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Medicare Can Now Cover Surgical Procedures for Transgender People

Emily Crockett

Transgender people seeking surgery as a part of their transition-related health care can no longer automatically be rejected by Medicare, a U.S. Department of Health and Human Services appeals board ruled Friday.

Transgender people seeking surgery as a part of their transition-related health care can no longer automatically be rejected by Medicare, a U.S. Department of Health and Human Services appeals board ruled Friday.

The board ruled that Medicare’s 33-year-old ban on covering sex-reassignment surgery is unreasonable, based on outdated and biased science, and contrary to contemporary medical care standards.

“This decision … is consistent with the consensus of the medical and scientific community that access to gender transition-related care is medically necessary for many people with gender dysphoria,” reads a statement from the American Civil Liberties Union, Gay & Lesbian Advocates & Defenders, and the National Center for Lesbian Rights.

The ruling vindicated an appeal by Denee Mallon, a 74-year-old Army veteran and transgender woman, who sued to overturn a decision denying her coverage for genital reconstruction surgery.

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Transition-related surgery is not limited to genital reconstruction; it can also involve breast implants, mastectomies, vocal cord modification, and other procedures. Major medical groups like the American Medical Association and the American Psychological Association now agree that transition-related surgery is a safe and often medically necessary option for transgender people, and no longer the “experimental” risk that it was considered to be in 1981, when the blanket Medicare coverage ban was enacted.

“Sometimes I am asked aren’t I too old to have surgery. My answer is how old is too old?” Mallon told the Associated Press. “I could have an active life ahead of me for another 20 years. And I want to spend those years in congruence and not distress.”

Medicare only covers individuals who are age 65 and older, and transgender people seeking transition-related surgery will not automatically receive Medicare coverage. As with any other service, the procedure has to be approved by a health-care provider. And given that Medicare has long refused to cover transition-related procedures, according to the National Center for Transgender Equality, there may be a period of confusion during which patients will have a hard time finding a provider who will accept Medicare.

But since private insurers and state-run Medicaid programs often take their cue from the federal government on which services to cover, transgender people may eventually see their options for coverage increase.

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