Medicare/Medicade coverage?

[HollyElizabeth]

I have questions about medicaid/medicare coverage in Illinois for things like facial feminization and breast augmentation. After looking for a couple hours I havent been able to find any information on whether either covers those for trans women. I even called medicare to see if I could get an answer. You won't believe this but the girl on the other side had no clue if either were covered. She just said to ask your doctor to submit a claim before and see if they say yes or no. Does anyone know if medicaid/medicare cover these two things. If I only get one I want the facial feminization, thats like 50 thousand and a boob job is like 4 thousand on average. They want me to have the gastric sleeve surgery and I expect to lose at least 200lbs, there goes my breasts. I can buy fake breast but I cant make myself more female looking with a masculine face. I know the bottom surgery is covered. I plan on doing that as soon as I can. It would be nice to get it all done around the same time.

 

So anyone know if facial feminization and breast augmentation are covered under Illinois insurance?

[Dana Michelle]

I did a Google search and found this https://www.sj-r.com/news/20200109/illinois-medicaid-now-covers-transgender-therapy   which says that genital surgery and breast surgery are covered by medicaid in Illinois. It does not mention facial feminization or electrolysis. This source also discusses transgender care and various states' medicaid.

[Dana Michelle]

The link for "This source also discusses transgender care and various states' medicaid. " didn't get included in my post, so here it is: https://www.americanprogress.org/issues/lgbtq-rights/reports/2016/08/09/142424/the-medicaid-program-and-lgbt-communities-overview-and-policy-recommendations/

[HollyElizabeth]

I saw that but I think they mean FTM  breast surgery. The removal of the breast. I'm wanting to know it they cover implants.

[Jani]

They probably do but for reconstruction after cancer.  I can't imagine BA would have been on their minds when writing the protocols.  As for genetic women, BA is considered cosmetic.  It appears to be one of the less expensive surgeries too, due to the demand and number of doctors who perform it.  

 

4 hours ago, HollyNoel said:

I expect to lose at least 200lbs, there goes my breasts.

Not necessarily Holly.  You may be surprised.  

 

Jani

[Dana Michelle]

I found this site https://www.ilga.gov/commission/jcar/admincode/089/089001400D04130R.html that says, "The Department will cover all gender-affirming surgeries, services and procedures that are medically necessary to treat a particular individual's gender dysphoria and are listed on the Department's fee schedule and in the Practitioner Handbook. Gender-affirming surgeries, services and procedures shall include, but are not limited to, breast/chest surgeries, genital surgeries, and related therapies."

I found a fee schedule here: https://www.illinois.gov/hfs/SiteCollectionDocuments/CopyOf06032020PractitionerFeeScheduleEffective04012020Final.pdf and a list of codes for procedures associated with gender affirming surgery: https://www.cms.gov/medicare/coverage/determinationProcess/downloads/Kalra_comment_01022016.pdf . The code for breast augmentation, 19316, is listed on the fee schedule with a state maximum of $567.10, though I don't know exactly what the state maximum means. For example, I don't know if things like anaesthesia or the hospital fee count toward the state maximum.

 

[HollyElizabeth]

Jani, in my mind BA is necessary for my well being. I know they will say it's not but to me having breast is one of the things that make a woman whole on the outside. Yes all they are is fat cells, but if they are willing to do reconstruction surgery for cancer, then shouldn't they be willing to do it for our piece of minds. I'm not going to hold my breath, but it would be nice. Jani, I hope you are right. I hope when I lose the weight I get to keep my breast.

 

Dana thank you. I hope BA is covered at least in part. I would be willing to make payments. Breasts aren't the only part of being a woman, but if you don't have them people notice.