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Sex reassignment surgery

Health insurance can reduce the cost of your gender reassignment surgery.

If you need sex reassignment surgery (SRS), you can get a lot of help from Medicare and private health insurance. Private insurers don't outright say they cover SRS specifically, but they will cover many of the individual treatments.

That means you'll need a policy that covers hormone treatments, medical imaging, blood tests, psychiatric expenses and any other treatments that are part of the procedure. You may even be able to claim for certain surgical operations if a doctor agrees that it is medically necessary.

Compare your health insurance options online

For purposes of the quote, select the gender you are transitioning from. You can then go directly to the provider's site or speak with an adviser. It's a good idea at that point to give them a call so you can discuss your need for SRS and to request to have your appropriate gender listed on the policy.

Is gender reassignment covered by private health cover?

Although the cost of SRS varies substantially depending on the procedures involved, the process can cost as much as $30,000. This includes surgery fees, specialist’s costs, hospital accommodation, anaesthetist fees and multiple consultations after the surgery.

Medicare provides cover for many of the major surgeries needed for SRS. However, there is quite often a gap between the Medicare benefit paid and the amount your surgeon will charge, sometimes to the tune of several thousands of dollars.

The good news is that some private health insurance policies will provide cover for SRS. In short, you should be able to find a private hospital cover policy that includes any SRS procedure that is also covered by Medicare. But there will typically be a waiting period before you can claim for these services, often for a length of 12 months.

It’s also worth pointing out that some of the procedures required to complete SRS, such as breast enhancement, facial surgery and hormone therapy, are not covered by either Medicare or private health insurance. With this in mind, even if you have a high level of private hospital cover in place you may still have to meet extensive out-of-pocket costs.

What is reconstructive surgery?

Reconstructive plastic surgery is an operation that is usually regarded as medically necessary, such as following an accident or to repair some sort of defect. According to the Australian Society of Plastic Surgeons, reconstructive surgery is "an operation, treatment or procedure performed on an abnormal structure, deformity or tissue of the body arising as a consequence of congenital defects, developmental or acquired abnormalities, trauma, disease, tumour, including surgery or other treatments for such conditions or defects".

As a result, most reconstructive surgery procedures can be covered by private health insurance. These include:

  • Operations for traumatic injuries
  • Surgery on congenital abnormalities, such as repairing cleft palates
  • Operations following severe burns, for example, skin grafts
  • Surgery following the removal of cancers or tumours

Of course, this also includes gender reassignment surgery, which means cover is available for some of the procedures associated with SRS.

How is this different to cosmetic surgery?

Reconstructive surgery is different to cosmetic surgery, which is usually not medically necessary. The Society of Plastic Surgeons explains that "cosmetic plastic surgery is an operation, treatment or procedure undertaken to improve appearance where no prior injury from trauma, disease, congenital disorder, congenital or acquired deformity exists".

This includes procedures such as:

  • Liposuction
  • Nose jobs
  • Breast implants
  • Face lifts
  • Botox injections

Cosmetic surgery is not covered by Medicare and therefore is not covered by private health insurance.

Services people can use to find help

There are several national organisations offering support, services and counselling to help transgender people around Australia. These include:

Headspace provides mental and health wellbeing support, information and services to young people around Australia.

Web: www.headspace.org.au

With an aim to provide for Australia’s sex- and gender-diverse community, A Gender Agenda provides advocacy, training and community development.

Web: www.genderrights.org.au

The Gender Centre provides a wide range of services and activities designed to help people with gender issues make informed choices.

Web: www.gendercentre.org.au

Trans Health Australia is an advocacy and support network that aims to improve the medical services available to support the health and wellbeing of 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

After undergoing SRS you will need to update your information with government departments. Following the adoption of the Australian Government Guidelines on the Recognition of Sex and Gender in July 2013, you can correct your sex marker with any Australian government department or agency by providing one of the following:

  • A statement from a registered medical practitioner or a registered psychologist (general registration)
  • A valid Australian government travel document, for example, a passport, which specifies your preferred gender
  • A state or territory birth certificate, or recognised details of a certificate showing your preferred gender

If you wish to change your name, you can do so by completing the relevant forms from the Births, Deaths and Marriages Registry in your state or territory.

You can also correct your sex on your Australian birth certificate. To do this you must complete the appropriate forms from your local Births, Deaths and Marriages Registry in your state or territory. Once this has been done, you can then apply for a passport showing your correct sex.

Compare health insurance that covers sex reassignment surgery

Picture: Shutterstock

Tim Falk

A freelance writer with a passion for the written word, Tim loves helping Australians find the right home loans and savings accounts. When he's not chained to a computer, Tim can usually be found exploring the great outdoors.

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2 Responses

  1. Default Gravatar
    TahnyaJune 19, 2018


    I am looking for information regarding sex reassignment surgery in Australia and the cheapest way to have it covered by Medicare or private health..if you can help that would be great..

    • Default Gravatar
      ArnoldJune 19, 2018

      Hi Tahnya,

      Thanks for your inquiry

      Before, gender reassignment surgeries were considered “experimental” and were banned by Medicare in 1981. As of May 2014, the 33-year exclusion on Medicare coverage of gender reassignment surgery was lifted.

      Now Medicare Administrative Contractors determine coverage of gender reassignment surgery on an individual claim basis. That means Medicare may cover gender reassignment surgery for Medicare beneficiaries with gender dysphoria whose doctors and health care providers determine there is a medical necessity for the surgery.

      It would be best to speak with Medicare directly for more information about this or you may want to check other health funds to confirm if they cover this type of surgery.

      Hope this information helps


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