Is Gender Reassignment Surgery Covered by Health Insurance?

Gender reassignment, affirmation, or confirmation are used interchangeably to indicate the surgeries and procedures aligning one’s gender identity with their physical body. The services and procedures to reaffirm one’s gender can be expensive when paying out-of-pocket, and many states do not yet explicitly mandate such coverage. Some private health plans offer coverage of gender reassignment but are dependent on meeting strict criteria.

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Is Gender Reassignment Surgery Covered by Health Insurance?

Federal nondiscrimination laws and policies aim to protect LGBTQ people from being denied health insurance coverage or coverage of certain medical procedures based on sexual orientation or gender identity. Unfortunately, 27 states do not have LGBTQ inclusive insurance protections, and one state explicitly permits insurers to refuse coverage of gender-affirming care.

According to Dr. Kyle Zrenchik, Ph.D., ACS, LMFT, and Co-founder of All In Consulting, LLC, no mainstream health insurance company is allowed to discriminate against someone for their sexual identity or refuse to insure one because of their sexual identity. Many states require insurance companies to cover trans-specific healthcare, including gender-affirming care.

What is Gender Reassignment Surgery?

Gender reassignment is also known as gender affirmation or confirmation surgery. According to the Cleveland Clinic, gender affirmation refers to the procedures that assist people in transitioning to their self-identified gender. This may include facial surgery and top or bottom surgery. People may pursue this surgery to match their physical body to gender identity, also known as gender dysphoria. 

Gender identity refers to an individual’s own concept of male, female, a blend of both, or neither. According to the American Medical Association (AMA), approximately 1.4 million adults in the United States identify as transgender, but not all transgender people experience gender dysphoria. 

We spoke with Dr. Kyle Zrenchik, who emphasizes that “the diagnosis of Gender Dysphoria (GD) is a bit controversial. Many argue that it unfairly places the “pathology” on the patient, making it appear that it is their emotional distress that is the problem instead of their biology and being born into the wrong body. Many argue that the problem is better understood in our conceptualization of gender and sex and the ways that fail people who fall outside the binary.

Conversely, the diagnosis of Gender Dysphoria is the basis that currently justified the coverage of medical care. Care should not be provided unless there is a problem. Someone should not be treated for a disorder or disease unless they conclusively have one. So, at least in our current medical system, the diagnosis of GD is needed to advocate for this type of care to be provided and paid for by insurers. If the disorder no longer exists, then providers have nothing to “treat,” and insurers have nothing to pay for, says Dr. Zrenchik.