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
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.
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!