Medicare may provide coverage for gender affirming surgery if a doctor deems it medically necessary for treating gender dysphoria.
For individuals whose gender identity differs from the sex they were assigned at birth, expressing their gender is crucial for feeling secure, validated, and at ease. This can be particularly true if they are living with gender dysphoria.
Although people may refer to a gender affirming surgery (GAS) as gender reassignment surgery, they do not alter a person’s gender. Instead, they modify their physical anatomy to be consistent with their internal sense of gender identity.
This article discusses Medicare coverage for GAS procedures.
Original Medicare (parts A and B) does not cover procedures that it considers cosmetic surgery. That said, it may cover a GAS procedure when medically necessary to treat gender dysphoria.
In addition, some Medicare Advantage (Part C) plans may cover GAS procedures depending on additional criteria. This is because private companies administer these plans, which can offer additional benefits beyond those that parts A and B (Original Medicare) offer.
When did Medicare start covering gender reassignment surgery?
Until 2014, Medicare did not provide coverage for GAS surgeries. The Centers for Medicare & Medicaid Services (CMS) then revised its policy to cover surgeries deemed medically necessary, including GAS procedures for people living with gender dysphoria.
In 2016, the CMS announced that it would not establish a national coverage decision for gender affirmation surgery. Instead, coverage for such procedures would be determined case-by-case by local Medicare administrative contractors (MACs) and Medicare Advantage plans based on medical necessity.
Then, in 2024, the Department of Health and Human Services (HHS), under Section 1557 of the Affordable Care Act, barred states from denying gender affirmation care on the basis of sex.
For coverage, individuals must go to doctors and surgeons who accept Medicare. If the person has a Medicare Advantage plan, they must go to doctors within their network. If they would like to use a doctor outside of the Medicare Advantage network, they must get permission to do so.
To find out if coverage is available, a person can check with their plan or use the Medicare online tool.
What types of gender reassignment procedures does Medicare cover?
Since Medicare Part A covers surgeries, approved GAS procedures would fall under its coverage.
There are various types of GAS surgeries, typically categorized into top surgeries and bottom surgeries, based on the specific body area involved.
Medicare may cover any of these procedures when medically necessary. That said, Medicare plans determine whether or not a particular GAS procedure is considered medically necessary on a case-by-case basis.
Medicare may consider certain criteria when deciding on coverage for GAS surgery. Generally, Medicare should cover the surgery if:
- A person is at least 18 years old.
- A person has a personalized gender affirmation plan with their doctor.
- A person has a diagnosis of gender dysphoria according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) and has exhibited symptoms for at least 6 months, which have caused significant distress.
- For at least 12 months, a person has undergone psychotherapy, received cross-sex hormone therapy, and received other medical treatments for any additional conditions they have, while living as their desired gender.
- A person has been fully informed about the surgery, including the procedures they will undergo, the length of their hospital stay, potential complications, and the recovery process.
These criteria align with guidelines from the World Professional Association for Transgender Health (WPATH), which states that individuals undergoing GAS need to:
- have experienced persistent gender dysphoria
- be able to give informed consent for their treatment
- be recognized as an adult under their country’s legal system
- have established treatment that effectively manages any current mental health or medical issues
How much a GAS procedure might cost without insurance varies widely and depends on the type of surgery and where surgeons perform it. For example, according to one 2022 study, an orchiectomy costs around $6,927, a vaginoplasty costs $45,080, and a phalloplasty costs $63,432.
How much a person will pay after insurance coverage also depends on the insurance and the specific plan. With Medicare Part A, a person must meet a deductible of $1,676 for every benefit period in 2025. There is no coinsurance if a person is discharged within 60 days, which means the procedure would be fully covered.
That said, while people do not pay a premium for Part A, some may need to pay a premium of $285 or $518 each month. This depends on how long they have worked and paid taxes in the United States.
Deductibles, coinsurances, and premiums for Medicare Advantage plans vary depending on the company providing the plan. An online tool can help people find and compare plan costs. According to the CMS, the average monthly premium for Part C plans is around $17 in 2025.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Gender affirmation surgery is usually the last step in the process of changing from one sex to the other. The surgery can help a person with gender dysphoria transition to another sex.
The process usually begins with psychotherapy to determine whether a person is ready to undergo a permanent physical change. Following that decision, the next phase usually involves hormone therapy. Males assigned at birth (MAABs) typically take estrogen, and females assigned at birth (FAABs) take androgens (male sex hormones).
Hormone therapy for gender dysphoria
Medicare Part D can also pay for hormone therapy to address gender dysphoria. Prior authorization is also generally required in order for coverage to be approved.
The purpose of hormone therapy is to change a person’s physical appearance. For example, FAABs who take androgens may develop facial hair, while MAABs who take estrogen may experience weight redistribution and changes in the skin.
However, there can be complications from therapy. Estrogen therapy
Androgen therapy may increase blood pressure, insulin resistance, and cholesterol levels.
Healthcare professionals may ask a person to take on the role of the desired sex, socially and professionally, for up to a year before surgery.
Surgery is the final step in gender affirmation. It may take several surgeries to complete the change from male to female or female to male.
Medicare pays for gender affirmation surgery and hormone replacement therapy, as long as doctors deem the surgery medically necessary. A person typically requires several surgeries to complete the gender affirmation process.
Medicare Advantage plans may apply different rules when approving surgeries. Individuals can check their plans for more information.
A person must pay the same premiums and deductibles as they would for other surgeries or medical treatments.