Hey, I'm an 18 year old M2F but pre-full time and I'm wanting to transition the day after my last A level exam in June. I'm also thinking about moving to the US but I'm not really sure where would be better to do this. On one hand, in the UK, the NHS can help you along the way in terms of therapy and hormones and sometimes even SRS. However, it's known for being inefficient and has huge waiting lists and is poorly funded. We also have a high income tax rate, about 20-30% and quite a high price level. In America however (this is my perception) people seem to be better paid, have more disposable income, price levels are lower and healthcare is more efficient and reliable. But there would be no freebies. Would some costs be covered by health insurance? If so what would be covered? It just seems like Americans TSs can transition more comfortably, financially speaking. Would anybody be able to give me any info and advice on this?

With the US, the thing to remember is that a lot of things vary state by state. I haven't started transitioning yet, so I really can't offer much advice on what insurance may cover and how much things cost, but everything will depend on where you live, if your employer/school offers insurance or what you can afford on your own, and what profession you are in.

Health care isn't always more efficient or reliable, there has been known instances of hospitals just leaving people to die or refusing to take them if they have no insurance.  Hopefully things will get a little better once the Affordable Care Act really kicks in. 

I've heard from some transguys here in the US that part of their testosterone is covered by their insurance, but things like chest surgery are not. It seems like a lot of transguys go to places like Serbia to get bottom surgery done because it is cheaper. I'd imagine that it would be somewhat similar for MTFs.

i have no idea but this is what it cost me in the US:

HRT doctor visits 10 dollars a visit
HRT 8 dollars a month
Therapist 70 dollars a visit (about 4 visits or so)
Laser 900 dollars 9 months lifetime touchups
Wardrobe 4,000 dollars (yeah...i like nice things lol)
Makeup   15 dollars a month
SRS 250 dollars

which is about 7000 dollars for me

But everyone is different.

Quote from: Annah on December 29, 2012, 07:40:58 PM
i have no idea but this is what it cost me in the US:

HRT doctor visits 10 dollars a visit
HRT 8 dollars a month
Therapist 70 dollars a visit (about 4 visits or so)
Laser 900 dollars 9 months lifetime touchups
Wardrobe 4,000 dollars (yeah...i like nice things lol)
Makeup   15 dollars a month
SRS 250 dollars

which is about 7000 dollars for me

But everyone is different.

are you sure you haven't missed any zeroes off your list? That sounds like a bargain! How come the cost of the srs, hrt and doctors visits were so low? I wouldn't have expected the wardrobe to be the biggest expense to be honest!

insurance makes the biggest difference in the world

Plus, I didn't spend 25K on FFS
and I didn't spend 20K on Electrolysis

The worst thing about the US is that for most people insurance is tied to your employer (or school, or whatever). Some employers have very good insurance, and others not so much. Insurance standards also do vary somewhat by state. If you want to get the very best coverage from a US employer for trans issues, you should go check out the CEI (Corporate Equality Index) at WPATH. The survey of employers for 2013 just released lists 252 companies which scored 100% on the survey, which means among other things they include a lifetime benefit of at least $75k to cover transition expenses. Even FFS and SRS are included as "medically necessary." Generally medical care in the US is actually quite excellent.

I can get an appointment with my therapist, or my medical doctor with little more than a few weeks notice to get into their queue for routine things, and almost immediately if I have an emergency. The full retail cost of my Spiro is about $90 a month, but my insurance pays for it with no copay, and my Estrogen is about $15 a month, which I pay out of pocket because it isn't medically recognized by my insurance company for males.

I do not have high hopes for the "affordable care act" and believe that will only make things much worse here. I would much prefer that we had opted for a more market-centric solution (which is not what we have today).

