Medicare and Medicaid in Pennsylvania Covering Bottom...

[WolfSoul]

Hello,

I'm very new to this site, and had a question. I'm on Medicaid and Medicare and I live in Pennsylvania, right outside of Philadelphia. My address is in Philly. I'm legally disabled. I was wondering if either of those insurances will cover any kind of bottom surgery. I had top surgery six years ago with Dr. Kathy Rumer, which I paid for out of pocket. I've recently been considering bottom, but don't even want to get into which if I can't get it covered  by insurance. There's no way I can afford it otherwise.

Peace,
Liam

[Dena]

I am unsure about Medicaid but I suspect it would come under the same guidelines that Medicare has as they are both government programs. As for Medicare, this link may help you.

[FTMax]

From what I understand, yes it is covered. You just have to provide them with documentation which your surgeon would already be requiring you to get anyway - 2 letters from mental health professionals, and a letter from the doctor supervising your HRT. I'm unsure if there are any other Medicare/Medicaid specific requirements. If there are, it's probably just internal paperwork that they can get to you.

The one thing that's sort of limiting with using any kind of insurance or Medicare/Medicaid is that you can only go to surgeons that accept that. Your best bet would be to look into surgeons working out of university hospitals. Most of them seem to have agreements with Medicare. Off the top of my head, you could look into: Dr. Berli & Dr. Dugi at OHSU, Dr. Salgado at the University of Miami, Dr. Kuzon at the University of Michigan, and Dr. Bluebond-Langner and Dr. Zhao at NYU.

If you have your heart set on a particular surgeon, you could always call and ask what they accept.

I don't know if you're on Facebook, but I believe there is a group there specifically for trans folks seeking to use Medicare/Medicaid for surgical coverage.

[WolfSoul]

Thanks for the info, everyone! I don't have my heart set on a particular surgeon, as I have to lose at least 150 pounds to get surgery. I'm 5'2 and close to 300 pounds and I know I can't get surgery at this weight. I had top surgery six years ago, and while I was large, I was nowhere near this big. So basically,  I am waiting until I lose a bulk of this weight to really focus on a surgeon. I'm kind of doing more general information gathering at this stage.

If you could point me in the direction of that Facebook group, that would be awesome. My name is Liam  Lyn  Wolf  on there.

[FTMax]

I'll send you a friend request on there and link you to it. I can also add you to some private bottom surgery groups.

[Mal]

I found this article that says that Medicaid in Pennsylvania does cover transgender care, which is good because Medicaid in most states don't cover it.

http://www.transequality.org/blog/pennsylvania-medicaid-removes-trans-health-exclusions

[Bimmer Guy]

From what I understand, yes it is covered. You just have to provide them with documentation which your surgeon would already be requiring you to get anyway - 2 letters from mental health professionals, and a letter from the doctor supervising your HRT. I'm unsure if there are any other Medicare/Medicaid specific requirements. If there are, it's probably just internal paperwork that they can get to you.

The one thing that's sort of limiting with using any kind of insurance or Medicare/Medicaid is that you can only go to surgeons that accept that. Your best bet would be to look into surgeons working out of university hospitals. Most of them seem to have agreements with Medicare. Off the top of my head, you could look into: Dr. Berli & Dr. Dugi at OHSU, Dr. Salgado at the University of Miami, Dr. Kuzon at the University of Michigan, and Dr. Bluebond-Langner and Dr. Zhao at NYU.

If you have your heart set on a particular surgeon, you could always call and ask what they accept.

I don't know if you're on Facebook, but I believe there is a group there specifically for trans folks seeking to use Medicare/Medicaid for surgical coverage.

Max,

I know that Medicaid will not pay for out of state surgeons (unless they have no one in-network in state), but with you saying the above, this leads me to think that they will pay out of state as long as they are the secondary insurance?