Any chance insurance plans such as Medicaid in the US will ever cover SRS?

[Declan.]

I need top surgery. It's not a matter of something I want anymore - I always wanted it - but a need now. If I keep binding, I could end up with permanent and severe back problems. But it's too expensive. We can't afford it anytime soon.

I have health insurance now under the ACA. It's kind of like Medicaid I think? I don't know. Anyway, my question is, is there any chance at all that that kind of health insurance will ever pay for SRS procedures? I guess what I'm asking is, do I have hope? I know nobody knows this kind of thing for sure, but I was wondering if there's any kind of information out there that suggests it might be a possibility. Thanks.

Edit: Edited it from "government insurance" to "basic insurance."
Edit: Edited again.

[mrs izzy]

Yes in some states they must not exclude gender related health care. Things will come around in short order with other states. Just now a matter of time.
Check your state and see what the exchange has to offer. Maybe another option is to make a move?

Izzy

[Declan.]

Yes in some states they must not exclude gender related health care. Things will come around in short order with other states. Just now a matter of time.
Check your state and see what the exchange has to offer. Maybe another option is to make a move?

Izzy

Really? Do you know how I could find out if my state is one of them?

[Miss_Bungle1991]

Even if they exclude certain things in the policy, you can get around it as long as the surgeons/docs, etc code things the right way. They want to get paid, after all.

[Declan.]

Even if they exclude certain things in the policy, you can get around it as long as the surgeons/docs, etc code things the right way. They want to get paid, after all.

Really?? I think I would qualify for breast reduction surgery, especially since I have fibromyalgia on top of it and a history of back issues. So with the insurance I signed up for, I might be able to pull it off??

[Jamie D]

Breast reductions are not always 1) cosmetic, or 2) related to gender affirmation surgery.

Laura is correct about the coding.  I got my mammograms covered by insurance because the diagnostic code was "gynecomastia," rather that "hormone replacement therapy."

And it is not really "government insurance."

[Declan.]

Breast reductions are not always 1) cosmetic, or 2) related to gender affirmation surgery.

Laura is correct about the coding.  I got my mammograms covered by insurance because the diagnostic code was "gynecomastia," rather that "hormone replacement therapy."

And it is not really "government insurance."

Did you have good insurance though? I have the basic insurance for someone of my income level (which is pretty low right now). $0 deductible.

[LordKAT]

Then you have medicaid, which is government insurance.

[Declan.]

Then you have medicaid, which is government insurance.

Yeah, that's what I originally had in the title, but she said it wasn't government insurance... 

[Jamie D]

Did you have good insurance though? I have the basic insurance for someone of my income level (which is pretty low right now). $0 deductible.

Blue Cross PPO

I thought DCQ was referring to an Obamacare policy.

[LordKAT]

Blue Cross PPO

I thought DCQ was referring to an Obamacare policy.

Originally, so did I, but the BC PPO is under medicaid. You usually have a few plans to choose from. I think it got mixed up due to medicaid expansions in many states.

[Declan.]

I have Neighborhood Health Plan of Rhode Island. I'm pretty sure that does fall under Medicaid.

Edit: Everything I'm reading around the forum says getting top surgery done under "breast reduction" would be fraud. As badly as I need top surgery, I'd rather be messed up than get slammed for fraud. So I guess my original post still stands about wondering if SRS will ever be covered by Medicaid and similar insurance plans.

[LordKAT]

I think it will happen sooner or later. Originally the language for ACA included trans related care but it was removed.

[Declan.]

I think it will happen sooner or later. Originally the language for ACA included trans related care but it was removed.

That's really frustrating to know it was originally included; do you know why it was taken out?

[Jenna Marie]

A good chance it will *someday,* I think... some states have, as mentioned, already determined that under their own state laws, they cannot exclude transgender care. CT is the most recent to decide that, but "Regulators in California, Colorado, Oregon, Vermont and Washington, D.C., have issued similar bulletins instructing insurers to cover treatment for transgender patients, according to GLAD."

http://www.courant.com/news/politics/hc-gender-identity-connecticut-1227-20131226,0,1545137.story 🔗

[Declan.]

A good chance it will *someday,* I think... some states have, as mentioned, already determined that under their own state laws, they cannot exclude transgender care. CT is the most recent to decide that, but "Regulators in California, Colorado, Oregon, Vermont and Washington, D.C., have issued similar bulletins instructing insurers to cover treatment for transgender patients, according to GLAD."

http://www.courant.com/news/politics/hc-gender-identity-connecticut-1227-20131226,0,1545137.story 🔗

Thank you so much for the link and information. We could easily move to Vermont or Connecticut, but the article says all New England states will probably be doing this eventually.

That does mean that top surgery would be covered... right??  😮 A little worried to get my hopes up, but that's what it looks like.

[Jenna Marie]

DCQ : Yes. 🙂 ALL trans care - hormones, doctors' visits, and surgeries. All surgeries. Heck, if they'll pay for bottom surgery on men and women both, top surgery is cheap by comparison!

The goal is all New England states, but obviously there's no timeline on that. Still, VT and CT are both great states to live, and goodness knows you'd save a ton of money by moving and having insurance pay for all necessary care!

(It's far too late for me, as I paid out of pocket for GRS in 2012. But I'm still delighted that my home state is so progressive.)

[Declan.]

DCQ : Yes. 🙂 ALL trans care - hormones, doctors' visits, and surgeries. All surgeries. Heck, if they'll pay for bottom surgery on men and women both, top surgery is cheap by comparison!

The goal is all New England states, but obviously there's no timeline on that. Still, VT and CT are both great states to live, and goodness knows you'd save a ton of money by moving and having insurance pay for all necessary care!

(It's far too late for me, as I paid out of pocket for GRS in 2012. But I'm still delighted that my home state is so progressive.)

Wow!! I can hardly believe what I'm reading... looks like we're moving unless it gets shot down somehow; is that even possible at this point?? Thank you so much Jenna!

[Jenna Marie]

Glad to help! These tiny states can use all the motivated, smart citizens they can get, after all. 😉

[Declan.]

Glad to help! These tiny states can use all the motivated, smart citizens they can get, after all.

We're in RI right now, so it'll be an easy move!