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Recent Study Has Found Great Variability – Hormone Therapies Are Covered By Medicare

Gender-affirming therapy and surgery can each have important positive effects on the quality of life for transgender individuals, as research has shown.

Anecdotal evidence and nationwide surveys also support this conclusion.

For example, according to a recent Trevor Project survey on a representative cohort of young transgender individuals in the United States, those who are able to affirm their gender identity are significantly less likely to attempt suicide than peers who are unable to do so.

Yet there are numerous obstacles to affirming one’s correct gender. Among people who seek gender-affirming surgery, for example, the cost is often prohibitive.

Recently, a team of researchers — from the Yale School of Medicine, in New Haven, CT, the University of California, San Francisco (UCSF) School of Medicine, and the Mayo Clinic, in Rochester, MN — assessed Medicare coverage for a range of hormone therapies used by transgender people. Their research appears in the journal LGBT Health.

Medicare is a U.S. government insurance program that provides some coverage for costs of healthcare for people aged 65 or over and others with certain health conditions.

In their study, the Yale, UCSF, and Mayo Clinic investigators looked at documentation for the second quarters of 2010, 2014, and 2018 from the Centers for Medicare and Medicaid Services.

“These files provide details about plan structure and coverage for all Medicare Advantage and stand-alone plans but do not provide information about the Medicare beneficiaries enrolled in each plan,” the researchers explain in their study paper.

This research was important because, as the study authors note:

“[Hormone therapy] is a mainstay of gender-affirming therapy because it can induce physical changes consistent with one’s affirmed gender identity, because it is safe when managed by a trained clinician, because it is associated with an improvement in mental well-being, and because it is commonly required before undergoing gender-affirming surgery.”

Despite this, 25% of transgender individuals in the U.S. who responded to a 2015 survey said that they had been unable to obtain coverage for the necessary hormone therapies.

The researchers behind the recent study found that there were 2,978 Medicare prescription drug plans available in 2010, 2,857 in 2014, and 3,052 in 2018.

They observed that between these periods, the proportion of Medicare Advantage prescription drug plans versus stand-alone prescription drug plans had shifted.

These Advantage plans, the researchers explain, “provide drug coverage in addition to benefits for other medical services, whereas stand-alone [prescription drug plans] solely provide prescription medication coverage.”

While in 2010 there were 1,622 (54.5%) of these Advantage plans versus 1,356 (45.5%) stand-alone plans, in 2018 the proportion had changed; there were 2,272 (74.4%) Advantage plans, compared with only 780 (25.6%) stand-alone plans.

The team also found pronounced variations in the availability of unrestricted and restricted coverage of hormone therapies, depending on the types of medication that people needed.

In 2018, the most recent year in the analysis, unrestricted coverage for masculinizing therapies — which promote the development of male secondary sex characteristics — ranged from 5% to 75%, depending on the therapy.

Sandesh Ilhe
Sandesh Ilhe
With an Engineers degree in Advanced Database Management and Information Security, Sandesh brings the deep understanding of the digital world to the table. His articles reflect the challenges and the complexities that come along with every disruption in the industry. He carries over six years of experience on working with websites and ensuring that the right article reaches the right reader.