Transitioning costs

[Bri2020]

Well, transitioning just got expensive again. Kaiser has officially said they won't cover my electrolysis "out of the network/area"   Problem is, no one "in network" does genital work around me.  My last 2 trips probably won't be reimbursed even though they had approved it beforehand.  Of course, I've escalated the claim but that may take months to resolve.  On the flip side, I can probably now itemize deductions due to medical costs.

I was going through my receipts for taxes from 2021.  Between all my copays, boobs, therapy etc etc I paid $16k+ out of pocket!  No wonder this year had felt like I'm poor and my debt slowly but surely climbed.  Mind you, being self employed, I pay $11,000 a year for my insurance!  Running though everything I still need to accomplish this year and I think finishing the "medical" portion of transitioning will run another $10k.  This doesn't include travel to chicago for electro or voice feminization.  For voice, I do have speech therapy coverage with $30 copays. I just haven't had the time or $ for it so far.  I don't think I will get the voice surgery.  and I will probably still have some electrolysis to do after this year but hopefully not much.  My biggest challenge now is my vanity.  Since I'm older, my sagging skin plus the reduction of mass in my face from FFS means you can't really see the results from the FFS in regards to the jaw/chin. The Dr put it in my head that I would need a face lift to appreciate the work.  Of course, now I pull my skin up by my ears when I look in the mirror and sure enough, you can really see how much thinner my jaw line became.  That vanity would cost me another $12K-$13K. Not sure if I can swing that anytime soon/ever.

Then there is all the dental work I avoided since I never smiled as a guy. I have a severe anxiety issue with dentists (sweating right now just thinking about it) so I avoided them for decades and it shows.  The last time I went they said I probably need 3 implants and a host of smaller cavities and replacing damaged fillings. Cha-ching! Another $17k.  

All in all I shouldn't complain, I'm privileged to actually be able to do this and so many can't even contemplate it.  It just makes me more aware we need to do something about health care costs for everyone.   

So far my transition has/will cost by the end of the year 3 years: 

Insurance 3 years:        $31,000 (I wouldn't have this level if it weren't for transitioning)

Boobs                              $ 8000

Copays/pharm/therapy  $10,000

Electrolysis out/pocket  $12,000

Travel for treatment       $ 3500

Total                               $64,500

Mind you, that is with some of the best insurance available for transgender care.

Once again, shouldn't complain. For some the total cost may be double that due to lack of access to decent health insurance.

On the other side of things, if you can find an employer who has good insurance benefits and you are younger (i'm 55) then you could cut $20-$25K out of this cost.

For reference my treatment so far included:

3 years of monthly therapy (sometimes more frequent)

HRT for 2 years

200 hours of facial electrolysis (roughly)

6 large volume genital hair clearing in Chicago (3 more visits to go)

Boob job 

FFS

Vaginoplasty (later this year but factored into my 3 year costs)

Not factored is what my divorce cost/impacts my finances. I figured if I didn't transition I probably would have made that relationship toxic over time and ended with a divorce anyways.

 

Lest you think this is all doom and gloom, I would do it all over again because I feel the best I've ever felt and my life and friendships have blossomed in ways I could never have anticipated.

 

 

[stveee]

I just watched one of Ashley Adamson's YT vids recent and she said she dropped 60k on her face. But I guess she had it divided up instead of one surgery. She said she went into stocks to fund it.

I have UHC and it's pretty standard. The biggest thing is not accumulating debt, and thus far I too am putting off dental work and adding to any savings but so far it's all been cash. 

This was a good topic to bring up as far as bring realistic and deciding what you are willing to live with. If I had any FFS at all I would hate to still have issues, so I am sorry you are dealing with that.

I would consider a brow treatment and rhinoplasty but it seems like the usual results are very subtle and it's very subjective. So not for me, not to go into debt 20k, good makeup work helps a lot. I also assume you should wait a few years, at least one to see how HRT works it out anyway. 

Mostly just all the hair removal and bottom surgery for me, probably won't even do top it's not a dealbreaker.

