Are you Eligible for Trans-related Medical Procedures?

The three largest US health insurance providers (Aetna, United Health, and Anthem Blue Cross) provide similar coverage and requirements for transition-related procedures used by those experiencing gender dysphoria.

Listed below are common FTM and MTF procedures that are covered by US-based health insurers with gender dysphoria coverage. For up-to-date policy details, we suggest you check directly with your provider using the direct links provided at the bottom of this page.

Common FTM (female-to-male) procedures that are typically covered by health insurance:

  • Bilateral mastectomy or breast reduction
  • Hysterectomy (removal of the uterus)
  • Metoidioplasty (creation of penis, using clitoris)
  • Penile prosthesis
  • Phalloplasty (creation of penis)
  • Salpingo-oophorectomy (removal of fallopian tubes and ovaries)
  • Scrotoplasty (creation of scrotum)
  • Testicular prostheses
  • Urethroplasty (reconstruction of the male urethra)
  • Vaginectomy (removal of the vagina)
  • Vulvectomy (removal of the vulva)

Common MTF (male-to-female) procedures that are typically covered by health insurance:

  • Clitoroplasty (creation of clitoris)
  • Labiaplasty (creation of labia)
  • Orchiectomy (removal of testicles)
  • Penectomy (removal of the penis)
  • Urethroplasty (reconstruction of the female urethra)
  • Vaginoplasty (creation of vagina)

 

Common MTF and FTM procedures that are typically not covered by health insurance:

Insurers only cover services that are deemed to be medically necessary. Procedures that are not clearly stated as “medically necessary” in the insurance policy are referred to as “cosmetic” and are not covered. We did the research and found 27 common trans-related procedures that are not covered by health insurance.

Provider-specific policy links:

Typical requirements for trans-related procedures:

Below are the typical requirements for the above procedures in an easy-to-read table.  Some policies are easier to interpret than others, and again, these procedures are only available for policies that include gender dysphoria coverage. If you have questions about your specific case, we strongly suggest contacting your health insurance provider or using the below direct links for additional research.

ProcedureTherapist (1) Letter of ReferralTherapist (2) Letter of ReferralDocumentation of Gender DysphoriaCapability to make Informed DecisionAge of 18+A trial of Hormone TherapyLiving in Gender Role
Breast AugmentationYesNoYesYesYesNoNo
Any Other Covered Trans ProcedureYesYesYesYesYesYes – 12 MonthsYes – 12 Months

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