Gender Transitions: Medical Treatment Cost and Utilization
The costs of providing insurance coverage for transgender-related care can be minimal and vary depending on:
- The number of employees and dependents who make claims for coverage.
Individual employers indicate that the number of employees taking advantage of related health insurance benefits is actually quite small. - The services and procedures requested.
The Standards of Care are useful for anticipating which treatments might be requested. - The employer's total number of employees.
This affects the additional cost it would incur and pass back to employees to cover the new benefits.
According to Mary Ann Horton, affiliated with Transgender At Work, the average costs associated with surgical transition are approximately $25,000 over a five-year term of employment. This estimate includes $5,000 per year for two years of counseling with one hourly session per week, $10,000 for the surgery itself, and $1,000 per year over five years for prescription drugs.[i] Horton writes that "most male-to-female transsexuals go to doctors charging between $8,000 and $13,000 for the surgery itself. ... Most female-to-male transsexuals have only [chest] surgery and possibly a hysterectomy, costing from $4,000 to $10,000. Only a few complete the [genital] surgery, [which can cost] … up to $50,000."[ii]
Estimates such as these are debated in that it may be safe to reason that providing comprehensive insurance would enable more people to obtain the surgery, and costs may vary depending on where services are obtained.
Depending on an employer's current healthcare costs, these numbers can appear high. However, when compared to the costs of other more common healthcare expenditures, the costs of coverage specific to transgender people's needs are comparable, or lower. For example, according to the American Association of Health Plans, the most common disease management programs in health plans are those for diabetes, asthma, and congestive heart failure.[iii] The American Diabetes Association reports that the per capita annual cost of healthcare for people with diabetes was $13,243 in 2002.[iv]
[i] Mary Ann Horton, “The numbers quoted for San Francisco are too high,” Transgender at Work. Available at: http://www.tgender.net/taw/tsmed/sf-bs.html.
[ii] Ibid.
[iii] American Association of Health Plans, “Highlights of 2001 AAHP Industry Survey,” at http://www.aahp.org/Content/NavigationMenu/Inside_AAHP/AAHP_Surveys/01_Industry_Survey_DM_pdf.pdf (obtained 2004).
[iv] American Diabetes Association, “Direct and Indirect Costs of Diabetes in the United States.” Available at: http://www.diabetes.org/diabetes-statistics/cost-of-diabetes-in-us.jsp.
