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What Does Medicare Cover if You’re Transgender?

If you’re transgender, you’re eligible for all the standard coverage offered under Medicare Parts A and B (Original Medicare). Coverage for services—like mammograms or prostate exams, for example—is provided based on medical necessity, not current gender or gender assigned at birth.

There are, however, some medical needs unique to transgender individuals and, since according to the Williams Institute, more than 1.3 million U.S. adults identify as transgender, we want to make it easy to understand what is or isn’t covered.

Covered: Gender-Affirming or Gender Confirmation Surgery

Surgery to confirm your transitioned gender is generally covered under Original Medicare if it’s deemed medically necessary. Medicare does recognize this treatment as necessary for individuals experiencing gender dysphoria, although you may be required to meet certain criteria before the surgery is approved. Similar standards and approval processes exist for many medical treatments under Medicare.

Criteria include:

  • Documented and persistent gender dysphoria
  • 1 year or more of continuous hormone therapy
  • Living 1 year or more in the transitioned gender role
  • No serious medical or mental health concerns, or controlled via medication
  • Two recommendations from qualified mental health professionals

Gender confirming procedures that are deemed medically necessary typically only include those that change primary sex characteristics (often called “top” and “bottom” surgeries).

Not Covered: Procedures Classified as Cosmetic

Many procedures that may be part of your transition are typically not deemed medically necessary by Medicare and will not be covered. These procedures may include facial and body contouring, hair implantations or removal, vocal alterations, and more.

Covered: Doctor Visits

Medicare Parts A and B include coverage for visits with your primary care physician and specialists.

Covered: Diagnosis Tests

Medicare will typically cover necessary tests to diagnose gender dysphoria.

Covered: Gender Dysphoria Treatment

Medicare also covers treatment for gender dysphoria.

Covered: Hormone Therapy

Medicare Parts A and B don’t include coverage for any prescription drugs, but private insurance plans with prescription drug coverage (Part C or D) should cover hormone therapy and other medications you may need.

Find a Medicare Plan

For assistance in finding a Medicare plan with prescription drug coverage or other benefits—like vision, dental, hearing, and wellness—call our Medicare Advocates at 1-800-991-4407 / TTY 711 between 10 a.m. and 9 p.m. Eastern, Monday through Friday. We’re here to help you find, evaluate, and enroll in Medicare plans without confusion and stress.

Alternatively, you can find, compare, and enroll in Medicare Advantage Plans through the Medicare Online Enrollment Portal.