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Insurance as a trans man? (Pennsylvania, USA)

Discussion in 'Gender Identity and Expression' started by PumpkinMuffin, Sep 30, 2021.

  1. PumpkinMuffin

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    I turned 18 this year and can finally start medically transitioning without my mom interfering. The problem is, I haven't been able to find anything on Google when searching for insurance companies that would work best for me. I don't really have time to sit down and thoroughly search either. Two jobs and trying to move out of my verbally abusive household. I figured my best option was to go directly to other trans people who have figured this stuff out already. Some information I assume you'll need to know is I'm afab planning to start testosterone and eventually have top and bottom surgery, I live in the United States in Pennsylvania, I turned 18 in April of this year, and I currently have a low income (I work part time at both of my jobs -transportation issues- only $8.50/hr and $9.25/hr)
     
  2. QuietPeace

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    My own personal experience in the USA was that I had to start transition and pay for things myself. I had to pay for therapy (My therapist charged on a sliding scale) and I had to pay for my hormones all without insurance. Later after I had my ID changed and had been on hormones a while I was able to get the hormones covered by my insurance (both private and later Medicare). I have never had insurance that would pay for vaginoplasty (nor would any insurance that I had pay for FTM top surgery, metoidioplasty or phalloplasty.

    From the experience of other people who I have known. Almost every woman that I have known who had vaginoplasty had to pay it all on her own, either by having multiple jobs for years or by doing sex work. The two who I have known that had insurance cover it had very high paying and powerful jobs (they easily could have paid cash on their own - one worked in IT for a major oil company and the other worked in healthcare). The trans guys that I have known (In the USA) that had top surgery all paid on their own. I have not known any trans guys who had either bottom surgery, usually because their insurances would not pay and they could not afford it though some simply did not want it.
     
  3. Chip

    Board Member Admin Team Advisor Full Member

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    I know very, very little about this. With that said, it is my understanding (from somewhere, which may not be reliable) that the Affordable Care Act (or possibly some California law) requires equal access for health care, which I believe include paying for gender confirmation surgery. It's my understanding that this is a relatively recent thing (last ~8 years?) I know that Kaiser, which is one of the largest health care HMOs in the country, does cover gender confirmation care, and I believe that includes hormones, surgery, etc, because I know one of the surgeons who specialized in this for Kaiser.

    OP, it sounds like you're on the right path by just earning as much as you can and getting yourself out of the house. I wish I had more specifics, but it's going to vary by state. You might first look into what Medicaid/Medicare offers are available in your state. In CA, the Medi-Cal program (our version of the US Medicare for low income folks) covers pratically everything, including, I believe gender confirmation surgery. Some states are better than others in what is availble.
     
  4. QuietPeace

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    Tiny detail. Medi-Cal is California's Medicaid program not Medicare (I have lived in California and been covered by both)

    The ACA has definitely improved things for our healthcare. Prior to 2014 I was unable to get individual therapy paid for because the assumption was that if I was in therapy that it had to be about transition related things and transition related healthcare was not covered by Medicare before Obama implemented a specific provision that we had to be covered.

    There is a difference between the policy saying that it covers GCS and being able to get GCS with the coverage. In 2016 I knew someone in Fresno California who was specifically working with people to get vaginoplasty covered on either Medicare or Medi-Cal. The thing is that while the policy does say that it will pay for GCS it limits how much that it will pay (to an amount so low that it will not pay what any surgeon in the USA charges, they also will not pay for surgeons out of the country who charge less). This means that in order to actually get GCS under those policies that tons of paperwork has to be done and even with that there is a lot of stuff to do and pay for before the actual surgery. It is not a simple process. I myself was only able to get my orchiectomy covered because I was found to have a precancerous condition after almost 30 years on hormones. With all of that and efforts by my physician I still could not get vaginoplasty covered and the charges for the orchiectomy were over $1000 even with the insurance.

    This is not to say that it is impossible to get coverage or that no one should try. I am only trying to point out that it is not an easy process. I should also point out that I have not been in the USA since 2019 and I have not paid attention to how these policies work since 2016 so things may very well have changed.
     
  5. clockworkfox

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    If you're low-income and can get medical assistance, don't be too prideful to do it. I have a GHP medical assistance plan, and it covers my therapy sessions, and the bulk of my appointments so far.

    I'm not sure how it's going to work out with hormones - I'm in the process of that right now. Without coverage, GoodRX can get you testosterone shots for under $50. Surgery, to my knowledge, is still considered "cosmetic". I have friends who have finally gotten enough together for top surgery, who are starting to save again for bottom surgery.

    Even part time, you can probably find better work. I know this is Pennsylvania, and we have a lower minimum wage than any other state, but I've noticed a lot of places offering considerably higher rates of pay because they're having trouble finding workers. You're also allowed to name your wages when you apply to most jobs - if you put "minimum" you'll get minimum, so don't be afraid to ask for the median wages on offer in your area on job applications. A job offer is a contractual agreement, so ask about the details of what's being offered to you once you've gotten through the interview process. Every penny counts, especially if surgery is a need for you, so don't be afraid to see what you can get away with.