Navigating Insurance Policies in the United States for Gender-affirming Surgery

Area of Science:

• Health Policy
• Medical Economics
• Gender Affirmation

Background:

• Gender dysphoria patients often face insurance barriers for gender affirmation surgery.
• Lack of consistent insurance coverage complicates access to medically necessary procedures.

Purpose of the Study:

• To review gender affirmation surgery policies of top US insurance companies.
• To identify and highlight discrepancies in coverage criteria.

Main Methods:

• Identified top 3 US insurance companies per state by market share.
• Analyzed policies for coverage of specific top and bottom surgeries.
• Collected data from company publications and direct inquiries.

Main Results:

• 124 of 150 identified insurance companies had gender-affirming surgery policies.
• High coverage for chest masculinization (98%) and vaginoplasty (97%).
• Lower coverage for nipple reconstruction (20%), vulvoplasty (21%), and penile prosthesis (60%).

Conclusions:

• Gender affirmation surgery insurance policies remain inconsistent despite increasing coverage.
• Standardized policies are needed to improve patient access to these procedures.