One of the nation’s leading health insurance providers will expand its gender-affirming surgery coverage following a lobbying effort from pro-LGBTQ+ legal advocates.
Aetna, which services an estimated 39 million customers, has agreed to include breast augmentation within its scope of coverage for gender-affirming surgeries for transfeminine individuals. The health insurer will categorize the procedure as medically necessary for those who have a referral from a mental health provider, a history of gender dysphoria, and have undergone one year of hormone therapy.
The move comes after the insurer — which is owned by the nationwide health care company and pharmacy chain CVS Health — refused to cover breast augmentation surgery for four transgender women. After joining forces with the Transgender Legal Defense and Education Fund and Cohen, Milstein, Sellers, and Toll, a national law firm that challenges corporate wrongdoing, the group collectively worked with Aetna to change its policy as an alternative to a lawsuit.
Nancy Menusan, one of the trans women involved in the effort, said she hopes the resolution “helps other transgender and non-binary people have access to the health care we deserve.”
“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,” said Menusan in a statement originally cited by the Hartford Courant newspaper.
The health insurer’s gender-affirming surgery and procedure policy is extensive and includes breast removal and gonadectomies, as well as genital surgeries like as phalloplasty and vaginoplasty. Aetna also includes hormone therapy to suppress puberty in trans-identified adolescents under its list of medically necessary procedures. However, the company categorizes other gender-affirming procedures — such as voice modification surgery, hair removal, and facial surgeries — as cosmetic in nature and generally excludes them from coverage.
In a press release, TLDEF Executive Director Andy Marra claimed that Aetna has long
“been an industry leader in providing access to medically-necessary, transgender-related health care coverage” and applauded the insurer for “continuing to lead by example.”
“Eliminating this exclusion is a vital step towards providing comprehensive and medically-necessary care that all transgender people deserve to ensure their health and wellbeing,” she said.
The policy change from Aetna comes as several court battles have emerged over gender-affirming healthcare coverage in recent years. In November, healthcare insurer Blue Cross Blue Shield of Illinois was sued by a 15-year-old trans teenager for denying gender-affirming medical coverage. The anonymous plaintiff, represented by the LGBTQ+ group Lambda Legal, alleged the company refused to provide further treatment for trans healthcare services after initially approving a hormone implant. As a result, the family had to pay out of pocket for treatments.
As of 2019, six states — including Alaska, Georgia, Iowa, Missouri, Nebraska and Tennessee — deny trans healthcare coverage in their Medicaid programs. Last fall, three trans residents in Alaska filed a lawsuit against the state alleging that the exclusions violate the Equal Protection Clause of the 14th Amendment, the comparability and availability requirements of the federal Medicaid Act, and the Affordable Care Act’s nondiscrimination guidelines.
The Trump administration also targeted gender-affirming healthcare coverage last year, as the Department of Health and Human Services decided to issue a rule to remove trans-inclusive language in the Affordable Care Act. Section 1557 of the ACA prohibits discrimination on characteristics such as sex in federally funded health centers, with the Obama administration having already extended its interpretation of sex to include gender identity. After 22 states sued the Trump administration over the policy change, as well as legal challenges from several LGBTQ+ organizations and trans plaintiffs, a federal judge issued an order to block the move just days before it was set to take effect.
Under the Biden-Harris campaign platform, the new administration has pledged to defend LGBTQ+ nondiscrimination protections in healthcare settings and ensure comprehensive care that includes gender-affirming care.
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