Leading Health Insurance Provider To Expand Gender-Affirming Surgeries Coverage

Aetna, one of the country’s leading health insurance providers, has announced that it will expand its coverage of gender-affirming surgeries.

The company, which serves around 39 million people, will now include breast augmentation as gender-affirming surgeries for trans-femme individuals after promising to categorize it as medically necessary. It will still be necessary for anyone hoping to get this surgery to procure a referral from a mental health provider, have undergone at least one year of hormone therapy, and exhibit a history of gender dysphoria.

The policy addition comes after Aetna refused to cover breast augmentation for four transgender women. However, after teaming up with national law firm Cohen, Milstein, Sellers, and Toll and the Transgender Legal Defense and Education Fund, the group decided to work with the insurance company to change its policy, rather than file a lawsuit.

“By dropping exclusions for medically-necessary care like top surgery, Aetna is paving the way and setting an example for other health insurance providers, and I hope others will take note,” Nancy Menusan, one of the trans women who pushed for a more inclusive policy, told the Hartford Courant.

Aetna’s gender-affirming surgery coverage is already fairly extensive, as it currently covers breast removal, gonadectomies, and genital surgeries like phalloplasty and vaginoplasty. The company also covers hormone therapy as a medically necessary procedure. However, it doesn’t cover other procedures like hair removal, facial surgeries, and voice modification surgeries.

The change in policy coverage from the health insurance company comes on the heels of several court battles over gender-affirming surgery coverage over the past few years. In November of last year, for example, a 15-year-old trans teenager sued the Blue Cross Blue Shield of Illinois for denying them gender-affirming medical services. And as of 2019, six states currently deny health care coverage in their Medicaid programs: Alaska, Georgia, Iowa, Missouri, Nebraska, and Tennessee.