Aetna expands coverage for gender-affirming surgeries for transgender women

Aetna announced last week that it will now be covering gender-affirming breast augmentation in most of its commercial plans. This is the result of a collaboration between Aeta, the Transgender Legal Defense & education Fund (TLDEF), Cohen Milstein Sellers * Toll law firm and several transgender Aetna members. 

This update aligns coverage for breast augmentation with coverage policies for other surgical procedures for transgender patients such as breast remove or gender-reassignment surgery. Aetna says that breast augmentation procedures will be covered with a referral from a doctor, documentation of the patient's gender dysphoria, and the completion of at least one year of hormone therapy. 

A 2018 study found that 70% of transgender patients experience significant hurdles to accessing care - leading nearly half to avoid visits to the emergency department for acute care needs. 

Jordan Pritzker, Senior Director of Clinical Solutions for Aetna, said “Our decision to update our clinical policy bulletin is consistent with many changes we have made over the years to better serve the needs of the LGBTQ community."