Do you ever have regrets, like what other things you could have done with the money instead? IDK, I am single so it would be nice to have my own house but it's just me, and I'm not too handy. I pretty much have everything I want and don't think twice about the cost of transitioning. Not yet anyway.

[Kylie]

I felt this post! Cost has definitely been a huge barrier for many people under the trans spectrum.  

 

Luckily my company has phenomenal health insurance coverage that is very trans inclusive in terms of coverage. Despite that, I have probably spent $60K in the past four years for a variety of stuff related to my transition. I have not had facial surgery, but luckily I don't need it thanks to feminine features I already had. I am having my breast augmentation this coming Friday - I dropped about $7K on that including my travel and accommodations as well as travel for my friend - and pet sitting fees for my cat. 

 

Transitioning is often thought to just affect relationships with friends and family - but the financial impact the first few years to basically kick start the new life we each have wanted is costly!

 

Despite all of the cost financially and family loss - I do not regret my transition at all & I know many can attest to that.

[Guest]

There is no question that transition is much more costly and painful as an adult. I remember 30-40 years ago when there was no coverage for what was considered cosmetic surgery. I thought about the costs over the last year. I came to the conclusion I could not go on as I was. In making my decisions for surgery, blending in was one of my biggest fears. I have a fairly masculine face that has softened with the estradiol and progesterone, but I still need the FFS. Of all the things that are visible publicly, our face often defines people's impressions, followed by voice. 

 

I had the opportunity to pursue surgeons based on being in-network or out-of-network. I chose to spend what I had to, in order to get what I felt were the best results. We all have an idea of where we want to be. I am not sure there is any formula one way or the other. It is unfortunate that we still have to scramble for coverage and get jerked around by insurance company representatives that often have absolutely no experience or knowledge of our needs. I had seen the big splash on the site of one of the Blue Cross/Blue Shield affiliates and it touted that they were committed to diversity, equality, and inclusivity, as well as LGBTQIA individuals, yet, they kept the information regarding covered transition coverage well-hidden. 

 

I came to the conclusion that regardless of the cost, I was going to get the services that I needed based on surgical recommendation. I have nobody that is my beneficiary, and I cannot take the money with me. So, with that said, the journey continues. I have committed my funding to my face and voice procedures. Strangely, finding care for breast reconstruction and gender affirmation surgery is not as daunting if you are willing to travel. 

 

In the grander scheme, while the Affordable Care Act mandated that transition coverages be offered, there is a very uneven landscape as evidenced by what you went through with Kaiser Bri. Sometimes there are just no resources in network, and there should be consideration of coverage outside the network. I am worried that with the current political climate, we may see some coverages or avenues to appeal, being reduced. I would imagine the insurance commissioners in the more conservative states my be reticent to assist when a complaint is filed. 

 

I have no illusions. I wish I had a more feminine body, but surgery is a necessity. I cannot go back to what I was. I am guessing that many of us feel the same way. I too, do not regret my transition. My only regret is that I did not have the ability to do this 40 years ago.

-Katie

[Artpetal]

My mother is in dentistry so I wanted to encourage you on that front, since I guess that's why teeth health is important to me.

[Bri2020]

 

 

 

On 4/7/2022 at 9:02 AM, stveee said:

 

This was a good topic to bring up as far as bring realistic and deciding what you are willing to live with. If I had any FFS at all I would hate to still have issues, so I am sorry you are dealing with that.

I would consider a brow treatment and rhinoplasty but it seems like the usual results are very subtle and it's very subjective. So not for me, not to go into debt 20k, good makeup work helps a lot. I also assume you should wait a few years, at least one to see how HRT works it out anyway. 

Mostly just all the hair removal and bottom surgery for me, probably won't even do top it's not a dealbreaker.

Do you ever have regrets, like what other things you could have done with the money instead?

The healing is going OK, I was told it would take up to 6 months to fully heal.

I never think in terms of what I could have done financially with transition decisions. Transitioning is like a medical decision for me. It just has to be done and it costs what it costs.

