Does Medicare Cover Gender Reassignment Surgery?

Steven Mott by Steven Mott | Licensed since 2012
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This article was updated on: 09/10/2018

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Individuals suffering from gender dysphoria may desire gender reassignment surgery. According to the American Psychiatric Association, gender dysphoria involves a conflict between a person’s physical or assigned gender and the gender he or she identifies with. Those diagnosed with gender dysphoria may also be referred to as transgender, or individuals who persistently identify with a gender different from their gender at birth.

What is gender reassignment surgery?

According to the American Society of Plastic Surgeons, that goal of gender reassignment surgery is “to give transgender individuals the physical appearance and functional abilities of the gender they know themselves to be.”

For male to female gender reassignment surgeries there are three categories:

  • Facial feminization surgery to transform masculine features of the face into a more feminine appearance
  • Transfeminine top surgery to enhance the size and shape of the breasts
  • Transfeminine bottom surgery to transform male genitalia and reconstruct it into that of a female.

For female to male gender reassignment surgeries there also three categories:

  • Facial masculinization surgery to transform feminine features into a more masculine appearance
  • Transmasculine top surgery to remove breast tissue and create a more masculine appearance of the chest
  • Transmasculine bottom surgery to transform female genitalia and reconstruct it into that of a male

Specific gender reassignment surgeries, according to transhealthcare.org could include:

  • Penile implant
  • Hysterectomy (surgery to remove the uterus)
  • Vaginectomy (surgery to remove all or part of the vagina)
  • Urethroplasty (surgery to reconstruct the urethra)
  • Clitoroplasty (surgery on the clitoris)
  • Phalloplasty (the creation of a penis using tissue from elsewhere on the body)

Does Medicare cover gender reassignment surgery?

Sir Harold Gillies performed the first female to male gender reassignment surgery in 1946, according to the U.S. National Library of Medicine. However, gender reassignment surgeries were considered “experimental” and were banned by Medicare in 1981. As of May 2014, the 33-year exclusion on Medicare coverage of gender reassignment surgery was lifted. Now Medicare Administrative Contractors determine coverage of gender reassignment surgery on an individual claim basis. That means Medicare may cover gender reassignment surgery for Medicare beneficiaries with gender dysphoria whose doctors and health care providers determine there is a medical necessity for the surgery.

Who can get gender reassignment surgery?

According to the American Society of Plastic Surgeons (ASPS), gender reassignment surgeries have risks, such as bleeding, infection, poor healing of incisions, nerve injury and hematoma. There also risks associated with specific surgeries, such as injury to the urinary tract for transfeminine bottom surgeries. According to ASPS, good candidates for gender reassignment surgery:

  • Have been diagnosed with persistent gender dysphoria (this means there may be a waiting period between when you are diagnosed and when you are advised to get surgery)
  • Have two letters of recommendation from mental health professionals who support your decision to undergo surgery
  • Have been living as a member of the opposite sex
  • Have a positive outlook and realistic expectations
  • Have reasonably well controlled medical or mental health concerns

Do you have more questions about Medicare coverage for people with gender dysphoria? I’m happy to help. You can request information via email or schedule a phone call at your convenience by clicking one of the links. To see a list of plans in your area that you may qualify for, click the Compare Plans or Find Plans buttons.

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