Currently I'm working on becoming a full FtM individual. I am moving out of the state in the next two months, so I am going to start my journey with a gender therapist, HOPEFULLY get some T shots and save up for top surgery when I'm settled and moved in. I am wondering, though if Medicaid and Blue Cross Blue Shield would cover either ALL or HALF of the T shots if anyone knows? I would like to find this out so that I know what I'm dealing with in the long run. I am on both and usually if one insurance cannot pay for something, the other picks it up or makes me pay a small fee. Thanks!
I'm not entirely sure on this, so don't quote me on it, but I heard that insurances won't cover T unless you're a Bio male. But I'm not sure on that. You'll have to do some research or try to talk to someone who's already transitioned. There are people on here that have already started their transition or finished though, so I'm sure you could find someone to talk to.
Most health insurances won't cover T for trans people, but there are some locations that are more lenient, and you may get coverage if you can get your doctor to spin it the right way to the insurance company. The health insurance I have does not cover it, but an 19 year old FTM I know with the same insurance as me got coverage for T despite that through his doctor.
Don't quote me because this is something that I read, but I cannot back it up. Most health insurances will not cover any or most part of the "transition" process, but if you are doctor is LGBT friendly or awesome enough then instead of asking for t-shots for you to transition he can ask t-shots based on some hormonal imbalance that you "have". With that loophole most health insurance will at least cover some of the cost because at that point they wont see it as a "cosmetic" procedure.
There's really two issues for healthcare providers: Psychiatric benefits: Gender disorder is covered under the psychiatric benefits of the insurance plan (that is, if there are psych benefits since some plans don't cover any psychiatric services). They'll pay for a portion of the psychiatric and therapy services but they won't pay for medical treatments under the psych portion of the plan. Medical necessity: This is where it gets really complicated. There's no medical diagnosis for gender disorder. Insurance companies require a diagnosis code on the bill. Based upon the diagnosis code, they decide what is "medically appropriate". So, for example, I couldn't list a diagnosis of "urinary tract infection" and then expect to get paid for administering an EKG. If testosterone is prescribed for a male with the diagnosis "hypogonadism", then the insurance company will pay for it. For women, they will cover certain male hormone treatments for endometriosis, etc. However, unless it is specifically written into the plan, they won't cover hormone therapy treatment for gender identity disorder under the medical portion either. Insurance companies are quite crafty on deciding what and when they will pay. Most of the people that I've talked to who are receiving hormone shots are paying out of pocket for them. They first have to get a letter from a therapist referring them to an endocrinologist or they have to find a trans-friendly doctor who will treat trans people. Since these medications are generic and not expensive, the shots are usually reasonably priced if you are paying cash. The patches or gels are not generic, so they are usually more expensive (and there's a difference of opinion about whether the shots are better than the gel or patch).