On 4/10/2022 at 10:41 AM, Katie23 said:

 In making my decisions for surgery, blending in was one of my biggest fears. I have a fairly masculine face that has softened with the estradiol and progesterone, but I still need the FFS. Of all the things that are visible publicly, our face often defines people's impressions, followed by voice. 

 

I came to the realization that surgery for me was more about the dysphoria of what I saw in the mirror when I saw the masculine features.  Blending in was a concern, but that was more of a social dysphoria. Trying to "pass" became less of an issue the further I transitioned. I knew many people would never see me as a cic-woman. I had to accept that and be OK with it. I thought that if I got FFS then people might not notice me with a casual quick interaction or just blend in with the crowd but between my stature and mane of red hair, people are going to stare for second. 

[Charlize]

10 hours ago, Artpetal said:

teeth health is important to me.

   I find this to be something we often chose to forget.  My father believed that as a male my teeth didn't have to look good.  Fortunately dealing with that made a big difference in my appearance as i transitioned and made me healthier as well.

   As to other expenses, while many feel the need for every possible surgery many others are content with much less intervention.  Being discouraged by costs does not  need to be a factor in finding peace with yourself. 

 

Hugs,

 

Charlize

[Kylie]

I agree @Charlize. Some people go the medical and surgical route. While others are very content with just the hormones. 

[Carolyn Marie]

Regarding the original post, I'd like to point out that if you itemize deductions, the cost of BA is tax deductible, as is the cost of bottom surgery.  I'm not sure about FFS; the IRS used to have a rule against it because "cosmetic surgery," but that may have changed.  I haven't researched it in a while.

 

The cost of meds may also be covered, but that cost would have to exceed 7 percent of your taxable income.

 

** caveat - I am not a tax professional, so don't take any of what I said as gospel.

 

Carolyn Marie

[Bri2020]

1 minute ago, Carolyn Marie said:

Regarding the original post, I'd like to point out that if you itemize deductions, the cost of BA is tax deductible, as is the cost of bottom surgery.  I'm not sure about FFS; the IRS used to have a rule against it because "cosmetic surgery," but that may have changed.  I haven't researched it in a while.

 

The cost of meds may also be covered, but that cost would have to exceed 7 percent of your taxable income.

 

** caveat - I am not a tax professional, so don't take any of what I said as gospel.

 

Carolyn Marie

According to my accountant pretty much all health related transitioning costs can be itemized after 7.5% of adjusted gross income. So if you make $100k (easy math) you have to have more than $7.5k in expenses to itemize. so if your health care costs (unreimbursed) are $10K then the $2.5k of that can be part of your itemization worksheet.  That said, since the standard deduction is $12.5K you need a lot more deductions than your medical to make itemizing be beneficial. Mortgage interest, student loan interest, personal biz losses etc etc.  It is very hard for the average person to exceed the "standard deduction".  I think this year, even with $16k in medical expenses, I'm just barely able to itemize.

[Heather Shay]

This is re-assuring, My wife is going to have a lumpectomy for a tiny cancer tumor in her breast and that cost is high and once again delays my transition. I'm not complaining because her current health needs take priority but I desire surgery more and more and can hardly stand it and know what I want and the doctor but had to cancel consult twice because my wife is still not on-board and on the advice of my therapist but I'm starting to go crazy with the continual delays.

I hurt.......a lot and it's getting worse and worse.

[Ivy]

4 hours ago, Kylie said:

I agree @Charlize. Some people go the medical and surgical route. While others are very content with just the hormones.

This is pretty much the way it is for me.

My health coverage is through the VA.  They do give me HRT (of sorts - but that's another issue) with a co-pay.

My income is not impressive – a small pension and SS which I split with my ex.

As much as I might wish otherwise, I can live with my current plumbing.  I'm already in my early 70's anyway.  I prefer loose clothing - full skirts, and I don't have all that much to conceal.  

HRT has helped the boobettes, and while the girls are not terribly impressive, they are quite real, which satisfies me.

 

However… If I was 30 -40 years younger, I might feel differently.

[Maddee]

I was at an age where GRS still seemed like the thing to do.  Didn’t want to regret (not doing it) later.  I want to use it.

