Information collection made by and for the trans community.
All of the following is based on US health insurance
HRT Coverage
For HRT coverage, some insurance plans will offer coverage and some won't. In my experience, many do but only with prior authorization from the prescribing physician. The diagnosis given in PA for insurance coverage of hormones is usually an official diagnosis of gender dysphoria. This is usually the same for hormone blocker coverage, however, it can be a lot more difficult to actually get insurance to help cover blockers. Gender Dysphoria (also called gender identity disorder in the ICD) is a condition marked by discomfort or distress in one's birth sex. It is diagnosed based on the following, a person must demonstrate at least 2 of the following for a period of 6 months or more:
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I. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)
II. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
III. A strong desire for the primary and/or secondary sex characteristics of the other gender
IV. A strong desire to be of the other gender (or some alternative gender different from one’s designated gender)
V. A strong desire to be treated as the other gender (or some alternative gender different from one’s designated gender)
VI. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s designated gender)
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Gender Dysphoria is diagnosed typically by a therapist, psychiatrist, or other mental health professional. If you/your child is a minor and displaying signs of gender dysphoria, you can bring it up with a GP who can then refer you to a gender specialist or other mental health worker.
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In other cases, the plan will not include HRT as a treatment for gender dysphoria but there are other work arounds to get coverage. I know some people who get a diagnosis of an unspecified hormone disorder which requires them to take hormones, in this case you may be able to get coverage.
HRT Coverage by Company
I've done my best to compile the HRT coverage for some of the larger health insurance providers. PA in this context is a diagnosis of gender dysphoria and/or a hormone disorder
Coverage varies by plan and location
FTM Top Surgery Coverage
Most health insurance companies provide coverage for top surgery, the requirements vary between company, states, and individual plans. For top surgery coverage you will need a diagnosis of gender dysphoria (DSM-5 302.85 (F64.9))
Coverage by Company
Top surgery coverage is a complicated process and as a result I was unable to fit everything piece of criteria into one chart. Below are common insurance providers and whether they cover top surgery at all, as well as a document containing all the coverage criteria for each.
Coverage varies by plan and location
MTF Top Surgery Coverage
Most health insurance companies provide coverage for top surgery, the requirements vary between company, states, and individual plans. For top surgery coverage you will need a diagnosis of gender dysphoria (DSM-5 302.85 (F64.9)) and proof of 12 months of estrogen therapy (HRT).
Coverage by Company
Top surgery coverage is a complicated process and as a result I was unable to fit everything piece of criteria into one chart. Below are common insurance providers and whether they cover top surgery at all, as well as a document containing all the coverage criteria for each.
Coverage varies by plan and location
Bottom Surgery Coverage
Most health insurance companies provide coverage for bottom surgery, the requirements vary slightly between company, states, and individual plans. For bottom surgery coverage you will need a diagnosis of gender dysphoria (DSM-5 302.85 (F64.9)), and documentation of HRT. Unlike top surgery, the requirements are the same for both FTM and MTF bottom surgeries.
Coverage by Company
Bottom surgery coverage is a complicated process and as a result I was unable to fit everything piece of criteria into one chart. Below are common insurance providers and whether they cover bottom surgery at all, as well as a document containing all the coverage criteria for each.
Coverage varies by plan and location
FFS Coverage
Some health insurance companies provide coverage for FFS, the requirements vary slightly between company, states, and individual plans. For coverage you will need a diagnosis of gender dysphoria (DSM-5 302.85 (F64.9)), and documentation of HRT.
Coverage by Company
Bottom surgery coverage is a complicated process and as a result I was unable to fit everything piece of criteria into one chart. Below are common insurance providers and whether they cover FFS at all, as well as a document containing all the coverage criteria for each.
Coverage varies by plan and location
FMS Coverage
Some health insurance companies provide coverage for FMS, the requirements vary slightly between company, states, and individual plans. For coverage you will need a diagnosis of gender dysphoria (DSM-5 302.85 (F64.9)), and documentation of HRT.
Coverage by Company
Bottom surgery coverage is a complicated process and as a result I was unable to fit everything piece of criteria into one chart. Below are common insurance providers and whether they cover FMS at all, as well as a document containing all the coverage criteria for each.
Coverage varies by plan and location
Body Contour Coverage
A few health insurance companies provide coverage for body contour surgery, the requirements vary slightly between company, states, and individual plans. For coverage you will need a diagnosis of gender dysphoria (DSM-5 302.85 (F64.9)), and documentation of HRT. Unlike facial surgery, the requirements are the same for both FTM and MTF body contour surgeries.
Coverage by Company
Bottom surgery coverage is a complicated process and as a result I was unable to fit everything piece of criteria into one chart. Below are common insurance providers and whether they cover body contour at all, as well as a document containing all the coverage criteria for each.
Coverage varies by plan and location
Hair Removal Coverage
A few health insurance companies provide coverage for hair removal with certain restraints. Very few cover it outright. The requirements vary slightly between company, states, and individual plans.
Coverage by Company
Hair removal coverage is a complicated process and as a result I was unable to fit everything piece of criteria into one chart. Below are common insurance providers and whether they cover hair removal at all, as well as a document containing all the coverage criteria for each.
Coverage varies by plan and location