July 15, 2014 — Although transgender-rights advocates are encouraged by a series of recent decisions expanding health insurance coverage for gender affirmation surgery, they expect progress toward widespread coverage to remain incremental, Politico reports.
In what was seen as "both a practical and symbolic shift," Medicare in May ended a longstanding ban on covering the surgery, according to Politico. Since then, Massachusetts and Washington have begun requiring health plans to cover gender affirmation surgery, citing provisions in the Affordable Care Act (PL 111-148) that prohibit sex discrimination in health coverage. However, HHS has said that the ACA does not specifically require health plans to cover the surgery.
In 2012, Oregon became the first state to require private insurers to cover medically necessary transition surgeries. Since then, California, Colorado, Connecticut, Vermont and Washington, D.C., have followed suit.
Despite the progress, coverage of gender affirmation surgery remains uneven overall and is "rarely comprehensive," according to Politico. For example, at least 167 of the Fortune 1,000 companies provide surgical benefits for transgender employees under their employer-sponsored plans, according to the Human Rights Campaign's Corporate Equality Index.
In addition, some insurance companies will cover changes to certain body parts but exclude other procedures, such as voice modification surgery, as cosmetic. Meanwhile, the Office of Personnel Management allows coverage for the surgery but does not require providers to include it in plans offered through the Federal Employee Health Benefits Program.
Mara Keisling, executive director of the National Center for Transgender Equality, said, "Sometimes inevitability takes a while" (Politico, 7/13).