Medicare and private both contribute toward the cost of gender reassignment surgery in Australia.
Medicare includes many of the surgeries on its official list of covered treatments, and private health insurance can pitch in for your hormone therapy, private doctor’s fees and counselling.
All you’ll need is the right insurance and a few doctor’s referrals. You'll still have some out-of-pocket costs, but your bill will be much lighter with help.
How much does gender reassignment surgery cost in Australia?
GRS can run you anywhere from $8,000 to $30,000 dollars depending on what treatments you need - that’s before Medicare or private health insurance kicks in. It includes surgery fees, specialist visits, blood work, hospital accommodation, anesthesiologist fees, psychological counselling and hormone replacement therapy.
GRS is sometimes called sex reassignment surgery (SRS) or gender confirmation surgery (GRS).
Is sex reassignment covered by Medicare?
GRS is a series of individual treatments that includes surgeries, medications, tests and consultations. Luckily, Medicare lists many of these on its official list of approved treatments (this is called the Medicare Schedule of Benefits), but you will need your doctor’s referral if you want them covered.
Here are some examples of the treatments Medicare will help out with:
- Penis amputation
- Vaginal reconstruction
- Exploration of spermatic cord
Just remember that Medicare’s payout toward for any one treatment will probably not cover the entire cost of the treatment and you’ll need to make up the difference. There are two reasons for this, and it has to do with the fact that you’ll be getting your GRS in a private clinic:
- Your private doctor is free to charge more than what a public facility would (this is called the gap).
- Since it’s a private clinic, Medicare only pays 75-85% of the amount it would pay to a public facility - which creates even more out-of-pocket expense over and above the gap.
Medicare will also cover your GP visits, specialist visits, blood tests, psychological counselling and a few prescriptions - again, with the right referrals from your doctor.
What Medicare won’t cover
You will find a few treatments that Medicare won’t pay for at all. So along with the partial expenses mentioned above, you will also need to come up with the full amount for the following expenses unless you have private health insurance:
- Your accommodation and theatre fees (since you’ll be in a private clinic)
- Cosmetic surgery that is not medically necessary (like breast implants and cosmetic facial reconstruction)
- Some medications for hormone replacement therapy (HRT)
As you can see, even with Medicare, you could still walk away with out-of-pocket expenses reaching into the thousands.
Will private health insurance cover sex change for transgender patients?
Luckily, private health insurance can pick up where Medicare leaves off. Here’s where it can help you:
- It will pick up the tab on that 15-25% that Medicare withheld on treatments you received in a private clinic.
- It will cover your accommodation and theatre fees for any treatments that are on that Medicare list we talked about.
- It can pay for some of the hormone prescriptions that Medicare won’t cover.
- It can help out with additional psychology sessions if you need them.
Keep in mind, there will typically be a waiting period before you can claim for most treatments. These can be anywhere from 2-12 months depending on the treatment.
What level of private health cover will you need?
None of the surgeries you’ll need are major surgeries like a heart transplant or hip replacement, so almost any basic hospital policy should be enough to cover hospital treatments. But you will need a top-level extras policy for your prescriptions and counselling.
Here are some tips to help make sure you get the right cover:
- Double-check the insurer’s terms. Every insurer is different, so your best bet is to double check that you insurer doesn’t exclude or restrict any treatments you plan on having.
- Get at least a basic hospital policy. You can buy a cheaper “public hospital” policy through private health insurance, but it won’t do you any good in a private clinic.
- Get a top extras policy. Some extras policies will cover prescriptions that Medicare won’t, but you’ll need a top-level extras policy if you want your HRT prescriptions covered.
Compare your health insurance options online
When selecting your quote, select the gender you’re currently registered as with Medicare. When you speak with one of the insurers, you can explain your situation and find out how you can be listed as the appropriate gender.
What is hormone replacement therapy (HRT) and how is it covered?
Hormone replacement therapy is when you take medication to help you look and feel more like the gender you really are. It’s usually the first step of your journey because it allows you to get more comfortable as they gender you are transitioning to before having surgery that can’t be undone.
What medication will you need?
Your body naturally produces many chemicals called hormones that affect your body and mind and two of these are closely related to gender. Males usually produce more testosterone and females usually produce more estrogen.
That means if you are transitioning from male to female, you will want medication that helps you create more estrogen and less testosterone. For female-to-male, you’ll want medication that helps you create more testosterone and less estrogen.
It usually requires a cocktail of meds and you will need to take them forever if you want to continue experiencing their effects.
