After rate hikes, Obamacare and insurers to pay for “gender reassignment” surgery
It’s never been easier for transgender people to access gender reassignment surgery — if they have insurance and live in the right state. More than two dozen major insurance carriers provide plans without blanket exclusions for transgender-related health care, either through fully-insured plans or as a third party administrator of self-insured plans, according to the Human Rights Campaign, a nonprofit group that works for lesbian, gay, bisexual and transgender equal rights. They include Aetna AET, -0.66%, at least eight Blue Cross state programs, Cigna CI, -1.10%, UnitedHealth UNH, +0.14% and Emblem Health.
Regulators in nine states and the District of Columbia have also introduced laws banning insurance discrimination against treatments for gender reassignment. The other eight are California, Colorado, Connecticut, Illinois, Massachusetts, Oregon, Vermont and Washington, according to the Transgender Legal Defense & Education Fund. “But some insurers still deny claims and flout the law until someone pushes back against them,” says Michael Silverman, executive director at Transgender Legal Defense and Education Fund. Last December, New York Governor Andrew Cuomo told insurers in a letter: “An issuer may not deny medically necessary treatment otherwise covered by a health insurance policy solely on the basis that the treatment is for gender dysphoria.”
New federal laws have also helped create a more inclusive environment. In May 2014, the Obama administration lifted a 33-year-old ban on Medicare coverage for gender reassignment surgery. The 2010 Affordable Care Act does not explicitly require insurers to cover gender reassignment surgery but, according to this White House letter, insurers “can no longer turn someone away just because he or she is lesbian, gay, bisexual, or transgender.” This has not yet been tested in court, says Josh Block, a senior staff attorney with the American Civil Liberties Union LGBT Project in New York.
Full gender reassignment surgery can cost from $10,000 to $100,000, but most people don’t spend more than $30,000 or $40,000, says Jamison Green, president of the World Professional Association for Transgender Health, an international nonprofit. While 61% of transgender Americans reported having medically transitioned with hormone therapy, for instance, only 33% said that they had surgically transitioned, according to a 2011 survey by the National Center for Transgender Equality and National Gay and Lesbian Taskforce. It may be because they chose not to have gender reassignment surgery or, the report found, because a sizable percent of those who have had hormone therapy are not yet living full-time in their new gender.
