Can Insurance Cover Your Gender Affirming Surgery?

If you’re considering gender affirming surgery, you have probably begun researching what options best suit your goals, as well as the overall cost of the procedure. If you’re like most people, you’re probably wondering what role insurance plays in all of this.

This blog walks through gender affirming surgery options, how insurance may or may not cover your procedure, what to do if you’re denied, and how to plan your next steps with clarity.

What Is Gender Affirming Surgery?

Gender affirming surgery can help align your physical body with your gender identity. These procedures vary based on your transition goals and needs. The surgeries fall into four main categories, each serving different aspects of gender transition.

What Are Transmasculine Surgery Options?

Transmasculine surgery, also known as female-to-male (FTM) surgery, is for people who were assigned female at birth but identify more closely with a masculine or male expression. These procedures are designed to help shape the body in a way that matches how a patient feels inside.

Transmasculine top surgery can:

• Remove breast tissue and reshape the chest
• Flatten and contour the torso to give it a more masculine look
• Include repositioning the nipples or minimizing scarring for a more natural result

Transmasculine bottom surgery can:

• Include procedures related to the internal and external female reproductive organs
• Can involve removing the uterus, ovaries, and vaginal canal
• May include constructing male genitalia through techniques like metoidioplasty or phalloplasty, depending on your goals

What Are Transfeminine Surgery Options?

Transfeminine surgery, also known as male-to-female (MTF) surgery, is for people who were assigned male at birth and want a more feminine or female-aligned body. These surgeries help soften or reshape features to better reflect a feminine appearance.

Transfeminine top surgery can:

• Use breast implants or fat transfer to create fuller breasts
• Shape the chest into a more rounded, traditionally feminine silhouette
• Often be performed after several months of hormone therapy, which helps with skin and tissue development

Transfeminine bottom surgery can:

• Focus on reshaping or reconstructing the genitals
• Include procedures like vaginoplasty, vulvoplasty, or orchiectomy
• Help create external anatomy that reflects a more feminine body structure

Is Gender Affirming Surgery Covered by Insurance?

Yes, most major insurance carriers now cover gender affirming surgeries. This includes Medicare and many commercial plans. However, coverage is dependent on state laws, your individual insurance plan, and the insurance provider. Overall, coverage has expanded significantly since these procedures have gained recognition as medically necessary treatments rather than cosmetic options.

It is important to understand that some insurance policies cover every aspect of gender affirming surgery, while others require pre-approval or only cover a portion of the costs. Also, getting insurance approval typically requires documentation like therapy records and medical evaluations to verify that you meet treatment guidelines. Make sure to reach out to your insurance provider for more information and keep all of your paperwork in order for a smoother experience.

What If My Insurance Denies Coverage?

You might feel discouraged if your insurance provider rejects your claim. But that doesn’t always mean the door is closed. Appeals are possible, and many people succeed after providing more documentation or adjusting the wording of their request.

At Restore Medical Center, our surgeons and staff have extensive experience helping patients navigate the labyrinthine insurance process. We customize assistance based on each patient’s needs, so if your initial claim is denied, we will help you with the appeal process. We are proud of the fact that we consistently achieve partial, if not full, insurance coverage for most of our patients, even if Restore Medical Center is not an official participating partner with certain insurance plans.

Get Covered With Cigna and Aetna

At Restore Medical Center, we work with both Cigna and Aetna to ensure our patients can receive the care they deserve. Our Cigna and Aetna contracts make it easier for you to move forward with care that’s covered.

Our team works behind the scenes to handle and assist with the documentation and paperwork, so you don’t have to worry. You already have enough on your plate. We’ll handle the insurance conversations while you focus on getting the care you deserve.

Start Your Gender Affirming Journey in Miami, FL

Gender affirming surgery requires a safe space where you feel completely comfortable and understood. You need experienced professionals, like Dr. John L. Whitehead and Dr. Alain Ramirez, who have dedicated their careers to helping people like you achieve their goals. Restore Medical Center stands out as Miami’s premier destination for gender affirming procedures, combining surgical expertise with compassionate care that puts you first.

Call (305) 865-2000 to speak with someone who can help, or reach out through our online form. At Restore Medical Center, we’re here to support you every step of the way.