Insurance Companies That Offer Gender Reassignment Surgery Coverage

Some insurance companies are now covering gender reassignment surgery, a significant step forward for the transgender community.

Aetna, for example, offers coverage for hormone therapy, chest reconstruction, and other related procedures.

Cigna also provides coverage for gender reassignment surgery, including vaginoplasty and phalloplasty.

UnitedHealthcare offers coverage for hormone therapy and other related services, but it's essential to check with your provider for specific details.

Insurance coverage for gender reassignment surgery varies widely among companies.

Some insurance companies, like Blue Cross Blue Shield, cover the surgery as a medically necessary procedure.

However, the majority of insurance companies, such as UnitedHealthcare and Aetna, do not cover it, citing it as a cosmetic procedure.

Many insurance companies, including Cigna and Humana, have specific requirements that must be met before they will cover the surgery, such as requiring a mental health evaluation.

Transgender individuals may be able to get coverage through their employer's health insurance plan, or through a private insurance company that specializes in covering transgender individuals.

The cost of gender-affirming care can be high, ranging from $25,000 to $75,000, according to the Human Rights Campaign.

Many insurance plans cover most of these costs, especially phalloplasty and vaginoplasty procedures, which have median total costs of $148,540 and $59,673, respectively.

However, not all transgender people desire surgery, and only 28% of transgender women and 42% to 54% of transgender men get some type of surgery.

Gender-affirming medication is far more common than surgery, with as many as 65% of transgender people receiving gender-affirming hormone therapy in 2019.

The costs of gender-affirming medications can vary widely, ranging from $6.76 to $398.99 for a 30-day supply, with median out-of-pocket costs ranging from $5.00 to $12.86.

Some organizations offer grants or financial aid to help cover the costs of surgery, such as the Jim Collins Foundation, Point of Pride, and The TransMission Program.

Here are some estimated out-of-pocket costs for specific surgeries:

It's essential to understand your insurance plan's coverage details and ask questions if you're unsure about what's covered.

Insurance plans can be complex, and securing coverage for your medically necessary gender-affirming surgery can be challenging.

At the Gender Confirmation Center, our insurance concierge team will work to secure you the most affordable care.

You may be able to save some money if you follow these tips for financing gender-affirming care and surgery.

CareCredit and other financing options are available to help patients cover the costs of surgery.

Research shows that insurance often covers most of the cost of gender-affirming surgery, but it's crucial to review your plan's coverage details carefully.

You can access some types of gender-affirming care through TRICARE, the health benefits provider for military members, which covers hormone therapy and psychological counseling for gender dysphoria.

Active duty service members may request a waiver for medically necessary, gender-affirming surgery, but coverage for surgery is generally not provided.

The Veterans Health Administration offers gender-affirming healthcare, including hormones and prosthetics, mental health care, and other healthcare, and is currently reviewing coverage for gender-affirming surgery.

If you have a flexible spending account (FSA) or health savings account (HSA), consider allocating some account money for gender-affirming care or surgery if you are anticipating it.

Here is a list of some insurance providers that cover gender-affirming surgeries, but note that this list may be subject to change and does not guarantee insurance coverage for top surgery:

There are many types of insurance plans that can cover gender-affirming care, including public, employer-sponsored, and private insurance plans. Public insurance plans include Medicaid and Medicare, while private insurance plans can be self-funded or offered by private insurance companies.

You can find out what's available to you in your member booklet, which should describe the insurer's clinical evidence criteria to qualify for claim coverage. For example, to begin hormone therapy, the requirements might include a diagnosis of gender dysphoria from a licensed mental health professional.

Insurance companies may use different language to describe exclusions for certain procedures, such as "services related to sex change" or "sex reassignment surgery." It's essential to carefully review the terms of your plan before enrolling.

Most insurers have eliminated transgender-specific exclusions, but policies can vary by state and in what they cover. According to Out2Enroll, a record 40% of silver Marketplace options in 32 states did not use transgender-specific exclusions.

If you have a health insurance plan that covers gender affirmation surgery, you'll need to meet certain guidelines, such as having a letter from a mental health professional detailing your gender dysphoria and medical need for the surgery.

Here are some insurance providers that cover gender-affirming surgeries, according to the GCC's list:

Keep in mind that this list may be subject to change and does not guarantee insurance coverage for top surgery. Successful approvals may vary based on several factors, such as the type of plan for each insurance company.

If you're denied coverage, you can appeal the decision with the help of an attorney, healthcare advocate, or your human resources department.

Military members have access to some types of gender-affirming care. TRICARE, the health benefits provider for military members, covers hormone therapy and psychological counseling for gender dysphoria.

Active duty service members may request a waiver for medically necessary, gender affirming surgery. However, this is not a guarantee of coverage.

The Veterans Health Administration offers gender-affirming healthcare, including hormones and prosthetics, mental health care, and other healthcare.

Navigating insurance can be a daunting task, especially when it comes to getting coverage for gender reassignment surgery. You may find that your insurance plan covers the surgery, but there are still steps you need to take to ensure you meet the necessary guidelines.

First, learn what your insurance plan covers for gender-affirming care by calling your insurance company and asking about the medical policies on gender dysphoria treatment. You may also find this information in the Member Handbook provided by your insurance.

