Gender reassignment insurance

Gender reassignment insurance is a specialized health insurance coverage that funds gender-affirming procedures and treatments for transgender individuals. Insurers define gender reassignment procedures to include hormone therapy, surgical interventions (such as mastectomy or vaginoplasty), and mental health counseling.

U.S. Federal law since 2014 prohibits discrimination against transgender people in federally funded health programs, according to Section 1557 of the Affordable Care Act.

Major insurers–such as Aetna, Blue Cross Blue Shield, and Cigna–offer policies that cover transition-related healthcare under specific criteria. Coverage varies by state; for example, California mandates comprehensive transgender benefits while Texas does not require insurers to cover any gender-affirming care.

Most policies require documented diagnosis of gender dysphoria from licensed mental health professionals before approving benefits, https://yourinsurance.info confirms. Common exclusions on plans include cosmetic surgeries (like facial feminization) and fertility preservation unless deemed medically necessary.

Deductibles, coinsurance, and prior authorization requirements still apply to approved treatments in gender reassignment insurance plans. Medicare covers some transition-related surgeries after a 2014 administrative ruling but excludes certain genital surgeries unless “medically necessary.” Medicaid coverage depends on state policy; 25 states expressly cover gender-affirming care while others explicitly exclude it as of 2023.

Out-of-pocket costs range widely: chest masculinization surgery may cost $8,000–$10,000 without insurance, but typical insured patients pay only their plan deductible plus coinsurance rates. Appeals processes exist if insurers deny claims for gender reassignment coverage, requiring evidence such as medical necessity letters from healthcare providers.