Gender-affirming Care
We're proud to provide coverage for comprehensive gender-affirming care to our members. Our coverage and support allow members to align their physical traits with their gender identity. We'll guide you throughout each stage of your journey, however that journey looks for you.
Gender-affirming Treatments
We cover a variety of gender-affirming treatments. Select any of the links below to view a specific treatment journey.
Understand Your Health Benefits
Medical coverage varies by plan. It's important to know whether you have a PPO (Preferred Provider Organization) or an HMO (Health Maintenance Organization) plan. Below are some key aspects of HMO and PPO plans that could affect your treatment journey:
HMO | PPO | |
---|---|---|
Need a primary care provider (PCP) | Да | Нет |
Need referrals for specialists (e.g., endocrinologist) | Да | Нет |
Can see out-of-network providers | Generally, no | Yes. Out-of-pocket costs may be more for care. |
Exclusive Provider Organizations (EPOs) are similar to PPOs and members don't need a PCP or a referral. If EPO members need assistance finding an in-network provider for gender-affirming care, call us at 1-888-243-4420.
Hormone Therapy
Gender-affirming hormone therapy (GAHT) is the primary medical intervention sought by transgender and nonbinary people. This treatment allows individuals to achieve sex characteristics that align more with the individual's gender identity.
Steps for gender-affirming hormone therapy
If your primary care provider (PCP) does not prescribe gender-affirming hormone therapy, they will refer you to an endocrinologist. You can find an in-network provider with our Find a Doctor tool.
If you can’t find an in-network endocrinologist, you can contact an out-of-network specialist and see if they would be willing to work with your insurance plan.
- You may also ask the out-of-network specialist if they would create a payment plan for you. Be aware that out-of-network care is typically more expensive that in-network care.
*If you need support finding a provider, call Member Service.
During your initial consultation, your health care provider will assess your overall health, explain the hormone therapy process, and discuss potential risks and benefits.
Your provider and pharmacist will work with us to determine which hormone therapy treatments are covered. If your pharmacy benefits are not provided through Blue Cross Blue Shield of Massachusetts, we'll still cover office visits, lab tests, and other services.
Examples of gender-affirming hormone therapy prescriptions
Feminizing Hormone Therapy
- Estradiol (Estrogen)
Masculinizing Hormone Therapy
- Testosterone
Blue Cross doesn’t require an authorization for gender-affirming hormone therapy.
Check the front of your member ID card to see if Blue Cross administers your pharmacy benefits.
After being prescribed hormone therapy, you may need one or two follow-up appointments for ongoing care. If you are receiving an injectable hormone treatment, these visits will help you learn how to inject yourself safely.
* There may be an out-of-pocket cost associated with follow-up appointments.
How much does hormone therapy typically cost?
To see how much gender-affirming hormone therapy costs, sign in to MyBlue to view your pharmacy benefits.
Speech Therapy/voice Training Services
Feminizing or masculinizing speech therapy and/or voice training services are specialized programs or interventions. They help transgender and non-binary individuals achieve a speaking and vocal tone that aligns with their gender identity.
Steps for speech therapy
Look for an SLP specializing in transgender and/or non-binary voice modification. You can search online or request referrals from health care providers, LGBTQIA+ organizations, or local transgender support groups.
Blue Cross will only cover visits with an SLP for feminizing and masculinizing speech therapy. These providers can bill directly to us.
* If you need support finding a provider, call Member Service.
Schedule an initial appointment with an SLP. During this meeting, you'll:
- Discuss your goals, concerns, and expectations regarding voice modification
- Talk about their therapy approach and the estimated number of sessions
- Receive an assessment
Based on the assessment, your SLP will create a customized treatment plan tailored to your voice goals.
Attend regular voice training sessions as recommended by the SLP. These sessions may involve exercises to work on your vocal pitch, intonation, breath control, and speech articulation to achieve a more gender-affirming voice.
Throughout the therapy, provide feedback to the SLP about your progress and any challenges you may face. Your SLP can make adjustments to your treatment plan as needed.
If your SLP is in network, the provider will submit the claim for you. Be prepared for the out-of-pocket cost of speech therapy, which can vary due to the number of sessions needed, the provider's geographic location, and whether the provider is in network.
To file a claim for insurance reimbursement, see the section Submit an Insurance Reimbursement Claim on this page.
