Does Medicare Cover My Top Surgery?

Can Medicare Cover Top Surgery in Sydney?

People on their gender affirmation journey, hoping to get an MTF Top Surgery or FTM top surgery wonder whether they are eligible for a Medicare rebate or not. If you are interested to find out if Medicare can cover for the costs of your top surgery, here are all the details of the procedure and getting a Medicare rebate.

A Male to Female top surgery is a complex surgical procedure that is performed at the level of the chest. The procedure is performed on Trans women who are unhappy with how their chest looks. During the procedure, Dr Hunt will insert breast implants to reshape and contour the breasts and make them look more feminine.

A Female-to-male top surgery is a procedure that aims at transforming feminine breasts into a more masculine-looking chest in Trans men. Dr Hunt removes excess fat and skin, as well as repositions the nipples to create a flat chest.

These procedures not only transform your body completely but can increase your confidence as well. And why not, your body will finally mimic your true self and you will be able to get rid of gender dysphoria.

Dr Jeremy Hunt is a specialist plastic surgeon who performs gender affirmation procedures in Sydney and Wollongong NSW. His techniques aim to bring out the best possible results.

Benefits of Getting MTF/FTM Top Surgery

When the physical form doesn’t match the gender identity, there could be a lot of internal and external struggles. MTF/FTM Top Surgery is one of the most important procedures in gender transformation surgery for trans women and men. It has the following benefits:

Treatment for Gender Dysphoria

When your physical appearance doesn’t match who you really are, it can be a huge source of distress. Top surgery can help with one of the major hurdles in overcoming your perception of yourself. Having a pair of breasts or getting rid of the breasts can be just the change you need to feel better.

Body Matches Your Identity

When your body matches your identity, it can bring considerable relief. The surgery can dramatically improve your mental health and well-being and allow others to see your true self.

Clothing Options Open Up

Trans women can say goodbye to the bra stuffing and padded bras and welcome a bunch of new clothing options. Strapless, body con dresses, and low-cut tops will look beautiful on you. Similarly, men can wear their favourite t-shirts, and dress shirts, and wear their favourite suits.

Improved Social Life

Your social life can improve considerably after getting the surgery done. Stop wasting your time wondering where you stand amongst the crowd. Get the happiness you deserve and enjoy your relationships to the fullest.

More about Gender Dysphoria

When your physical identity doesn’t match your psychological and emotional identity, the condition is called gender dysphoria. It can be a source of significant distress and leads to problems like anxiety, depression, and many other mental health issues.

The stress stems from feeling different from everyone else around you. Similarly, homophobic and transphobic attitudes from people, bullying, and alienation from close ones can contribute to deteriorating mental health. Please know that you aren’t alone and there are multiple resources to help you out.

2007 Australian Research Centre in Sex, Health & Society published ‘TranZnation: A report on the health and well-being of sex and gender diverse (Trans) gender people in Australia and New Zealand’ and it shows that:

4% have experienced at least one form of stigma and discrimination
Around 53.4% of individuals have experienced verbal abuse at some point in their lives
Nearly 33.6% of people have received threats of violence or intimidation
One in five people have experienced physical violence
Transgender people also experience bullying in school, workplace

Reasons for Considering Gender Affirmation/Confirmation Surgery

While transgender individuals don’t need medical intervention to get valid identities, some of them choose to go for transitioning. There are two main kinds of transitioning:

1. Social Transitioning

It essentially refers to going for different pronouns, altering the style, acquiring a new name, and affirming one’s gender.

2. Medical Transitioning

It involves taking certain hormones and opting for surgical procedures to modify genitals, reproductive organs and physical changes to the appearance of the individual. That is where gender affirmation surgery comes in.

Top Surgery

Top surgery is a very important element of gender affirmation surgery. There are two types of Top Gender Affirmation surgery: MTF Top Surgery and FTM Top Surgery.

MTF or MTN – It calls for a breast augmentation surgery to increase the size of your breasts

FTM or FTN – It essentially involves the removal of breast tissue and flattening of the chest

Will Medicare Cover My Top Surgery?

