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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.

Let’s take a look at the details and guidelines for Gender Reassignment coverage through Medicare.

Medicare and Gender Reassignment Surgery

Previously, Medicare didn’t cover gender reassignment surgery because a “sex change” was thought an experimental procedure. Now, Medicare extends coverage to gender reassignment or gender confirmation surgeries on a case by case basis. This is the same standard Medicare uses for many other treatments and procedures.

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.

Medicare Coverage for Transgender Surgery

Medicare covers necessary surgery to change primary sex characteristics from one gender to the other.

Covered surgeries might include:

  • Transmasculine bottom surgery to remove female sex organs and create male genitalia
  • Breast removal surgery
  • Transfeminine surgery to remove the penis and testicles and create female genitalia

Medicare Part B covers outpatient services. If you’re hospitalized for your surgery, Part A pays for it.

With Medicare, you can see any doctor that accepts Medicare. To get the most coverage, make sure your doctors accept Medicare.

Medicare Coverage for Facial Feminization 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.

Medicare usually only covers transition surgery that alters a person’s primary sex characteristics. But, Medicare won’t pay to change a person’s appearance because Medicare considers it cosmetic and not “necessary.”

So, this means Medicare won’t cover facial feminization, breast augmentation, hair removal, face or body contouring, or vocal cord surgeries.

Medicare Advantage Plans and Gender Reassignment

By law, Advantage plans must offer the same benefits as Medicare. Gender reassignment surgery should be covered no matter what kind of Medicare plan you have. But, some Advantage plans have extra guidelines related to coverage for transition surgery.

The National Center for Transgender Equality recommends that you get pre-authorization from your Advantage plan before you get healthcare related to your transition.

Also, unlike Medicare, Advantage plans rely on networks. You’ll pay much less for healthcare if you use in-network providers.

Some plans may not cover out-of-network care. Also, this can pose a problem if you can’t find a doctor in your plan’s network who can perform gender reassignment surgery.

Contact your plan if you’re struggling to find in-network care. Advantage plans set their own deductibles and co-pays, so your costs with an Advantage plan may be different than Medicare.

FAQ’s

Does Medicare cover Phalloplasty?
Phalloplasty is a series of procedures for a female-to-male transition. It includes lengthening the urethra, creating a penis and scrotum, and removing the vagina and female sex organs.

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 top surgery?
Medicare classifies some top surgeries as “necessary,” and others as “cosmetic.” For a female to male transition, Medicare will pay for the removal and reconstruction of the breasts.

But, for a male to female transitions, Medicare normally won’t pay for breast enlargement.

Does Medicare cover hormones?
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.

The cost of your hormones will vary depending on your plan and the type of hormones your doctor prescribes. If you’re denied coverage, you have a right to appeal.

Does Medigap cover gender reassignment?
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.

For example, if you have Plan G, you pay your premium and the Part B deductible. Then, the plan covers the charges Medicare would’ve sent you.

Get the Right Medicare Plan for You

Gender reassignment surgery is a special procedure, and you’ll want to choose an expert healthcare team. But if you only have Medicare, your costs can be high. A Medigap plan can make gender reassignment surgery more affordable.

Let the experts at MedicareFAQ help you find the right Medigap plan for your needs. We offer free quotes, and our friendly agents are always willing to answer your questions.

Give us a call at the number above. Or, fill out our online rate form to learn about the rates in your area now!

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

2 thoughts on “Does Medicare Cover Gender Reassignment Surgery

    1. Hi Michael! Yes, as long as Medicare covers it, your supplemental Medicare plan will also cover it. However, as stated in the article, Medicare Advantage plans may come with extra guidelines. So if you have an Advantage plan with Blue Cross Blue Shield, you’ll need to contact them directly to find out if they have any extra guidelines. If you have a Medigap plan through them, then there is nothing you need to worry about. Your Medigap plan will cover the surgery as long as Medicare does.

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