Medicare covers gender affirmation surgery when a doctor deems it medically necessary, generally after you’ve spent at least a year getting other treatment for gender dysphoria.

Gender affirmation, sometimes called gender confirmation and formerly referred to as gender reassignment, is a surgical procedure or series of procedures that transgender people may undergo to help support their gender identity.

Most gender affirmation surgeries are major procedures that can be quite costly without insurance. That said, Medicare generally covers gender affirmation surgery when needed for treating gender dysphoria. This article will examine gender affirmation and what Medicare covers for affirmation-related services.

Gender affirmation surgery is a group of surgical procedures that allow trans people to change their physical appearance so that it better represents their gender identity.

Since Medicare Part A covers hospitalization and inpatient surgical procedures, gender affirmation surgery coverage would fall under Part A.

Many types of gender affirmation surgeries exist. They’re commonly divided into top surgeries and bottom surgeries, depending on the area of the body. Gender affirmation surgeries that Medicare covers when medically necessary are as follows:

Assigned male at birth to female:

Assigned female at birth to male:

Additional procedures, such as laser hair removal, tracheal shave surgery, and facial feminization surgery, may also be performed as part of your gender affirmation. But because Medicare generally considers these surgeries to be cosmetic in nature, it doesn’t cover them.

It’s important to understand that the Centers for Medicare & Medicaid (CMS) often set national coverage determination (NCD) guidelines for coverage. Gender affirmation surgery, however, does not have an NCD. This means that individual Medicare Administrative Contractors (MACs) determine coverage on a case-by-case basis.

That said, there are some criteria that MACs may go by when determining coverage. Gender affirmation surgery should generally be covered as long as:

  • You are age 18 or older.
  • You have a personalized gender affirmation plan in consultation with your doctor.
  • You have a diagnosis of gender dysphoria based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). You’ve shown symptoms for at least 6 months, and this has caused you significant distress.
  • For at least 12 months, you’ve undergone psychotherapy, received cross-sex hormone therapy along with other medical treatment for additional medical conditions you have, and lived in your desired gender role.
  • You’ve been fully informed about your surgery, including what procedures you will undergo, how long you will be hospitalized, what complications you may experience, and what your recovery will look like.

If you want to find out more about your Medicare plan’s coverage of your gender affirmation procedure, the best thing to do is to speak with your doctor directly.

Even if Medicare covers gender affirmation surgeries, you’ll still have out-of-pocket costs.

In 2025, Part A costs include:

  • a premium of $285 or $518 per month per month if you don’t qualify for premium-free Part A
  • a deductible of $1,676 per benefits period
  • a coinsurance of $0 to $838 per day, depending on the length of your hospital stay

If you’re covered by Part C, also called Medicare Advantage, you’ll get the same level of coverage as you would with Part A. These plans are managed by private insurers who set their own premiums, deductibles, and coinsurance.

According to the Centers for Medicaid & Medicare (CMS), the average monthly premium for Part C plans is around $17.00 in 2025. In most cases, you must also pay the Part B premium of $185 per month, though some Part C plans cover this cost.

That said, it’s important to be aware that if you’re enrolled in a Part C plan that uses in-network professionals only, such as a Health Maintenance Organization (HMO) plan, your affirmation-related services will be covered only if the doctors you choose are in your plan’s network.

Part D

After your surgery, you may need to take pain medications or other drugs to support your recovery. These fall under Part D, which covers prescription drugs. Alternatively, you can also get drug coverage through certain Part C plans.

Part D costs include:

  • a variable premium depending on your plan
  • a deductible not higher than $590
  • a variable copayment or coinsurance for your medications, depending on your plan’s formulary

Medicare covers medically necessary services. This refers to any standard services needed to diagnose or treat medical conditions.

While Medicare hasn’t always considered affirmation services medically necessary, two important changes were announced in the past decade.

In 2014, the Medicare Appeals Board lifted an exclusion on affirmation-related medical care that had classified services like gender affirmation as experimental. The decision to lift the ban was supported by research findings that affirmation-related services are medically necessary for transgender people who wish to undergo them.

In 2016, the Centers for Medicare & Medicaid Services (CMS) announced that it would not issue a national coverage determination for gender affirmation surgery. Instead, gender affirmation surgery is covered if it’s deemed medically necessary by local Medicare administrative contractors and Medicare Advantage plans on a case-by-case basis.

Finally, in 2024, under Section 1557 of the Affordable Care Act, the Department of Health and Human Services (DHHS) prohibited states from denying gender affirmation care based on sex.

If Medicare denies your request for coverage for gender affirmation, but you and your doctor believe it to be medically necessary, you can appeal Medicare’s decision. Here’s how:

  • For Original Medicare (parts A and B): You can complete a Redetermination Request Form to appeal. Medicare then has 60 calendar days to make a decision on your appeal.
  • For Medicare Advantage: You must appeal directly through your plan provider. Your plan has 30 to 60 calendar days to respond to your appeal.

If you disagree with the decision made after your first appeal, you can appeal up to four more times before making a final decision.

If your gender affirmation surgery is deemed medically necessary, Medicare will cover it generally under Part A or Part C. You’ll usually still have out-of-pocket costs after your coverage kicks in.

The law has changed to allow the coverage of affirmation-related services for transgender Medicare beneficiaries. If your coverage is denied, you can appeal any decision directly with Medicare or your plan.

For more information on which gender affirmation procedures your Medicare plan covers, consult your doctor.