To determine if your plan covers the surgery, check your policy documents, including the certificate of coverage, benefit plan, or summary plan description. These documents should describe the insurer's clinical evidence criteria to qualify for claim coverage.

If your plan does not cover the surgery, you may consider paying out of pocket or exploring fundraising initiatives, such as crowdfunding. Alternatively, you may be able to apply for a personal loan to cover surgery costs.

Here are the different types of insurance plans and how they might cover gender-affirming care:

When navigating insurance, it's essential to understand the process for pre-authorization and pre-approval for the procedure. This may involve applying for a pre-authorization to determine if the surgery or procedure will be covered.

If your insurance plan does not cover the surgery, you may have the option to request an independent review by a third-party organization. This review can provide an unbiased evaluation of your case and potentially overturn the denial.

In some cases, you may need to appeal the denial of a pre-authorization request or claim for reimbursement. Understanding the reason for denial can help determine your options for appealing this decision.

Keep in mind that insurance companies may have different policies and procedures for covering gender-affirming care, so it's essential to carefully review your policy documents and ask questions if you're unsure about coverage.

There are various types of gender-affirming care, including puberty-blocking medication, hormone therapy, top surgery, bottom surgery, and mental health services.

Some insurance companies will include blanket exclusions on transgender-related care, so it's essential to check the plan documents before buying insurance. You can also ask your employer's human resources department if they have an exclusion.

To find an insurance company that covers gender-affirming surgeries, you can check the list provided by the Transgender Legal Defense & Education Fund (TLDEF) or the Gender Confirmation Center's list of insurance providers that cover gender-affirming surgeries. The list may be subject to change and doesn't guarantee insurance coverage for top surgery.

AETNA, ANTHEM BLUE CROSS, and BCBS FEDERAL EMPLOYEE PROGRAM are some of the insurance providers that cover gender-affirming surgeries, according to the GCC's list. However, even if an insurance provider appears on the list, you'll need to check your individual plan to make sure it covers transgender care.

Letters from mental health professionals and healthcare providers can help establish medical necessity, especially when appealing a claim denial. Following the WPATH Standards or the World Professional Association for Transgender Health (WPATH) guidelines can strengthen your case for insurance coverage.

Financial aid options are available to help cover the costs of gender reassignment surgery. There are several organizations that offer grants to help fund surgery.

The Jim Collins Foundation, Point of Pride, and The TransMission Program are examples of grants that can provide financial assistance for gender affirmation surgery. These grants can help cover all or part of the costs.

You can also consider using CareCredit, a credit card that offers payment plans to help cover the costs of surgery. The Gender Confirmation Center (GCC) has partnered with CareCredit to make this option available to patients.

If you're looking for other ways to pay for gender-affirming care or surgery, there are options beyond health insurance. You can explore surgery grants, use CareCredit, or look into other financial aid programs.

Here are some organizations that offer grants for gender-affirming care or surgery:

Healthcare providers play a crucial role in establishing medical necessity for gender-affirming care. Letters from mental health professionals and healthcare providers can work to establish medical necessity, especially in the case of seeking coverage and appealing a claim denial.

Following the WPATH Standards or the World Professional Association for Transgender Health (WPATH) guidelines can strengthen a case for insurance coverage. You can read more about these guidelines as they apply to support letters for surgery here.

Insurance companies may have varying policies regarding transgender health care coverage, and some may have exclusions or limitations on coverage. Not all plans cover all procedures, and the process can be murky and require preauthorization.

Healthcare providers play a crucial role in establishing medical necessity for gender-affirming care. Letters from mental health professionals and healthcare providers can work to establish medical necessity, especially in the case of seeking coverage and appealing a claim denial.

The World Professional Association for Transgender Health (WPATH) guidelines can strengthen a case for insurance coverage. Following the WPATH Standards can help ensure that a healthcare provider's letter is effective in supporting a patient's claim.

Healthcare providers can write letters that establish medical necessity, but it's essential to note that insurance providers may still deny claims. In such cases, a denied claim can lead to significant difficulties when trying to secure reimbursement.

To increase the chances of a successful claim, it's recommended to go through the pre-authorization process first. A denied claim without prior authorization can make it more challenging to secure reimbursement.

Here are some key points to keep in mind when working with healthcare providers:

Provider Policies can be confusing, especially when it comes to transgender healthcare. Many insurance providers offer coverage for gender-affirming care, but exclusions and limitations can vary greatly.

Insurance provider policies may include categorical exclusions, which can affect individuals under 26 on their parent's plan or those employed by an employer with an ERISA plan. This means that even if an insurance provider offers coverage for transgender healthcare, certain plans may not.

To navigate these policies, it's essential to understand the terms and conditions of your plan. Pre-authorization, exclusions, and medical necessity are key concepts to grasp. Pre-authorization refers to the services insurance providers determine are medically necessary and therefore eligible for coverage.

Here's a list of some insurance companies that offer gender-affirming care, but it's crucial to check individual plans for coverage:

Keep in mind that this list may not be exhaustive, and coverage can change. It's always best to check with your insurance provider directly to confirm their policies and coverage.