What is an endocrinologist and how can you find one?
There’s nothing stopping your GP from issuing the drugs you need, but they will probably refer you to an endocrinologist instead. This is a doctor who specialises in hormones.
You can trigger major mood and behaviour reactions if you disrupt the balance of hormones in your body. So it’s very important to go through HRT with the help of an endocrinologist who help you make lifestyle and medication adjustments as you get used to the new feelings.
Your GP should have the names and numbers of a few endocrinologists and can make the right referrals.
At this point, it’s probably worth asking your GP to refer you to a psychologist because some endocrinologists won’t prescribe meds unless they are absolutely sure you are mentally ready for it. Don’t wait until your first appointment with the endo before finding out they want you to see a psychologist. See the psychologist first and show up to your first endo appointment with the right paperwork.
Is HRT covered by the government and private health insurance?
Medicare will cover your visit to the endocrinologist plus any blood work they do. As for the medication itself, it’s a mixed bag. Medicare pays for many hormones through the Pharmaceutical Benefits Scheme (PBS), but they won’t pay for others
Since you’ll probably need a few medications, there’s a good chance you won’t be covered for some of them. Luckily private health insurance can help you here too, by offering a refund on certain medications that aren’t covered by the PBS.
Note: Medicare can deny you cover for certain medications if you’re registered as the gender they’re not intended for (for example, men are not normally supposed to take estrogen). So if you are transitioning from male to female, you’ll need to update your gender details with Medicare and other government departments before you can get estrogen. There’s more on how to do this later in this guide.
Is psychological treatment covered?
Seeing a psychologist can be a great way to stay positive as you go through this challenging journey. Your doctor may even require it before starting some of your treatments.
The good news is both Medicare and private health insurance can cover your sessions. Anyone with a Medicare card can get up to 10 sessions covered. All you have to do is see a GP and ask them to put you on a mental health treatment plan.
A private health insurance extras policy can also help. You can use this on top of Medicare cover for even more sessions, or you can use it on its own. With private cover, you don’t have to see a GP or get a mental health treatment plan. You can just book directly with the psychologist.
What is reconstructive surgery?
Reconstructive surgery is plastic surgery that is medically necessary, such as to fix a birth defect or replace skin after a burn. Medicare and private health insurance cover most reconstructive surgeries, including some of the treatments you’ll need for GRS. For example, you can get a rebate for some of the surgeries used in male-to-female vaginal reconstruction.
This is different to elective cosmetic surgery, which is not medically necessary. Medicare or private health insurance won’t cover elective cosmetic surgeries including breast implants, facial feminisation, hair removal, face lifts, nose jobs, liposuction or botox injections.
Will Medicare or private health insurance cover top surgery?
Top surgery refers to breast implants for those transitioning from male to female and breast reduction/removal for those going from female to male. You’ll only be covered for these if they are medically necessary.
Breast implants will almost never be medically necessary, so if you’ll most likely need to pay for your own breast implants if you choose to have them.
Breast reductions are different because they can often be considered medically necessary. For example, males with too much soft breast tissue or females with related back pain can often get a referral and have the surgery covered.
If you are transitioning to male and are registered as a male with Medicare, you may be able to have your breast reduction covered because too much soft breast tissue can be a medical complication in and of itself. But if you haven’t changed your gender with Medicare yet, you’ll ask your doctor for a referral based on another condition like back pain.
Services people can use to find help
There are quite a few national organisations that offer support, services and counselling to transgender people all around Australia. Here are a few you can reach out to:
Headspace provides mental health and wellbeing support, information and services to young people around Australia.
A Gender Agenda provides advocacy, training and community development for Australia’s sex- and gender-diverse community.
The Gender Centre provides a wide range of services and activities designed to help people with gender issues make informed choices.
Trans Health Australia is an advocacy and support network that aims to improve the delivery of medical, health and wellbeing services to members of the transgender and transsexual community.
Facebook: Trans Health Australia
There are also several state- and territory-based support and service organisations, so keep an eye out for one in your area.
Updating your documents
As of July 2013, anyone in Australia has the right to update their gender listing with any government agency, so you’ll definitely want to do that at some point along your journey. All you need to do is providing one of the following specifying your preferred gender:
- A statement from a registered medical practitioner or a registered psychologist
- A valid Australian government travel document, such as a passport
- A state or territory birth certificate (you can have your gender and/or name changed by filling out the appropriate forms from your local Births, Deaths and Marriages Registry)
- A document from your local Registrar of Birth Deaths and Marriages recognising your change of name and/or gender