Transgender people deserve insurance coverage

By Editorial Board

Aetna, an insurance company that participates in the Federal Employee Health Benefits Program, announced Oct. 31 that it would cover surgical gender reassignment procedures for federal workers beginning in 2015.

Aetna is one of many insurance companies to cover sex-change operations in recent months. Medicare, the federal insurance program for retired and disabled individuals, announced July 2 that it will offer coverage for sex-change surgery. Both entities neglect to offer coverage for aftercare and hormones, though.

Insurance companies’ increasing coverage for sex-change surgeries is commendable and a step toward increasing acceptance of the transgender community, but the lack of coverage for hormones and aftercare in these plans is problematic for those who decide to undergo the operation. Post-treatment costs are significant, and it is important to guarantee these services in the insurance plans so all individuals who decide to undergo the surgery receive adequate care.

The average cost of sex reassignment surgery for trans male-to-female is $140,000 and more than $150,000 for trans female-to-male, according to the Philadelphia Center for Transgender Surgery. But this only covers part of the cost. The decision to undergo sex reassignment surgery requires ongoing appointments with doctors and hormone treatments, which cost thousands of dollars, according to the Transgender Health Benefits website. These treatments must be included in the plan in order to truly support the transgender population. If not, transgender people may find themselves unable to continue necessary treatment to live the lives they want.

Admittedly, this is a steep burden for insurance companies to take on, but the number of people who decide to undergo sex reassignment surgery is relatively small. According to the Gender Centre, about 800–1,000 male-to-female operations are performed each year. The American Psychiatric Association estimates that one in 30,000 people in the U.S. are male-to-female transgender and one in 100,000 are female-to-male transgender people. This is not a large percentage of the population compared to the roughly 300 million in the country, and companies can afford to take up the added financial burden.

Furthermore, Aetna covers 120,829 federal workers. Based on the statistics, it is safe to assume that only a slim margin of those employees will seek a sex reassignment surgery. Considering this, Aetna should alter its policy to include hormones and treatment needed before and after a surgery. This will alleviate the burden of having to pay out-of-pocket for the necessary additional treatments.

Insurance companies have made impressive improvements in accepting the transgender community by providing insurance coverage for sex-change surgeries, but they are also shortchanging patients with their coverage. By neglecting the necessary aftercare such companies are missing a big part of the essential transition for the individual.

Aftercare is necessary for transgender people to properly transition. With this aspect unaccounted for, transgender individuals can be at risk for further complications and financial woes. If insurance companies truly want to support the transgender community, altering the plans to include aftercare is the obvious next step.