and guidelines.
Does Medicare cover gender reassignment surgery 2022?
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.
Is gender reassignment covered?
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.
Does CMS cover gender reassignment surgery?
The Centers for Medicare & Medicaid Services (CMS) is not issuing a National Coverage Determination (NCD) at this time on gender reassignment surgery for Medicare beneficiaries with gender dysphoria because the clinical evidence is inconclusive for the Medicare population.
Is gender reassignment surgery free in Canada?
Most Canadian provinces cover the cost of gender reassignment surgery. However, feminizing surgeries considered cosmetic, such as breast augmentation, voice surgery, Adam's Apple reduction, and facial feminization, are not currently covered by all health insurance programs.
How do you pay for gender reassignment surgery?
Consider these options to pay for gender-affirming surgery and care:Online personal loan.Credit union personal loan.Credit card.CareCredit.Home equity line of credit.Family loan.
What does Black FOLX mean?
Definition of folx : folks —used especially to explicitly signal the inclusion of groups commonly marginalized Having women teach other women matters. Women of color. Transgender women. Disabled women.
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.
Is gender reassignment surgery legal in the US?
No states have enacted a blanket ban on gender reassignment treatment for transgender minors.
Does Medicare cover facial feminization?
Medicare does not cover certain cosmetic surgery procedures, such as laser hair removal and facial feminization surgery, because these are not considered medically necessary.
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 is the goal of a gender surgery?
The goal of the surgery is to give the person the appearance and function of the desired gender. To achieve that goal, a person may need to go through several surgeries. As such, the surgical team often includes a plastic surgeon, urologist, gynecologist, and an ear, nose, and throat specialist.
How long does Medicare enrollment last?
There is a total of 7 months in the IEP, including the birth month.
How much is Medicare Part B 2020?
The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. After a person pays the deductible, Medicare pays 80% of the allowable costs. The coinsurance is 20% of the charges. If a person goes into hospital, there is a $1,408 deductible for every benefit period.
What is the best Medicare plan?
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan: 1 Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments. 2 Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%. 3 Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Is Medicare coverage nationwide?
While Medicare coverage is nationwide, there may be state variations in policies and guidelines. In this article, we discuss gender reassignment surgeries, Medicare coverage, enrollment, and costs. We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
Does Medicare cover cosmetic surgery?
Medicare coverage. Medicare does not cover what they rule as cosmetic surgery, and until 2014, did not cover surgeries to change gender. The rule was changed to include surgeries for medical reasons, which includes gender reassignment.
Does Medicare have a national policy?
However, the Centers for Medicare & Medicaid Services (CMS) has not created a national policy, which means a person’s plans will decide if the surgery is medically necessary. This online tool will help a person find more information about their local state policies.
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.
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.
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.
What Is Gender Dysphoria?
Gender dysphoria is a clinical diagnosis often given to individuals who experience distress or discomfort because their gender identity doesn’t match their sex-related physical characteristics.
What Is Gender Reassignment Surgery?
Gender reassignment surgery, which is sometimes referred to as sex reassignment surgery or gender affirmation surgery, is part of the process of physically transitioning from one gender to the other. The surgery may involve more than one procedure, and it typically follows other transitional steps such as counseling and hormone replacement surgery.
Is Gender Reassignment Surgery Medically Necessary?
Gender reassignment surgery may be considered medically necessary to treat anxiety and depression related to body dysphoria.
Does Medicare Cover Gender Reassignment Surgery?
Medicare covers the costs of gender reassignment surgery if it’s considered medically necessary. Surgery may be deemed medical necessary to treat mental health issues related to a gender dysphoria diagnosis or simply because an individual demonstrates a committed desire to transition.
Does Coverage for Gender Reassignment Surgery Vary by State?
Although Medicare is a federally regulated program, state laws may impact Medicare's decision to cover gender reassignment surgery. Information on state health care laws and policies that may affect coverage for transgender-related medical care can be found by visiting the Movement Advancement Project .
What Is Hormone Therapy?
Hormone therapy is a medical treatment that adjusts an individual's hormone levels so they align with their gender identity. Individuals who wish to undergo gender reassignment surgery must typically undergo hormone therapy for a year or more prior in order to be approved for the procedure.
Does Medicare Cover Hormone Therapy?
Medicare covers the cost of hormone therapy through its Part D prescription drug plan or any Medicare Advantage plan that bundles in prescription drug coverage. The therapy must be deemed medically necessary.
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 ...
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.
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.
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.