Quick Answer
Yes - since 2014, Medicare covers gender reassignment surgery (also called gender confirmation or gender affirmation surgery) on a case-by-case basis when deemed medically necessary. Coverage includes inpatient hospital stays (Part A), outpatient procedures (Part B), and hormone therapy medications (Part D). Cosmetic procedures are not covered.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Medicare Part A (Inpatient) | Covered (when medically necessary) | Covers inpatient hospital stay for gender-affirming surgery when medically necessary |
| Medicare Part B (Outpatient) | Covered (when medically necessary) | Covers outpatient gender-affirming procedures, doctor visits, follow-up care |
| Medicare Part D | Covered | Covers hormone therapy medications (estrogen, progesterone, testosterone) when medically necessary |
| Medicare Advantage (Part C) | Covered (when medically necessary) | Must cover same services as Original Medicare; may require prior authorization and in-network providers |
Understanding Your Coverage Options
Original Medicare (Parts a, B & D)
Case-by-case determinationSince 2014, Original Medicare covers gender reassignment surgery on a case-by-case basis when deemed medically necessary. CMS does not have a national standard for approving or denying gender affirmation surgery - coverage is determined based on your state and local precedents.
**Medicare Part A** covers inpatient hospital stays for gender-affirming surgery. **Medicare Part B** covers outpatient gender-affirming procedures, doctor visits, and follow-up care. **Medicare Part D** covers hormone therapy medications (estrogen, progesterone, testosterone) when medically necessary.
To be considered a good candidate for Medicare coverage, you should have a diagnosis of gender dysphoria, proof of counseling, and evidence of hormone therapy. If Medicare denies coverage, you have the right to file an appeal through the Medicare appeals process.
What It Covers
- Inpatient hospital stay for gender-affirming surgery (Part A)
- Outpatient gender-affirming procedures (Part B)
- Doctor visits and follow-up care (Part B)
- Hormone therapy medications when medically necessary (Part D)
- Preventive care regardless of gender markers (mammograms, prostate exams, colonoscopies)
- Mental health services related to gender dysphoria
What It Doesn't Cover
- Cosmetic procedures not deemed medically necessary
- Facial feminization surgery (nose, chin reduction)
- Vocal cord surgeries for voice feminization
- Body contouring procedures
- Hair removal procedures
- Breast augmentation for cosmetic reasons (male-to-female transition)
Part B: You pay 20% coinsurance after the $283 annual deductible (2026). Part A: You pay $0 after the $1,736 per-benefit-period deductible for days 1–60 of a hospital stay.
Medicare Advantage (Part C)
Prior authorization typically requiredBy law, Medicare Advantage plans must cover everything Original Medicare covers, including gender-affirming surgery when medically necessary. However, private companies manage these plans and may have additional guidelines - including referrals, network restrictions, and prior authorization requirements for gender-affirming surgeries.
Always pre-authorize your procedure with your Advantage plan before scheduling. If you cannot find a surgeon within your Medicare Advantage network who performs gender-affirming surgery, your out-of-pocket costs could be significantly higher.
What It Covers
- All Original Medicare gender-affirming care benefits
- Usually includes Part D drug coverage for hormone therapy
- May include additional mental health or behavioral health benefits
What It Doesn't Cover
- Out-of-network providers unless your plan allows it
- Procedures requiring prior authorization that was denied
- Cosmetic procedures not deemed medically necessary
Costs vary by plan. If you cannot find a surgeon within your Medicare Advantage network, your out-of-pocket costs could be significantly higher. Verify your plan's network before scheduling.
Always Pre-authorize Gender-affirming Surgery
Medicare Advantage plans may require prior authorization for gender-affirming surgeries. Always contact your plan before scheduling to confirm coverage, obtain prior authorization, and verify that your surgeon and facility are in-network.
Medicare Supplement (Medigap)
Covers Original Medicare cost-sharingMedicare Supplement (Medigap) plans pay the out-of-pocket costs that Original Medicare leaves behind - including the 20% Part B coinsurance and the Part A deductible. For gender-affirming surgery, Medigap can significantly reduce or eliminate what you owe.
Medigap Plan G covers all Medicare-approved costs except the Part B deductible ($283 in 2026). Unlike Medicare Advantage, Medigap plans have no provider networks - any doctor who accepts Medicare will also accept your Medigap plan.
What It Covers
- Part A hospital deductible and coinsurance for inpatient gender-affirming surgery
- Part B coinsurance (20%) for outpatient procedures and follow-up care
- Part B excess charges (Plan F and Plan G)
What It Doesn't Cover
- Prescription drugs including hormone therapy - you need a separate Part D plan
- Procedures not covered by Original Medicare (cosmetic)
Plan G covers all Medicare-approved costs except the Part B deductible ($283 in 2026). Monthly premiums vary by age, location, and insurer.
Gender-Affirming Care: Medicare Coverage Overview
| Service | Medicare Part | Coverage Status | Your Cost (with Plan G) |
|---|---|---|---|
| Gender-affirming surgery (inpatient) | Part A | Covered when medically necessary | $0 (Plan G covers Part A deductible) |
| Outpatient gender-affirming procedures | Part B | 80% covered - you owe 20% | $0 after Part B deductible |
| Hormone therapy medications | Part D | Covered by Part D formulary | Part D plan required (separate) |
| Facial feminization surgery | N/A | Not covered (cosmetic) | Not covered |
| Breast augmentation (cosmetic) | N/A | Not covered (cosmetic) | Not covered |
| Preventive care (mammograms, colonoscopies) | Part B | $0 (preventive) | $0 |
✦ What Medicare Does and Does not Cover for Gender-Affirming Care
Medical Necessity Requirement
All gender-affirming procedures must be deemed medically necessary by your doctor. CMS does not have a national standard - coverage is determined based on your state and local precedents. To be considered a good candidate, you should have a diagnosis of gender dysphoria, proof of counseling, and evidence of hormone therapy.
Top Surgery Coverage
For female-to-male or female-to-nonbinary transitions, Medicare covers breast removal and chest reconstruction. For male-to-female or male-to-nonbinary transitions, Medicare covers medically necessary top surgeries but does not cover breast augmentation for cosmetic reasons.
Cosmetic Procedures not Covered
Medicare does not cover facial feminization surgery (nose, chin reduction), vocal cord surgeries for voice feminization, body contouring, or hair removal procedures. These are considered cosmetic with no medical benefit.
Appeals Process
If Medicare denies coverage for a procedure you believe is medically necessary, you have the right to file an appeal through the Medicare appeals process. Many denials are overturned on appeal with proper documentation from your healthcare provider.
Preventive Care Regardless of Gender Markers
Medicare covers preventive care regardless of gender markers. Transgender beneficiaries are entitled to screenings appropriate to their anatomy - prostate exams, mammograms, colonoscopies, and other preventive services - regardless of how their gender is recorded.
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is a licensed Medicare expert and member of the Forbes Finance Council who has been helping beneficiaries navigate their Medicare options.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare. She trains agents on CMS compliance guidelines.