 

Having done it, I am glad, but I totally RESPECT ❤️❤️anyone who opts not to go the surgical route.

 

insurance statement arrived yesterday  from by bottom surgery and hospital stay at IU in March:

$151,000

i owe: $0

insurance got it all, not even a copay- cuz it got done just before my plan year ended. 
 

That cost doesnt include my January FFS and BA surgeries, which were another $70,000 ballpark…also covered

 

If you want it, and like me, there was no way to ever make it happen, consider to get a job where the insurance pays full trans surgeries.  I’m at @mazon, and its like starting over at middle age.

 
I drive a 30 year old car, and can barely afford rent, but OMG has the insurance been worth it for transition!!!

🌈🌈

 

[stveee]

1 hour ago, Maddee said:

 

 

If you want it, and like me, there was no way to ever make it happen, consider to get a job where the insurance pays full trans surgeries.  I’m at @mazon, and its like starting over at middle age.

 
I drive a 30 year old car, and can barely afford rent, but OMG has the insurance been worth it for transition!!!

🌈🌈

 

I have been picturing this myself, I lived on SSI for over ten years in the hood, somehow I got by, and have started over a few times in my life. Still going to give it a year or so to think about it, but I understand being willing to go to any length for yourself. 

[Maddee]

28 minutes ago, stveee said:

I have been picturing this myself, I lived on SSI for over ten years in the hood, somehow I got by, and have started over a few times in my life. Still going to give it a year or so to think about it, but I understand being willing to go to any length for yourself. 

We are similiar 

[Mmindy]

2 hours ago, Maddee said:

If you want it, and like me, there was no way to ever make it happen, consider to get a job where the insurance pays full trans surgeries.  I’m at @mazon, and its like starting over at middle age.

 
I drive a 30 year old car, and can barely afford rent, but OMG has the insurance been worth it for transition

Maddee, I'm so happy you're able to complete these surgeries, and hope you're doing well. I really want to here your outlook this Fall when you should be really getting around and settled in to a regular daily routine

 

Hugs,

 

Mindy🐛🏳️‍⚧️🦋

[JennaLSinclair]

2 hours ago, Maddee said:

insurance statement arrived yesterday  from by bottom surgery and hospital stay at IU in March:

$151,000

i owe: $0

insurance got it all, not even a copay- cuz it got done just before my plan year ended. 
 

That cost doesnt include my January FFS and BA surgeries, which were another $70,000 ballpark…also covered

 

 

@Maddee what insurances offer full coverage for Trans surgeries? I'm on BCBS. It's good but doesn't cover everything. Open enrollment is coming in November and I can make the switch. 

[Maddee]

I have blue cross too, but it’s amazons Premera blue cross /BS 😀 it covers a lot up front, like trans surgeries.  Other things they reimburse, if I pay up front, like electrolysis.

1 hour ago, JennaLSinclair said:

 

@Maddee what insurances offer full coverage for Trans surgeries? I'm on BCBS. It's good but doesn't cover everything. Open enrollment is coming in November and I can make the switch. 

I’ve heard gooogle and Starbux are other companies that cover nearly all medical transitioning.  

[Maddee]

1 hour ago, Mmindy said:

Maddee, I'm so happy you're able to complete these surgeries, and hope you're doing well. I really want to here your outlook this Fall when you should be really getting around and settled in to a regular daily routine

 

Hugs,

 

Mindy🐛🏳️‍⚧️🦋

Thanks Mmindy sweetie I’m back to work this coming Tuesday.  Hoping with God for the best, playing to win🌈🌈

[Bri2020]

1 hour ago, JennaLSinclair said:

 

@Maddee what insurances offer full coverage for Trans surgeries? I'm on BCBS. It's good but doesn't cover everything. Open enrollment is coming in November and I can make the switch. 

Kaiser covers everything

[Ivy]

18 hours ago, Maddee said:

I drive a 30 year old car, and can barely afford rent, but OMG has the insurance been worth it for transition!!!

Wow!   That certainly worked out for you.

If I was in that position, I might reconsider doing without it.