Electrolysis & Laser Hair Removal
Electrolysis and laser hair removal are methods for permanent hair removal. Electrolysis uses an electric current to destroy hair follicles, while laser hair removal uses light waves to target melanin in the hair follicles.
Steps for electrolysis & laser hair removal
Depending on your chosen method for hair removal, you can see an electrologist, dermatologist, or aesthetician.
Most electrologists have their own practices or operate under dermatology practices. Please note electrologists are not part of our provider network and are not featured in our Find a Doctor tool. Electrolysis is still considered to be under the Massachusetts Board of Cosmetology and, therefore, most of the time can’t be billed directly to insurance. Most electrologists require payment at the appointment. Blue Cross may reimburse electrolysis and laser hair removal for members in preparation for genital reconstruction, if we have authorized the surgical procedure. You’ll need an authorization on file for genital reconstruction surgery before your initial hair removal appointments.
To be reimbursed for more than 12 electrolysis or laser hair removal sessions, you must get prior authorization from your provider and a letter of medical necessity.
The provider will assess your hair type, skin type, hair growth patterns, and other factors to create a personalized treatment plan. This plan will outline:
- The number of sessions required
- The duration of each session
- The expected results
Attend your scheduled electrolysis or laser hair removal sessions. The session length varies, depending on the area being treated and your pain tolerance.
Electrolysis and laser hair removal are gradual processes that typically require multiple sessions to achieve permanent hair removal.
Be prepared for the cost of electrolysis or laser hair removal. Costs can vary based on the treatment area, the number of sessions needed, and the provider's geographic location. Some of our insurance plans may cover electrolysis and laser hair removal as part of preparation for genital reconstruction, so check your policy for details.
If you paid out-of-pocket for electrolysis or laser hair removal in preparation for an authorized genital reconstruction surgery, you can submit a reimbursement claim for the covered expenses.
To file a claim for insurance reimbursement, see the section Submit an Insurance Reimbursement Claim on this page.
Facial Surgery (Masculinization & Feminization)
Facial masculinization surgery is a set of surgical procedures performed to alter and enhance the facial features of transgender individuals who were assigned female at birth and wish to achieve a more masculine facial appearance.
Facial feminization surgery is a set of surgical procedures used to alter the facial features of transgender individuals who were assigned male at birth and want to achieve a more feminine facial appearance.
Steps for facial surgery
Begin by talking to a qualified health care provider. The provider could be a gender therapist, a mental health professional, or your primary care doctor. This step is essential to assess your needs and confirm your readiness for gender-affirming facial surgery.
From there, begin researching surgeons specializing in facial feminization surgery (FFS) or facial masculinization surgery (FMS).
Use our Find a Doctor tool to locate an in-network surgeon, or call us at 1-888-243-4420 for support.
Work with your surgeon's office to obtain authorization from Blue Cross for facial surgery. This often requires documentation, including a letter of medical necessity from your health care provider.
Each surgeon has different documentation requirements for gender-affirming surgeries. Typically, surgeons require two letters of support from two different health care providers. Blue Cross doesn’t require letters of support for surgeons to conduct gender-affirming surgeries. However, we require that the medical records from your provider show that you have been receiving gender-affirming care for six months or more to determine that this care is medically necessary (exceptions can be made for specific conditions).
Learn more about our gender-affirming care medical policy.
To find out your estimated out-of-pocket costs, ask your health care provider or the hospital where the surgery will be performed to provide an estimate of the costs, then call Team Blue Member Service to validate. When you have insurance approval and are ready to pay any applicable costs, schedule your gender-affirming facial surgery.
Follow your surgeon’s and medical facility’s pre-operative and post-operative instructions to help reduce the risk of complications.
If your surgeon is in network, the provider will submit the medical claim for you. However, if you've paid for out-of-network care for facial surgery, submit a claim to Blue Cross for reimbursement for the covered portion of expenses.
To file a claim for insurance reimbursement, please see the section Submit an Insurance Reimbursement Claim on this page.
Chest Surgery (Top Surgery)
Chest surgery, also known as "top surgery," is a medical procedure performed as part of gender-affirming care for transgender and non-binary individuals. This surgery is primarily sought by individuals who have been assigned either male or female at birth and who wish to align their physical appearance with their gender identity. This surgery can be performed as a mastectomy for individuals who were assigned female at birth, or performed as a breast augmentation for individuals assigned male at birth.
Steps for chest surgery
Speak with a qualified health care provider, such as a gender therapist, mental health professional, or a primary care physician, about chest surgery. This step is essential to assess your needs and confirm your readiness for the procedure.