My opinion probably isnt very educated, as I dont know how things would be for me if I had been transitioning in America, but my Mum is American, and we were looking to move back there when I was about 11, and Im actually glad now, that we didnt, simply because of the NHS.
   Theres no way I could have afforded the treatment that I have gotten, and since I started so young, if I had to go this long without being able to get the ball rolling, so to speak, I really dont think Id be here now.
  Ofcourse, there are the cons aswell as pros, to transitioning in the UK. But also, if you have the money, you also have the option of going private in the UK.
I went down the NHS route, I was on the clinics waiting list for 15months after being seen by other health professionals for 18months, which almost killed me to wait that long (HOWEVER, I was 16 when referred, and at the time, they did not accept people under 18. They have since, changed this and drastically shortened the waiting time. I think people are seen between 1 and 6 months of referral, apparently).
    At the time of my wait to be seen, I knew of 3 people my age that "came out" all after me, all went private and all got T before me. (While I despised this out of jealousy at the time, I would have done it if I had the money).
     Short term, I would have gone private, but having been patient, I do think the NHS has treated me very well (and this is taking into account all the mishaps, misplaced files, long waits,me chasing things up etc. I am still grateful).
    Also, the guys I know who went private, got T quickly yes, but eventually had to go down the NHS route as they all are still waiting for surgery. And some NHS clinics, regardless of what youve done privately, make you start your RLE all from the beginning once youre being seen by them.
     The wait of the NHS route was worth it for me (I can admit this now, but younger, more impatient me would disagree :p ).
        From first seeing my GP at 15, to where I am now, post T, top and lower surgery, I feel I have the NHS to be thankful for. All Ive had to pay for is my travel to the clinics, hospitals etc, and any prescriptions regarding surgery (bandages, cream, gauze etc).
   I couldnt afford to go private for T,so theres no way I could have afforded any of my surgery, which I so desperately felt I needed. I am pleased with how things have turned out getting treatment in the UK.
    However, I guess similar to things working differenlty in different States, we also have what seems to be the "postcode lottery", some people get funding for this and that under local funding, other people elsewhere dont. Someone I know pays for T, but I dont.

The short answer is more freedom in the US (especially if you go informed consent), more financial support in the UK. Technically my insurance covers NOTHING if it's related to gender identity. Not counseling, not blood tests, nothing. I was told this directly by my insurance company in no uncertain terms.

In reality I have some sympathetic doctors who are willing to do some creative billing. That counseling isn't for gender identity, it's for depression, anxiety, or other issues. The blood tests aren't for HRT, they're for nonspecific problems with my endocrine system. Technically this is all true and they never told insurance there weren't concurrent gender identity issues so they aren't doing anything illegal. Generics for HRT cost me 20 dollars a month even without insurance, so I'm okay there.

Without support of insurance you could be looking at paying 200+ (sometimes that's a big plus too) for a doctors visit. It's pretty rare for insurance to cover SRS but occasionally they do, it's all based on what the employer wants and some employers feel like the small cost of getting that added is worth it.

Yes, it very much depends on what kind of insurance you have, and that varies wildly. (The state-sponsored insurance plans for the very poor are generally not going to cover much, either; that's as close as the US gets to "nationalized healthcare"for someone who is neither a war veteran nor elderly.) Some plans are pretty good, but some are awful, and a lot do have exclusions for trans care.

Because I'm the sort of person who keeps track of these things anyway, the cost of transition for my wife *without* insurance :

laser - $2000
endocrinologist - 4 visits yearly, $150 per visit and $400 for lab work done every visit ($2200/year)
ultrasound to check liver function, once - $5000
therapist - $100 per visit, 1 visit per week ($5000 per year)
HRT, patch - $50/month generic, $150/month brand name ($600 or $1800 per year)
GRS - $20,000 US (it was $18K Canadian, but the exchange rate was in their favor)

plus about $500 total to get all the necessary documentation for name and gender change and pay the various fees to send in the applications.

As it happens, insurance actually did cover the therapist, ultrasound, endocrinologist and HRT.  My employer's insurance plan specifically excluded *only* GRS, while paying for all other transgender care. Could be worse.

Actual cost there per year : $1200 for the therapist, $120 for the endo and about $200 for lab work after the insurance paid their share, $600 for patches ($50 copay per month), and I think $50 for the ultrasound. Oh, and a "cost" of approximately an hour per month on the phone for me, arguing with my insurance.

But, as Carbon said, we do have a better choice of doctors, and waiting lists were basically nonexistent in this area.

Quote from: Annah on December 29, 2012, 07:40:58 PM
i have no idea but this is what it cost me in the US:

HRT doctor visits 10 dollars a visit
HRT 8 dollars a month
Therapist 70 dollars a visit (about 4 visits or so)
Laser 900 dollars 9 months lifetime touchups
Wardrobe 4,000 dollars (yeah...i like nice things lol)
Makeup   15 dollars a month
SRS 250 dollars

which is about 7000 dollars for me

But everyone is different.

Was your SRS covered by a health insurance?

The affordable care act might help somewhat. I am not ultra optimistic, but US Medicare does cover some trans stuff. I have heard hrt and some people have gotten surgeries. Should mention US insurance is highly dependent on who your employer is. Your experience is also dependent on your state--that part might be similar to the UK though, as I have heard people having very different experiences in different cities?

Jay

Quote from: peky on December 30, 2012, 10:56:47 AM
Was your SRS covered by a health insurance?

yes