Aetna expands gender-affirming surgery coverage

Aetna will now cover breast augmentation for trans women, signaling hope for increased access to healthcare for the transgender community. The coverage expansion comes after transgender individuals and groups advocated for the change.

Aetna has expanded its coverage of gender-affirming surgery to include breast augmentation for certain trans women.

Announced Wednesday, the expansion was the result of a collaboration between Aetna, the Transgender Legal Defense & Education Fund, civil rights law firm Cohen Milstein and several transgender Aetna beneficiaries.

Though the payer covers some gender-affirming surgeries, such as breast removal for trans men, it previously did not extend the coverage to breast augmentation for trans women. Through the Transgender Legal Defense & Education Fund and Cohen Milstein, four trans women brought the issue to Aetna’s attention after being denied coverage for breast augmentation.

The payer — one of the largest in the country with about 22 million members — agreed to revise its clinical policy. It now considers breast augmentation as medically necessary rather than cosmetic surgery for certain transgender members.

“My hope is that being part of this groundbreaking collaboration helps other transgender and non-binary people have access to the healthcare we deserve,” said Nancy Menusan, one of the four trans women who approached the payer, in a news release. “By dropping exclusions for medically-necessary care like top surgery, Aetna is paving the way and setting an example for other health insurance providers, and I hope others will take note.”

Though there are U.S. health insurers that cover breast augmentation for trans women, they tend to be among the smaller payers, said Noah Lewis, trans health project director at the Transgender Legal Defense & Education Fund, in a phone interview. Aetna is now one of the few major insurers in the country to cover the surgery, along with Health Care Service Corporation.

“Here we see an insurance company being proactive about ensuring that trans people have equal access to healthcare,” Lewis said.

Research shows that insurer coverage for gender-affirming surgeries was on the rise. From 2012 to 2014, the percentages of gender-affirming surgery patients who identified as self-payers decreased over time, according to a study published in JAMA Surgery. Over half (53%) of patients were self-payers in 2012, compared with 39.4% in 2014.

Though healthcare access for transgender individuals appeared to be moving forward, the Trump presidency spelled a great deal of uncertainty for the community, Lewis said.

The Trump administration revised regulations implementing Section 1557 of the Affordable Care Act, which prohibits discrimination in healthcare. The revisions eliminated nondiscrimination protections based on gender identity.

But a Supreme Court ruling issued in June 2020 stated that an employer who fires an individual merely for being gay or transgender is breaking the law. This ruling led to two federal courts blocking the Trump administration from implementing parts of the revised regulations.

The administration of President Joe Biden now provides new opportunities for trans rights activists and advocacy groups. Biden recently signed an executive order stating that his administration will “fully enforce Title VII and other laws that prohibit discrimination on the basis of gender identity or sexual orientation.”

Though the fight for transgender rights is nowhere near over, there does appear to be some change on the horizon.

“In conjunction with the new administration and executive orders, the voluntary action by Aetna signals hope for the transgender community who have been through a lot in the last four years,” Lewis said.

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