Susan's Place Transgender Resources

SRS Medicare Coverage "Debate" Period Opens

Paul Bedard for the Washington Examiner
29-03-15

http://www.washingtonexaminer.com/in-shift-medicare-would-pay-for-sex-change-operations/article/2525782

For the first time since 1981, when it dubbed sex-change operations "experimental," Medicare has opened the door to covering transexual operations, adding to the growing list of operations that would be allowed under Obamacare.


Post modified to meet formatting requirements.

Too late for me.  Started my medicare benefits on Jan 01, 2013, and had SRS Jan 15, 2013 paid from my own pocket.  SIGH!!!

Thought some might be interested? Update

HHS Expected To Lift Blanket Medicare Ban On Sex-Reassignment Surgery Soon
BuzzFeed

Medicare has for decades considered sex-reassignment surgery "experimental," despite opposition from many major medical professional associations and LGBT advocates, who say the ban denies necessary care to transgender people.

http://www.buzzfeed.com/evanmcsan/hhs-expected-to-lift-blanket-medicare-ban-on-sex-reassignmen?s=mobile


Izzy

Thanks for posting this. I'm interested as I have Medicare. There's no way I can pay for SRS on my own so I'm hoping the ban gets lifted.

Thanks for posting Izzy! I hope they finally change it.

Quote from: mythy on May 06, 2014, 06:41:47 PM
Thanks for posting Izzy! I hope they finally change it.

If and when I hear anything I will make a update

Izzy

Wow the comments on that articles make me wanna vomit , altho I am not surprised at them strangely. So has this provision been added yet and if it is added do you have to use a USA surgeon to get it covered..? or can you use a surgeon in thailand..?

Has to be a U.S surgeon if it ever passes. :)

Quote from: Jessica Merriman on May 12, 2014, 01:32:57 AM
Has to be a U.S surgeon if it ever passes. :)

lame if that is the case I would rather just save up and pay for it myself. I really don't feel that the USA surgeons are as good as some of the other ones.

Today, an independent review panel in the U.S. Department of Health and Human Services ruled that Medicare cannot categorically exclude treatment for gender dysphoria, including transition-related care.

To learn more, download our Fact Sheet on Medicare Coverage of Transition-Related Care This decision eliminates the nationwide rule that transition-related surgeries cannot be covered by Medicare. Now, decisions on coverage for transition-related care, like hormone therapy or surgeries, will be made on the basis of individual medical need and clinical standards, not outdated prejuic

Repealing this rule means Medicare will now treat transgender healthcare just as other healthcare procedures are treated under Medicare. It puts decisions about our healthcare back in the hands of doctors and patients rather than bureaucrats or insurance companies. If you are covered by Medicare use our updated resource for information on accessing coverage or filing an appeal.

We congratulate our friends at the American Civil Liberties Union, Lambda Legal, and the National Center for Lesbian Rights for the smart advocacy that won this victory. The National Center for Transgender Equality will continue to advocate with our partners to make sure no insurance plan in the United States discriminates against the healthcare needs of transgender people.


http://transequality.org/PDFs/MedicareFactSheet.pdf

Izzy

My apologies for bumping this topic after a year but I assure you, I got a good reason. Given the past with how health care has treated us (SRS) I am wondering, is this really true? (What the last poster posted) Does Medicare really cover things like Hormone therapy along with tests from the doctor to make sure the hormones aren't hurting you and possibly even Laser/electrolysis? Can ANYONE verify that Medicare does indeed cover the cost of transition? Is there anything they don't cover? Lastly, does Medicaid cover this as well?

Thanks in advance.

Medicare does cover but finding a doctor who will accept it is an issue. This ruling does NOT include medicaid.

We've kicked this topic around before. As of May 31 2014, Medicare does indeed cover transition service HRT and SRS. As LordKAT mentioned finding a physican that accepts Medicare is the issue. The first Medicare covered surgery was done by Dr Loren Schecter at Weiss Hospital in Chicago. Whether or not he's still accepting Medicare, I don't know. Someone else on here says they contacted his office and was told no. It may be worth a call to his office as I know he said he wanted to make SRS affordable.

If you call, please let us know what his office says.

Medicaid is subject to state regulations but some states have now mandated coverage and so their Medicaid may now cover transition services. Finding a doctor who accepts medicaid though will be even tougher than Medicare because Medicaid usually reimburses less than Medicare.

It's my understanding that the reimbursement for GRS is terrible, and due to legality of Medicare payments to providers, the patient is unable to pay anything additional.

Does anyone here know if the appeal process for medicare can work for both determination of coverage, as well as adjustments to reimbursement rates (more accurate rates based on current US market).

I would be very interested in pursuing coverage, if I knew that real world prices could be achieved through appeal process.


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My doctor's office has been busy for the past 6 months, trying to find any surgeon willing to accept Medicare for GRS. This is after I gave up looking. If anyone has any useful information, it would be appreciated.

I have already reviewed links to government sites. They have no useful information.