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.
Should CMS issue a NCD for surgery for gender dysphoria?
Response: The purpose of this NCA is to determine whether or not CMS should issue a NCD to cover surgery for patients who have gender dysphoria. NCAs do not establish payment amounts or spending priorities and, therefore, these comments are outside the scope of this consideration.
Are there other therapeutic options for gender dysphoria?
Although there are other therapeutic options for gender dysphoria, consistent with the NCA request, this decision only focuses on gender reassignment surgery. B. Prevalence of Transgender Individuals
Does Medicare cover gender reassignment surgery?
Gender reassignment surgery is a general term to describe a surgery or surgeries that affirm a person's gender identity. D. Other The Centers for Medicare & Medicaid Coverage (CMS) conducted a National Coverage Analysis that focused on the topic of gender reassignment surgery.
Does Medicare cover hormone therapy for transgender people?
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.
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.
Does Medicare cover gender affirmation 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.
Is facial feminization surgery covered by Medicare?
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 insurance cover non binary top surgery?
Getting Insurance To Cover Non-Binary Top Surgery If the surgeon doesn't use informed consent, then a letter of medical necessity from a qualified mental health professional is required. Non-binary folks who want to use insurance for Top Surgery may face more hurdles.
Does Medicare cover surgery?
Does Medicare Cover Surgery? Medicare covers surgeries that are deemed medically necessary. This means that procedures like cosmetic surgeries typically aren't covered. Medicare Part A covers inpatient procedures, while Part B covers outpatient procedures.
How much is a gender reassignment surgery?
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 Obamacare cover hormone therapy?
Cross-gender hormone replacement therapy is a covered benefit, as are some forms of gender reassignment surgery. Surgical treatment options are approved on a case-by-case basis.
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.
Is phalloplasty covered by insurance?
Phalloplasty and metoidioplasty are covered by 118 of 124 (95%) and 115 of 124 (93%) of insurance companies, respectively. Slightly more than half, 75 of 124 (60%) insurance companies covered penile prosthesis.
How do you prove medically necessary for top surgery?
PRO TIP: Provide thorough documentation to prove that Top Surgery is medically required in your case. Include letters that explicitly state this from your primary care provider and a mental health professional.
How do you get approved for top surgery?
The criteria state that you must:Have persistent, well-documented gender dysphoria.Be able to make a fully informed decision and to consent to treatment.Have reached legal age to make health care decisions in your country (age of majority or age 18 in the U.S.)More items...•
How can I get my insurance to pay for surgery?
In a nutshell, surgeries are generally covered by health insurance policies but with some terms and conditions. In most cases, they must be 'medically necessary' to be approved by the insurance company when you file for a claim. However, the details of the coverage vary greatly among different policies.
Is phalloplasty covered by insurance?
Phalloplasty and metoidioplasty are covered by 118 of 124 (95%) and 115 of 124 (93%) of insurance companies, respectively. Slightly more than half, 75 of 124 (60%) insurance companies covered penile prosthesis.
What is affirmation surgery?
Gender affirmation surgeries, also known as gender confirmation surgeries, are performed by a multispecialty team that typically includes board-certified plastic surgeons. The goal is to give transgender individuals the physical appearance and functional abilities of the gender they know themselves to be.
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 surgically change your gender?
Gender-affirming surgery gives transgender people a body that aligns with their gender. It may involve procedures on the face, chest or genitalia. Common transgender surgery options include: Facial reconstructive surgery to make facial features more masculine or feminine.