Some seniors are wondering if Medicare will cover gender reassignment surgery. Many Americans have a condition known as gender dysphoria. Individuals with this diagnosis may want to undergo gender reassignment surgery. Over the years, more American’s are given this diagnosis.
Surgeries for these situations have become medically necessary in recent years. Doctors are seeing gender dysphoria as a real issue for thousands of patients across the country.
The American Psychiatric Association identifies gender dysphoria as a real diagnosis. Stating that when a person has a problem between their physical and identifiable gender, they’re suffering from gender dysphoria.
A more common term is transgender. These people are individuals who constantly identify with a gender that is different than the one they were born.
Gender Reassignment Surgery: Will Medicare Cover
Over the last 15-18 years, gender reassignment surgery has been on the rise. In more recent years, studies are determining who qualifies for insurance coverage for gender reassignment surgery.
As of late, 4,118 gender-affirming surgeries have been found. However, health insurance didn’t cover most of these surgeries between the years 2000 and 2011.
This trend of out-of-pocket costs came to a turning point between 2012 through 2014. Thanks largely, due to Medicare and Medicaid.
Explanation of Gender Reassignment Surgery
Gender reassignment surgery gives transgender people the physical presentation as well as functioning abilities of the gender they believe themselves to be. This is the result or goal of this surgery, according to the American Society of Plastic Surgeons.
When a female to male reassignment surgery occurs, there are three categories to fall under. Transmasculine top surgery, which involves removing the breast tissue to create a more masculine appearance of the chest
Transmasculine bottom surgery transforms the female genitalia by constructing it into male genitalia. Lastly, facial masculinization surgery transforms the feminine aspects of the face into a more masculine man-like appearance.
Likewise, when a male to female reassignment surgery occurs, there are also three categories to fall under. Opposite of the female to male, transfeminine top surgery enhances the size and shape of the breasts, giving a more feminine appearance.
However, transfeminine bottom surgery transforms male genitalia by reconstructing the anatomy of current female genitalia. Then, facial feminization surgery transforms the masculine features of one’s face to a more feminine presentation.
Gender reassignment procedures may include surgery to remove the uterus, all or part of the vagina or reconstruction of the urethra. Surgeries for creating a penis using the tissue of another body part, penile implants, hair grafts, breast and/or butt augmentations are also specific to reassignments.
Voice feminization surgery for male patients wishing to have a more feminine voice is also available. Many different specific gender reassignment surgeries are available. Always seek medical advice from your healthcare professional before making any decisions.
Your doctor can assess and determine what procedures might be right for you. Furthermore, your doctor can provide you with a care plan and explain when you may undergo any procedure(s).
Medicare Covers Medically Necessary Gender Reassignment Surgery
The first gender reassignment surgery was performed in 1946 by Sir Harold Gillies. This surgery was unlike any of its kind and was a female to male reassignment surgery. Although, Medicare put a ban on these surgeries in 1981 as they saw them as “experimental”.
In May of 2014, Medicare’s ‘ban on transgender surgeries’ came to a complete stop. After a long 33 years of being in effect, this was a major shift within the medical association in the United States.
Medical professionals are describing transition-related surgeries (gender reassignment surgery) as “medically necessary”. They believe reassignment surgeries are vital to transgender patients’ physical and mental health.
This change suggests that health insurance companies treat these surgeries as if they were any other type.
Coverage for surgeries will be made on an individual claim basis. Medicare Administrative Contractors will determine coverage based on each situation.
Patients with gender dysphoria must have a diagnosis from a health care professional. Furthermore, they must deem any surgeries to be medically necessary before Medicare will cover the costs.
Getting the Surgery
Risks from gender reassignment surgery are common. Your doctor will determine if you’re healthy enough to have any procedures. Many complications and risk factors include infection, bleeding, lack of healing or hard-to-heal incisions, nerve damage, hematoma and more.
Risks involving specific procedures such as urinary tract complications for patients who have transfeminine bottom surgeries.
The best candidates for gender reassignment surgery or specialty surgery should meet a specific criterion. Such as individuals with a diagnosis of persistent gender dysphoria. This may mean you were waiting for a period following diagnosis to when you may have surgery.
Patients with two letters of recommendations from mental health-care professionals supporting the decision to undergo reassignment surgery.
Have you been living as a member of the opposite sex? Do you have a positive outlook and expectations that are real and achievable? Do you have mainly well-controlled medical or mental health concerns?
Patients answering yes to any of these questions may be the perfect candidate to undergo gender reassignment surgery. The best part, your insurance company is likely to cover the surgery. If your health care provider(s) believe it’s medically necessary and beneficial to your mental and physical health, Medicare may provide coverage.
Get Help Covering Costs Medicare Doesn’t Cover
Times are changing; more people are accepting new standards of what they consider to be ‘normal’. This results in more individuals are given are proper diagnosis with gender dysphoria are getting the treatment they need and desire.
This shift in the medical industry could be considered a game changer for the transgender community. These individuals no longer need to come out of pocket for reassignment surgeries. The medical industry is finally acknowledging their diagnosis as if it were any other.
If you have any questions or concerns about Medicare coverage for gender reassignment surgery give one of our licensed agents a call today! To discover the best policy in your area, fill out an online rate form today!
Coverage for individuals diagnosed with gender dysphoria is available. Make sure to seek out your Medicare agent to find out what options are available to you.