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Medicare Covers Gender-Affirming Surgery in 2023 if Medically Necessary

Medicare's 2023 coverage includes gender-affirming surgery. Know your plan details to understand what's covered.

This image consists of a poster with a few images of women and there is a text on it.
This image consists of a poster with a few images of women and there is a text on it.

Medicare Covers Gender-Affirming Surgery in 2023 if Medically Necessary

In 2023, Medicare generally covers gender-affirming surgery if deemed medically necessary. This is part of Medicare's broader hospital and physician services (Parts A and B), but usual eligibility criteria apply. Most people with government healthcare plans have Medicare, which is categorized into Original Medicare, Medicare Advantage Plan, and Medicare Supplemental Insurance.

Original Medicare (Part A and B), Medicare Advantage Plan (Part C), and Medicare Supplemental Insurance (Part D) typically cover gender affirming surgery, paying some portion of the overall cost. Part D usually covers hormone replacement therapy. All 'medically necessary' services and surgeries, including gender affirming surgeries, are covered by Medicare if deemed appropriate.

The U.S. government offers six healthcare plans: Medicare, Medicaid, SCHIP, DOD TRICARE, VHA program, and IHS program, covering about one-third of the population. The Health Insurance Marketplace provides coverage for the uninsured or underinsured, generally covering surgeries and preventive services deemed medically necessary. Medicare's Extra Help program assists with prescription drug costs.

Medicare, covering about one-third of Americans, generally covers gender-affirming surgery if medically necessary. Other government healthcare plans and the Health Insurance Marketplace also provide coverage for various procedures. It's crucial to review plan details, such as 'Evidence of Coverage' and 'Certificate of Coverage', to understand what's covered.

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