Medicare and Gender
Medicare determines coverage for gender reassignment surgery on a case-by-case basis. However, hormone therapy medications are not covered by Original Medicare at all.
If Medicare covers your gender reassignment surgery, a Medicare Supplement (Medigap) plan can help pay for your gender affirmation out-of-pocket Medicare costs, such as deductibles, copays, coinsurance and more.
To receive Medicare coverage for prescription medications, you must enroll in a Medicare Part D plan in addition to Medicare Part A and Medicare Part B.
Medicare Part D Plans May Cover Hormone Therapy Medications
The types of hormone therapy medications that may be covered by a Medicare Part D prescription drug plan may vary from one plan to the next.
Drug costs will vary depending on the Part D plan you enroll in because each plan has its own formulary (list of covered drugs). Your Part D monthly premium will also vary.
You should enroll in Part D as soon as you are eligible. If you enroll in a Medicare prescription drug plan after you are first eligible, you may have to pay a late enrollment penalty.
This rule does not apply to you if:
You have other creditable prescription drug coverage
You get Extra Help (a program that helps Medicare beneficiaries with limited financial resources pay for prescription drug coverage)
You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.
Medicare May Cover Gender Reassignment Surgery in Some Cases
In 2014, Medicare lifted exclusions for gender reassignment surgery under Medicare Part A.
Although Medicare may cover the cost of gender reassignment surgery if you qualify, there are some out-of-pocket costs that you should familiarize yourself with.
Medicare Part A deductible
In 2022, the Medicare Part A deductible is $1,556 per benefit period.
Medicare Part A coinsurance
Under Medicare Part A, beneficiaries are responsible for paying a coinsurance, based on the length of their hospital stay.
Days 1-60: $0
Days 61-90: $389 per day of each benefit period in 2022
Days 91 and beyond: $778 per each "lifetime reserve day" in 2022
Beyond lifetime reserve days: all costs
Medicare Part B deductible
In 2022, the standard Part B deductible is $233 per year.
Medicare Part B coinsurance
Once you’ve met your Part B deductible, Medicare cover 80 percent of the Medicare-approved amount of your gender reassignment surgery. You are responsible for the remaining 20 percent.
Medigap Plans Can Help Cover Gender Affirmation Surgery Medicare Costs
If your gender reassignment surgery is covered by Medicare, a Medicare Supplement Insurance plan can help pay for some of your out-of-pocket Medicare costs like deductibles and copays.
Learn more about common procedures that medicare covers.
A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.
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Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.