Medicare & Transgender Services Coverage

[JennJenn]

Hi, I am new here.  My name is Jennifer.  I transitioned 11 years ago.

I am still pre-operative and have been on large dose of spironlactone and estradiol for the past 10 years. 

I can't yet afford GRS and I am seriously considering a properly done orchiectomy -- which will allow me to have GRS later on without issue.  I really need to get rid of these testes so I can reduce my medications, to lower any risks associated with higher doses for extended periods of time.

I am disabled with SSDI and Medicare.

I was wondering if anyone had any tips on how to actually get Medicare to pre-authorize and cover surgeries like an orchiectomy, as well as GRS later on.

I figure I should at least get the orchi asap since the new (2014) Medicare transgender policy might change with the new administration in office -- already the administration has said the relatively small costs of transgender related surgeries in the military are "expensive" and "burdensome".  (I can only think Medicare is next.)

Are there any SRS/GRS surgeons at all in USA that take Medicare?  That spend the time to get it pre-authorized?

ANy help would be greatly appreciated thanks.

[Dena]

Welcome to Susan's Place. Not all doctors accept medicare so you need to talk to the doctors office and see what they will accept. I am using Dr Meltzer's office for HRT and they don't accept medicare. If you search the web for "medicare transgender" you will be able to find a good deal of information on the subject however when I did it, I found this which is a pretty good starting point.

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[Tommi]

One of the ladies in my group is using medicaid, and is travelling up to Massachusetts, I believe, next month!

--
"You do realize, this means you get to do character creation & the newbie zone all over again? "

[Lady Sarah]

I was living in California when mine was done. Medicaid and Medicare covered it 100%. Of course, I was dealing with a lot of pain from them being pulled so far inside me, from HRT. My options were to either stop HRT, or get the orchiectomy. There was no thinking about it. I knew what I wanted.

[JennJenn]

I do get testicular pain from time to time.  And I notice they are much higher and pulled in like you say.  10 years of HRT.  Shrunk to size of a small grape.

So if I keep complaining about the pain, then I might get it preauthorized by medicare to cover it as medically necessary?  The orchi that is.

I'm in Oklahoma, so I am guessing that Medicaid here wouldn't be that helpful in supplmenting Medicare.. heck they even have a bathroom bill introduced here.  [Btw, if that bill did ever pass I'd freak out all the guys because I dont look remotely like a guy and I'd put myself in danger both mentally and physically.  I never get an odd stare and by law I'd be forced to share with the world my personal private past medical history.. it just doesn't make sense to me.]

[Laurie]

Hi Jennifer,

I'm Laurie, Hi and welcome to Susan's place (Hug) Come on in and have a seat.  I am probably looking at either medicare or  a Kaiser Permanente HMO senior plan as it would only cost about $45 more a month than what Medicare would contribute. plus co pays of course.
  Here in Portland Or we do have Dr. Dugi who I believe accepts Medicare. The VA will not perform surgeries or cosmetic procedures and I am sure this administration will soon be targeting any and all medical care for transgender veterans. Our future with the government does look bleak. Such are the fruits of ignorance and hate.

  I hope you have good luck in your search for care.

Hugs,
   Laurie

[Lady Sarah]

I do get testicular pain from time to time.  And I notice they are much higher and pulled in like you say.  10 years of HRT.  Shrunk to size of a small grape.

So if I keep complaining about the pain, then I might get it preauthorized by medicare to cover it as medically necessary?  The orchi that is.

I'm in Oklahoma, so I am guessing that Medicaid here wouldn't be that helpful in supplmenting Medicare.. heck they even have a bathroom bill introduced here.  [Btw, if that bill did ever pass I'd freak out all the guys because I dont look remotely like a guy and I'd put myself in danger both mentally and physically.  I never get an odd stare and by law I'd be forced to share with the world my personal private past medical history.. it just doesn't make sense to me.]

On a positive note: in most states, getting an orchiectomy may allow you to get your birth certificate changed to female, as it is a permanent surgery that leaves you sterile. It is to my understanding that the only states that does not apply to are the ones that do not EVER allow gender changes to birth certificates.