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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Imagine having to out yourself as transgender every time you had to show a birth certificate – every school, every job, every time you encountered a bureaucracy. That is the current situation for many people around Australia, who live in a no-man’s land between their gender presentation and the law.
In South Australia this week, Premier Jay Weatherill announced that a new bill will be introduced to parliament to make it easier for transgender people to change their registered gender, a move that will significantly ease the difficulty of gender transition. Currently, in every state and territory of Australia, barring the ACT, transgender people must undergo sexual reassignment surgery (SRS), be unmarried and over the age of 18 to apply for a new birth certificate. Following a similar law in the ACT in 2014, the proposed new South Australian law will allow transgender people to change their documents with only a letter from a medical professional declaring that they have received appropriate clinical treatment.
What is wrong with the current requirements for sex marker change? Firstly, SRS is rarely if ever covered by Medicare, and with endemic rates of under employment in the transgender community, many transgender people cannot afford expensive surgery. This limits gender recognition to only the most privileged trans people. Some may not even wish to have surgery but still require recognition from the state. In any case, legally mandating surgery in the service of disciplining aberrant trans bodies into prevailing cisgender (that is, not transgender) norms seems unfair and unjust.
Not until every state has followed the lead of South Australia and the ACT on this issue will transgender people finally get some justice - and the ability to control when and where they out themselves.
Further, transgender children under the age of 18 have had difficulties with being treated as the correct gender by schools, who are still often more in thrall of bureaucratic technicalities than the lived realities of transgender lives. There is a growing population of transgender children who cannot wait until the age of 18 to be treated as the correct sex. Currently in Australia, transgender children need to go to the Family Court to receive hormonal treatment, a process which can cost up to $30,000. SRS is not even legally possible before the age of 18. Clearly, there needs to be provision made for young transgender people to have their genders recognised before they reach adulthood.
Finally, married transgender people may need to get divorced in order to access the correct documents - a fact that will continue until Australia passes marriage equality for same-sex couples. With an uncertain future on that score, it seems a long way off before marriage is irrelevant to transgender rights. In the meantime, the governmental fear of creating married same-sex couples forces trans people into an impossible position in choosing between their marriage and their gender.
In the meantime, the governmental fear of creating married same-sex couples forces trans people into an impossible position in choosing between their marriage and their gender.
It is a great step by South Australia in moving towards transgender acceptance, however more needs to be done nationally. While some Federal document requirements (passport, Medicare) require only a letter, transgender people still have to navigate a formidable array of GPs, psychiatrists, specialists, surgeons and government departments in order to receive gender recognition from their respective birth states. Not until every state has followed the lead of South Australia and the ACT on this issue will transgender people finally get some justice - and the ability to control when and where they out themselves.
Image from Timo Luege (Flickr).
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