Ask Lambda Legal – Medicare and Sex Reassignment Surgeries  

I am a transgender woman in my late 60s. I only recently came out and I’m not sure what type of transition-related medical care I need yet. What is covered by my Medicare plan for people like me?

Congratulations on coming out! There have been some recent changes in coverage for transgender people who have Medicare, and thankfully the changes are headed in the right direction.

On May 30, 2014, a U.S. Department of Health and Human Services review board ruled that transgender people receiving Medicare may no longer be automatically denied coverage for sex reassignment surgeries. Before this, Medicare, the federal government’s health insurance program for people over the age of 65 and people living with long-term disabilities, uniformly banned coverage of sex reassignment surgeries (SRS) for its nearly 50 million beneficiaries. Now, Medicare recipients can seek coverage for all medically necessary transition-related health care, including routine preventive care, hormone therapy, and surgeries.

This ruling is a tremendous development for transgender seniors, many of whom rely solely on Medicare for health coverage. The end of a categorical exclusion on SRS coverage means that transgender seniors will now have access to the care that doctors deem medically necessary for them without the constraints of a discriminatory blanket rule. This ruling affirms what the medical community has understood for many years ― that transgender people and their health-care providers are best equipped to determine whether SRS is appropriate treatment for any individual. Removing this barrier is particularly important because transgender seniors face a disproportionate number of obstacles to accessing health care in general.

This ruling also marks a broader victory for transition-related health care. Currently, very few insurance companies and employers, private or public, cover SRS in their health insurance plans, despite both the medical consensus on the necessity of this care for transgender people and the data showing that insurance companies that do cover SRS are able to do so at minimal cost. Without insurance coverage, the costs of SRS for individual patients often cause transgender people to delay or forgo necessary health care.

Check out Lambda Legal’s publications about transgender health care at Transgender Health.

Lambda Legal congratulates our colleagues at GLAD, the ACLU, and NCLR for this decisive victory and applauds this new decision as a positive step toward ensuring fair access to health care for transgender people in general, and particularly for the older members of the community.

If you feel you have been discriminated against because of your gender identity, sexual orientation, or HIV status, contact Lambda Legal’s Help Desk at 866-542-8336, or see Lambda Legal Help Desk.
Karen Loewy is a senior attorney and seniors program strategist for Lambda Legal, the national organization that works to secure full civil rights for LGBT people.

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