Deciding to get gender-affirming care is a big step. You’ve likely already thought about which interventions are best for you, and you may have discussed them with your health care team. Now it’s time to determine your next steps and investigate your insurance coverage so you can learn more about the expenses you can expect.

Most insurance plans cover gender-affirming hormone therapy, which used to be called hormone replacement therapy (HRT). Most plans also cover gender-affirming surgery, which used to be called gender reassignment surgery. That means you can get the care you need to help express your gender identity and more fully be your authentic self. But always check with your insurance company’s Member Services for the most up-to-date information.

Below, we’ll cover intervention options for gender-affirming care, the approximate costs of these options, and other expenses related to recovery that may not be covered by insurance.

Prior authorization is often needed for transgender care

One important thing to note as we get started: Insurers often require prior authorization (PA) for care before they’ll pay for it.

Prior authorization for gender-affirming care usually includes getting the right documentation from your care team. For example, your insurer might like to see confirmation of your readiness for the treatment and procedures ahead. This helps them know you’re fully prepared.

Specific requirements for prior authorization differ based on each insurer, so be sure to check with yours on what you’ll need before you start making appointments. For example, HealthPartners members can find prior authorization details online.

One of the gender-affirmation options available for transgender and gender diverse people is hormone therapy. Hormone therapy can help you reach gender congruence by making changes to your body that better align with your gender identity. You and your care team will develop a plan for your personal hormone regimen. Options for hormone therapy include testosterone hormone therapy (PDF), and estrogen and anti-androgen hormone therapy (PDF).

How much does hormone therapy cost?

Hormone therapy can cost $30 to $100 a month. It’s usually covered by insurance, so if you have a health plan, the amount you’ll pay will probably be less. But be sure to check what your specific plan covers. You may also need to get prior authorization from your insurer, but details vary by carrier.

If you and your care team want to pursue gender-affirming surgery, many insurance companies cover it. But because all surgeries are complex (whether they’re gender affirming or not), you’ll need prior authorization from your insurer, even if you didn’t need prior authorization for hormone therapy.

If your care is covered, it’s still a good idea to confirm all out-of-pocket costs to make sure you can afford your surgery. HealthPartners offers many coverage options so you can focus less on the cost and more on your care.

Keep in mind: Unless otherwise noted, costs below are estimates for out-of-pocket expenses without insurance. If you do have health insurance, you may end up paying considerably less. Always call the Member Services number on the back of your health insurance ID card for the most accurate information about your plan.

Costs for masculinization surgery

Common masculinizing surgeries (PDF) – which used to be called female-to-male or FTM surgery – include the following:

• Chest surgery (top surgery) – The average cost of top surgery is $13,000 to $17,000. This includes a mastectomy or a breast reduction and is commonly called chest masculinizing surgery.
• Phalloplasty (bottom surgery) – This kind of bottom surgery typically costs around $25,000 to $35,000. Skin from other parts of the body is used to create a penis.
• Metoidioplasty (bottom surgery) – Costs vary widely for this kind of bottom surgery, but the average is about $12,000. This procedure involves using the existing clitoris to create a penis.
• Hysterectomy – Costs also vary widely for a hysterectomy, ranging from $1,200 to $27,000. During this procedure, the uterus, fallopian tubes and possibly ovaries are removed.

Costs for feminizing surgery

Common feminizing surgeries (PDF) – which used to be called male-to-female or MTF surgery – include the following:

• Breast augmentation or implants (top surgery) – These procedures can cost between $3,000 and $10,000. They’re usually done in combination with hormone therapy.
• Orchiectomy (bottom surgery) – This surgery can cost less than $1,000 if you have insurance and involves removing the testicles, often in an outpatient setting.
• Vaginoplasty (bottom surgery) – Vaginoplasty, which is a surgery to create a vagina, costs an average of $6,000 with insurance coverage. There are various types of this surgery based on which skin is used in vaginal creation. You’ll discuss with your provider which is best for you.

Gender affirmation care that may or may not be covered by insurance

There are some costs associated with the gender-affirmation process that are increasingly, but not always, covered by insurance. These may include:

Always check with your health plan to see how your own benefits would apply to these services. Call the Member Services number on the back of your health insurance ID card for the most accurate information.

Using an FSA or HSA can help pay for gender-affirming care

If you have one, using your Flexible Spending Account (FSA) or Health Savings Account (HSA) can help you keep your out-of-pocket costs down when paying for gender-affirming care. FSA and HSA money is tax free and can be used for medical treatments and procedures, plus mental health counseling and other related health care. As always, confirm eligible expenses with your account’s administrator before you spend. And be sure to consider your care plans for the next year when making your annual elections and contributions.

Remember: Gender-affirmation care is only part of the equation. Preventive care, counseling and regular wellness exams are also essential to your health and happiness as you begin this new chapter of your life.

Generally, insurance will cover most costs associated with mental health support and routine care. But check with your plan to confirm the details, such as when your coverage kicks in. You deserve to have your whole you cared for, so don't be afraid to take advantage of the coverage available to you from your plan.