The transgender community scored a major victory Friday: for the first time, Medicare patients are eligible to have gender reassignment surgery covered by their insurance.
The historic decision came as a result of a legal challenge by Denee Mallon, a 74-year-old Army veteran and Medicare recipient. In addition to being approved for her own surgery, Mallon is thankful that her case will have an impact on the greater transgender community. “I am relieved to know that my doctor and I can now address my medical needs, just as other patients and doctors do,” Mallon said.
Although the ruling by the U.S. Department of Health and Human Services is by no means a rubberstamp of approval for gender reassignment, the ongoing policy of automatically denying all such surgery requests is officially off the books. Now doctors will have the authority to decide if a patient is the right candidate for transitional surgery.
Medicare’s change in stance is a big step that shows the progress the transgender community has made with the medical community. Rather than dismissing gender dysphoria as a phase or mental illness, medical professionals are increasingly agreeing that gender reassignment surgery is helpful for many patients who identify as transgender.
“There is considerable evidence that shows that this is a valid condition [and] that the treatment is effective,” said Jamison Green, head of the World Professional Association of Transgender Health. “It can be disabling if it’s not treated.”
An estimated 1.5 million transgender people live in the United States. While not all transgender individuals will pursue or even desire this extensive surgery, there’s good reason to believe that additional insurance coverage will see a rise in such procedures. A few years ago, the National Transgender Discrimination Survey found that more than half of transgender Americans wanted to have surgery, but found the costs of having it done unfeasible.
For now, the decision will not impact Medicaid. The National Center for Transgender Equality is also warning people that they should not expect to see the system completely overhauled overnight. Since Medicare has traditionally denied paying for these surgeries in the past, health care providers may be slow to start accepting Medicare as a form of insurance.
While the majority of insurance plans still discriminate against the transgender community, the tides are certainly beginning to turn. Medicare is not the only significant change, either. In April, California joined Washington, D.C., Colorado and Oregon in passing legislation that required state insurance providers to cover reassignment surgeries for transgender patients.
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