Medicare Can Now Cover Sex-Change Surgery

A federal health board decision Friday knocks down a rule excluding the procedure from government health insurance.

Supporters take part in an annual gay pride march calling for equal rights for lesbian, gay, bisexual and transgender people in Manila on December 7, 2013. The Philippines made headlines when it held the first gay pride march in Asia in 1994 and a few years ago became the first country in Southeast Asia to have an official gay political party. AFP PHOTO / Jay DIRECTO 
National Journal
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Sophie Novack
May 30, 2014, 10:31 a.m.

Trans­gender in­di­vidu­als will now be able to have their sex-change op­er­a­tions covered by Medi­care.

A Health and Hu­man Ser­vices De­part­ment re­view board said Fri­day that cov­er­age for sex-re­as­sign­ment sur­gery can no longer be auto­mat­ic­ally denied by the fed­er­al health pro­gram, ac­cord­ing to the As­so­ci­ated Press.

The rul­ing lifts a 30-year ban on cov­er­age for the sur­gery, ac­know­ledging the pro­ced­ure as med­ic­ally ne­ces­sary for some in­di­vidu­als who don’t identi­fy with the gender they were giv­en at birth.

The an­nounce­ment does not mean that Medi­care re­cip­i­ents will ne­ces­sar­ily be en­titled to cov­er­age for the op­er­a­tion. They will need to sub­mit doc­tor’s state­ments say­ing it is “med­ic­ally in­dic­ated” in their case.

The de­cision does not af­fect Medi­caid — which is state-reg­u­lated — or private in­surers, but trans­gender-rights ad­voc­ates hope that the rul­ing may prod them to fol­low suit.

It is un­known how many people fall in­to the cross-sec­tion that will be af­fected by Fri­day’s rul­ing. About 0.3 per­cent of the U.S. adult pop­u­la­tion iden­ti­fies as trans­gender, ac­cord­ing to a study from the UCLA Law School. More than 49 mil­lion in­di­vidu­als are cur­rently en­rolled in Medi­care cov­er­age.

This isn’t the first time this year that the fed­er­al health pro­gram ex­pan­ded cov­er­age for LGBT be­ne­fi­ciar­ies. HHS an­nounced in April that eli­gible in­di­vidu­als in same-sex mar­riages can ap­ply for Medi­care be­ne­fits.


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