Does Health Insurance Cover Gender Affirming Care?

Does health insurance cover gender affirming care? In the United States, health insurance typically includes coverage for gender-affirming care, albeit with variations based on factors such as your specific plan’s benefits, your state of residence, and your employer’s policies.

Does Health Insurance Cover Gender Affirming Care?

However, it’s important to note that not all procedures may be covered by every plan, and obtaining coverage for certain treatments may require appeals or preauthorization.

The cost of gender-affirming care in the USA can amount to tens of thousands of dollars. While many insurance companies recognize such care as medically necessary and offer policies to cover it, some transgender individuals may still face rejection for coverage.

Additionally, certain states have enacted legislation that imposes restrictions on coverage for individuals over 18 seeking gender-affirming care.

What Is Gender Affirming Care?

Gender-affirming care, also known as transgender health care, encompasses the diagnosis, prevention, and treatment of mental and physical health conditions, including sex reassignment therapies for transgender individuals.

A pivotal component of transgender health care is gender affirmation, which facilitates gender transition. Therefore, the objective of this policy is to affirm and support individuals’ gender identity when it deviates from the gender assigned to them at birth.

Does Insurance Cover Gender Affirming Care?

Health insurers, as per the American Medical Association, cover a broad spectrum of medically necessary services aimed at treating gender dysphoria or affirming gender.

Gender dysphoria is a mental condition that arises when an individual experiences conflict between the sex or gender assigned at birth and their current gender identity.

With this health insurance coverage, individuals can access gender-affirming care to address their dysphoria. This includes counseling, hormone therapy, and surgical procedures, enabling individuals to align their gender expression in terms of voice, appearance, and anatomy.

The federal Affordable Care Act, enacted in 2010, prohibited health care discrimination based on gender identity and sexual orientation. Before this law, insurance companies generally did not cover hormones and medically necessary gender-affirming surgeries.

However, coverage varies depending on whether it’s an employer plan, ACA plan, or public plan, and is managed at state and federal levels.

Consequently, not all insurance companies adhere to the same rules, and requirements and coverage may differ based on plan type, state regulations, employer policies, and other factors.

What Does Gender Affirming Care Cover?

Here’s what a typical transgender healthcare insurance policy will cover:

  • Adam’s apple removal.
  • Breast removal.
  • Orchiectomy.
  • Nullification surgery.
  • Vocal surgery.
  • Augmentation.
  • Forehead reduction.
  • Metoidioplasty.
  • Browlifts.
  • Jawline contouring.
  • Hysterectomy.
  • Vaginoplasty and vulvoplasty.
  • Phalloplasty.
  • And Oophorectomy.

Different Types of Gender-Affirming Care

There are different types of gender-affirming care. They include;

  • Speech therapy.
  • Puberty-blocking medication.
  • Nullification surgery.
  • Hormone therapy.
  • Facial feminization surgery.
  • Bottom surgery.
  • Mental health services.
  • Top surgery.
  • Laser hair removal.

How Much Does It Cost?

The cost of gender-affirming care in the United States varies depending on the specific treatment and procedure desired.

Estimates suggest that for an individual, expenses range from $25,000 to $75,000 for transgender healthcare, as reported by the Human Rights Campaign Foundation.

Possible Ways to Pay for Gender-Affirming Care

Apart from health insurance, there are other possible ways to cover the cost of gender affirming care or surgery. Here are some of the best alternatives:

  • Loans.
  • Health accounts.
  • Payment plans.
  • Loans from friends and family.
  • Crowdfunding.
  • Home Equity Line of Credit.
  • Coupons.
  • Health reimbursement agreement.
  • Surgery grants.
  • Credit cards.

You can turn to any of these means if you want to cover the cost of gender-affirming surgery or care.

How To Get Financing Gender-Affirming Care and Surgery

While there are numerous options available for accessing gender-affirming care insurance or securing financial coverage for surgeries or therapy, it can sometimes be overwhelming to choose the right one. If you find yourself in this situation and require guidance, we are here to help. Below are some useful tips to ensure you receive the best transgender healthcare:

  • Shop around for various options.
  • Check the interest rates.
  • Discover how much coverage you need.
  • Negotiate.
  • Ask questions on financial assistance.

Once you find a good insurance company or insurer that can give you just what you need, you can go into the application process and begin.

Insurance Companies That Offer Gender-Affirming Care

Several insurance companies offer gender-affirming care. Some of these companies include:

  • Aetna.
  • Blue Cross Blue Shield Federal Employee Program.
  • Alliant.
  • Progressive.
  • Amerigroup.
  • BridgeSpan Health.
  • Anthem.
  • Highmark.
  • AmeriHealth.
  • GEHA.
  • Ambetter Peach State Health Plan.
  • Medi-Cal.
  • Network Health.
  • UnitedHealthcare.

The above are reputable and good companies that offer gender-affirming care. Compare these options, then select the insurance company that best suits you and your budget.

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