Gender reassignment surgery is one way to help with gender dysphoria. Gender dysphoria is the feeling of discomfort or distress that a person may feel if their gender is different from the sex that they are assigned at birth.
So a common question many people have is, “does Medicare cover gender reassignment surgery?” In this article, we answer that question in clear, plain English. You will also find the average costs of gender reassignment surgery, as well as other helpful info.
Does Medicare Cover Gender Reassignment Surgery?
The short answer is yes; Medicare will cover the cost of gender reassignment surgery. But not 100% of the time. As is often the case with Medicare, you must meet certain conditions for Medicare to pay for your gender reassignment surgery. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for gender reassignment surgery if it is medically necessary to cope with gender dysphoria. Your local Medicare Administrative Contractors will decide if your gender reassignment surgery is medically necessary.
We commonly divide gender reassignment surgery into top surgeries and bottom surgeries.
There are many types of top surgeries depending on your desired result. For a female to male transition, it involves removal of the breast tissue to flatten the chest. For a male to female transition, it involves breast augmentation which enlarges the breasts.
Bottom surgeries work in a similar way. For a female to male transition, it involves a metoidioplasty and phalloplasty to construct a neopenis and scrotoplasty and testicular implants for constructing a scrotum. For a male to female transition, it involves vaginoplasty and penile inversion to construct a vagina.
Medicare provides coverage for most surgeries mentioned above. The exception is breast augmentation, because it is not considered medically necessary. However, Medicare does not cover these types of surgeries as they are cosmetic:
- Laser hair removal
- Tracheal shave surgery
- Facial feminization surgery
Medicare also provides coverage for related services such as counseling for gender dysphoria.
Part C Coverage for Gender Reassignment Surgery
Medicare Advantage plans (Medicare Part C) also provide coverage for Gender Reassignment Surgery. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and your out-of-pocket costs will vary depending on the specifics of your plan.
How Much Does Gender Reassignment Surgery Cost?
Gender reassignment surgery may cost up to $15,000 for just the reconstruction of genitals. It may include an additional $10,000 for the top surgery, making it $25,000. Additionally, with $25,000 or more for procedures to look more masculine or feminine, the total cost may be $50,000 or higher.
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 Hemorrhoid surgery?