Does Medicare Cover Gender Reassignment Surgery?Print
This article was updated on: 11/03/2017
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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. For assistance, please call me or one of our other licensed insurance agents at 1-844-847-2660 (TTY users can call 711) Monday through Friday, 8AM to 8PM ET.
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Gender reassignment surgery, sometimes called sex reassignment surgery, is performed to transition individuals with gender dysphoria to their desired gender.
People with gender dysphoria often feel that they were born in the wrong gender. A biological male may identify more as a female and vice versa.
Surgery is typically the last step in the physical transition process, but it is not a decision to be made lightly.
Many healthcare providers require patients to be formally diagnosed with gender dysphoria and undergo counseling to determine if they are truly ready to surgically transition.
Patients usually undergo hormone therapy first. Hormones can suppress the secondary sex characteristics of the biological gender and make them appear more like their desired sex. For instance, women take androgens and start developing facial hair. Men take estrogens and anti-androgens to look more feminine.
Surgeons may also require that patients live as their desired gender for at least one year. A man might dress as a woman traditionally does in the culture. Many men change their names and refer to themselves with female pronouns. Women transitioning to men would do the reverse.
Surgical transition may include several procedures. Males transitioning to females have their testicles and penis removed. The prostate gland may or may not be removed as well. Tissue from the penis is used to construct a vagina and clitoris. Labia – the “lips” surrounding the vagina - can be made from scrotal skin. The urethra (the tube from which urine leaves the body) is shortened.
Many biological men also have facial feminization surgery to change the appearance of their lips, eyes, nose, or Adam’s apple.
After surgery, patients use vaginal dilators to keep the new vagina open and flexible.
Surgery for females transitioning to males is more complicated and expensive. The breasts, ovaries, and uterus are removed and the vagina is closed. A penis and scrotum may be made from other tissue. In some cases, a penile implant is used. The urethra is extended so that the patient can urinate while standing.
Continued psychotherapy is recommended for most patients as they adjust to their new bodies and lifestyles.
Not all people with gender dysphoria have surgery. Some feel comfortable living as the opposite gender without medical intervention. Others find that hormone therapy is sufficient for their personal needs.