- On Friday, an HHS review board lifted a 33-year ban on Medicare coverage for gender reassignment surgery. The board said that exclusion was “no longer reasonable” because the surgery is safe, effective and not considered experimental.
- The new rule covers only surgery and not hormone therapy. Recipients are not entitled to coverage, but will have to provide a doctor's statement indicating that it is "medically indicated" in their case.
- The impact to Medicare's bottom line is likely to be negligible. Although gender reassignment surgeries are expensive, with the cost to insurers ranging from $10,000 to $50,000 per surgery, only 0.3% of the US adult population identifies as transgender, and few people opt for surgical interventions, according to the Washington Post.
The decision is likely to have an impact on private coverage of gender reassignment surgeries as well, as private insurers often take their cue from Medicare policies. The federal payer joins a small but elite group of university and large corporate health plans that cover the procedure — 28% of Fortunate 500 companies offered such benefits in 2014. Shell Oil and Campbell Soup's plans are two prominent examples.
The board decision comes in the wake of a series of announcements this year that expanded coverage for the LGBT community. HHS announced in March that insurers in the individual market cannot deny coverage to same-sex marriages, and must treat them the same as opposite-sex couples. In April, the organization announced that same-sex couples were eligible to apply for Medicare benefits for the first time.