Research and find a plastic surgeon who specializes in gender-affirming chest surgery. Make sure they are in your health plan’s network. You can find surgeons with our Find a Doctor tool, or by calling 1-888-243-4420.
*Some surgeons have BMI (body mass index) requirements for gender-affirming chest surgeries.
Work with your surgeon's office to obtain authorization from Blue Cross for chest surgery. This often requires documentation, including a letter of medical necessity from your health care provider.
Each surgeon has different documentation requirements for chest surgeries. Many surgeons require two letters of support from two different health care providers. Blue Cross doesn’t need letters of support for surgeons to conduct gender-affirming surgeries. However, we require that the medical records from your provider show that you have been receiving gender-affirming care for six months or more to determine that this care is medically necessary (exceptions can be made for specific conditions).
There are multiple types of feminizing and masculinizing chest surgeries (e.g., breast augmentation, mastectomy). Your surgeon will decide on the procedure that is best aligned with your goals. To find out your estimated out-of-pocket costs, ask your health care provider or the hospital where the surgery will be performed to provide an estimate of the costs, then call Team Blue Member Service to validate. Schedule your chest surgery when insurance authorization is secured and you're prepared to cover any applicable costs.
Follow your surgeon’s and medical facility’s instructions before and after surgery; this will help reduce the risk of complications.
If your surgeon is in network, the provider will submit the medical claim for you. However, if you've paid for out-of-network care for chest surgery, submit a claim to Blue Cross to seek reimbursement for the covered portion of the expenses.
To file a claim, see the section Submit an Insurance Reimbursement Claim on this page.
Genital Reconstruction
Genital reconstruction, also known as gender-affirming genital surgery, gender confirmation surgery, or bottom surgery, is a set of surgical procedures that are performed to alter a person’s genitalia to be consistent with their gender identity.
Steps for genital reconstruction
Speak with a qualified health care provider, such as a gender therapist, mental health professional, or a primary care physician about genital reconstruction. This step is essential to assess your needs and confirm your readiness for the surgery.
From there, you can begin researching surgeons who specialize in gender-affirming genital surgeries. Look for surgeons with experience in doing procedures such as vaginoplasty or phalloplasty, or other genital reconstruction surgeries. You can find surgeons in our Find a doctor tool, or by calling 1-888-243-4420.
Work with your surgeon's office to obtain authorization from Blue Cross for the surgery. This requires documentation, including a letter of medical necessity from your health care provider.
Each surgeon has different documentation requirements for chest surgeries. Many surgeons require two letters of support from two different health care providers. Blue Cross does not require letters of support for surgeons to conduct gender-affirming surgeries. However, we require that the medical records from your provider show that you have been receiving gender-affirming care for six months or more to determine that this care is medically necessary (exceptions can be made for specific conditions).
To find out your estimated out-of-pocket costs, ask your health care provider or the hospital where the surgery will be performed to provide an estimate of the costs, then call Team Blue Member Service to validate. When insurance authorization is secured and you're prepared to cover any applicable costs, schedule your genital reconstruction surgery.
Learn more about our gender-affirming care medical policy.
If you haven't had laser hair removal or electrolysis before, you may need to do this step. Most surgeons require it to perform genital reconstruction. See the Electrolysis section for more information.
Follow your surgeon’s and medical facility’s pre-operative and post-operative instructions to decrease the risk of complications.
If your surgeon is in network, the provider will submit the medical claim for you. However, if you've paid for out-of-network care for genital reconstruction, submit a claim to Blue Cross to seek reimbursement for the covered portion of the expenses.
To file a claim for insurance reimbursement, see the section Submit an Insurance Reimbursement Claim on this page.
Submit An Insurance Reimbursement Claim
To receive insurance reimbursement for gender-affirming care, complete the reimbursement form, provide the required documents (e.g., bills, receipts, Explanation of Benefits (EOB) statements), and ensure that all details are correct.
You may submit a claim via:
Blue Cross Blue Shield of Massachusetts
P.O. Box 986030
Boston, MA 02298
Fax
1-617-246-9480
Track your claim on MyBlue, if you submitted it digitally. If you don’t receive a reimbursement, reach out to us for assistance.
Contact Our Team
If you have any questions about gender-affirming care, our specially trained team of clinical experts, mental health providers, and psychiatrists is ready to help.