Medicare Will Finally Cover Gender Reassignment Surgery

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.



Robert Hamm
Robert Hamm3 years ago

Wrong Sara H drs are leaving it becaue they can no longer GOUGE it as they once did. Medicare used to be a cash cow for them. Its easier to steal from insurance companies.

Sarah Hill
Sarah Hill3 years ago

Medicare is for those over 65, how many are there going to be? The Medicare system is broken! Doctors are leaving the system and getting paid less and less for their care for their patients. Instead of taking over our WHOLE medical system, why didn't they fix this one? Or the VA?

Vee Jackson
Past Member 3 years ago

good news

Jan L.
Past Member 3 years ago


Anita B.
Anita B3 years ago

As i see it, you got problems because you don´t wanna pay more in taxes, if you would there would be Money to care for all.

It workes in my Country, the "state" take care of us from birth to death, no one ever become so poor that they need to live on the streets because they got ill and couldn´t take care of their job anymore, not either if they got to old /over 65.

Vicky P.
Vicky P3 years ago

okay :)

Cedar F.
Past Member 3 years ago

Since you can't get Medicare until you are 65 or have been on Social Security disability for 2 years, I'd guess there won't be a huge demand for this.
It's hard not to agree with those who pointed out the Medicare does not pay for dental or vision services (vision as in refraction- if you have a medical condition like cataracts, glaucoma or macular degeneration, that is covered).

Vicky Locke
Vicky Locke3 years ago

As it should be; physicians and patients decide the nature of a medical problem and determine the appropriate treatment for each individual. I think review by insurance companies/agencies is fine, but ultimately the decisions should be made by physicians and patients. I must be a Luddite!

Darryll Green
Darryll Green3 years ago

great, i can't get dentures, which i need, yet someone can have gender surgery because they think they were born the wrong sex, how screwed up is that

John S.
Past Member 3 years ago

But how many providers of this service accept medicare?