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Does Medicare Cover Facial Feminization Surgery

Does Medicare Cover Facial Feminization Surgery?

Facial feminization surgery can include many surgical procedures. This includes hairline surgery, cheek fillers, lip augmentations, chin reshaping, and jaw resizing. Just to name a few. In general, facial feminization are procedures that change masculine facial features into more feminine ones.

If you are considering one or more of these procedures, you may be wondering “does Medicare cover facial feminization surgery?” 

In this article, we answer that question in clear, plain English. You will also find the average costs of facial feminization surgery if you have to pay for it without insurance.

Does Medicare Cover Facial Feminization Surgery?

The short answer is no. In most cases, Medicare will not cover the cost of facial feminization surgery. That being said, there may be some situations where getting coverage for these costs may be possible. Let’s examine how you might be able to get Medicare to pay for your facial feminization surgery. 

Original Medicare Coverage of Facial Feminization Surgery

Original Medicare (Medicare Part A and Part B) does not provide coverage for facial feminization surgery. This means you will have to pay 100 percent of the costs. 

In general, Parts A and B of Medicare do not provide coverage for cosmetic surgeries. Medicare will not cover any treatment that is not medically necessary.

However, Medicare’s benefits are starting to evolve to provide benefits to the transgender community. For example, Original Medicare does provide for gender reassignment surgeries and treatments. 

Original Medicare Coverage of Gender Reassignment Surgery

Medicare Part A and Part B provides coverage for gender reassignment surgery. But coverage is only available if it is considered medically necessary. One situation where this is the case is in coping with gender dysphoria. If you have gender dysphoria you are likely to get approval.

When Gender Reassignment Surgery is May Be Medically Necessary

Local Medicare Administrative Contractors (MACs) decide if your gender reassignment surgery is medically necessary. 

Gender reassignment surgery, and related services, are considered medically necessary for individuals who wish to transition. Gender reassignment surgery is commonly divided into top surgeries and bottom surgeries. 

Medicare provides coverage for what is involved in top and bottom surgeries, except for breast augmentation. This is because it is not considered medically necessary. 

Part C Coverage for Facial Feminization Surgery

Similarly to Original Medicare, Medicare Advantage plans (Medicare Part C) do not cover facial feminization surgery. 

Medicare Advantage plans have to cover everything Original Medicare covers. But these plans will offer coverage for things Original Medicare won’t cover. You’ll need to check with your plan to see exactly what extra services they cover and what the costs for these services are.

How Much Does Facial Feminization Surgery Cost?

Facial feminization can cost between $20,000 and $50,000. This depends largely on the procedure(s) you get.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover hormone replacement therapy?

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