Medicare functions on the basic principle: if the procedure is medically necessary, you will get coverage. If the procedure is aesthetic in nature, Medicare won’t pay for it. However, if any of your conditioning gets so bad that it impacts your day-to-day functioning, then there is a possibility to get coverage from a private health fund and Medicare. The procedure needs to be justified medically in order to get a Medicare rebate. If you meet Medicare criteria, then chances are your private health fund will also cover some of the charges.

MBS Item Number for Top Surgery is 31519 – Mastectomy / Total Removal of Breasts. Normally the surgery is done as a part of gender reassignment surgery.

Medicare also has MBS Item Numbers 45451 – Free Grafting (full thickness), and 41879 – Tracheoplasty that are a part of gender reassignment surgery procedures. When it comes to implants or augmentation, there is no Medicare rebate for it.

Why is Medicare for Top Surgery so Confusing?

Plastic surgery procedures are customised for each patient. Top surgery is no different. Typically, it is done as a part of Gender affirmation/confirmation surgeries – a series of surgeries that can be different from one person to the other. As all patients are different and have different needs, wishes, and expectations, the procedures or techniques used to achieve the desired outcome are also different. The goal of most of the procedures that are a part of gender reassignment surgery isn’t only to improve the physical appearance but to align the physical and spiritual facets of a human being. That makes the surgery very different and the Medicare rebate even more confusing than it already is.

All in all, if your condition is taking a toll on your mental health and day-to-day living, there is a chance that Medicare will pay for a part of your surgery, provided that you meet the eligibility criteria and you have a valid referral.

Top-Surgery Is a Life-Changing Procedure

Top surgery or any other surgery that is a part of gender affirmation procedure are interventions that can completely transform your life. If you decide to go for complete gender reassignment surgery, your treatment will include psychological preparation, hormone therapy, and a series of plastic surgeries to transform your physical appearance.

The number of plastic surgery you include in your gender reassignment surgery depends on your physical predispositions, results of hormone therapy, and, more importantly, what you want to achieve. It is important to note that surgery will change your appearance permanently. Hence, it is important to seek the help of a psychologist. Professional help can make the transition easier.

Medicare Rebates Are Subject to Change and Review

Please note that MBS Item codes are subject to change and review. If your Top Surgery is eligible for a Medicare rebate it is better to get it done as soon as possible.

Tips for Dealing with Medicare

Dealing with Medicare isn’t a piece of cake. You need to be completely knowledgeable if you wish to get the most out of the procedure. First things first, know the difference between plastic and cosmetic surgeries. Plastic or reconstructive surgery is subject to a rebate while cosmetic surgery isn’t. Another point to note is that if your request gets approved, it is unlikely that you will get complete financial compensation. If you are getting the procedure done for aesthetic reasons, your request will be denied.

Gender affirmation surgery could be expensive. If you don’t have the financial means to pay for it yourself, there is a possibility that Medicare will pay for a part of the costs. If we specifically talk about top surgeries, Medicare covers FTM Top Surgery but doesn’t cover MTF Top Surgery. Find out more details about using super to pay for plastic surgery and a payment plan to cover your Top surgery.

Don’t confuse coverage for Medicare with Private Health Insurance. They are different in terms of coverage as well as terms. It is important to reach out to your Private Health Fund directly to learn about the scope of coverage.

While submitting the request, make sure to include as many details as possible. Explain your condition in detail and attach medical records, tests, and findings, along with any photographic evidence. Always enclose the doctor’s referral with your request.

Top surgery isn’t for every Trans person. Some patients feel confident in their bodies while expressing their gender of choice. Others choose to live with gender dysphoria. In some cases, people only wish to undergo hormone replacement therapy. Please note that it is almost impossible to go back to how you looked after undergoing the surgery. Hence, take your time to think this through before making the final call. Gather all the information you can, seek the help of a psychologist, go to counselling and be absolutely sure that you want to proceed.

If you are getting top surgery done as a part of your gender affirmation surgery, you need to be fully aware that the transformation isn’t overnight. Do not expect to get everything sorted in a matter of one year. Good things take time. Trust your surgeon, read about other people who have transitioned, and research the subject.

MTF/FTM Top Surgeries can either be done alone or as a part of gender reassignment surgery
FTM Top surgery is covered by Medicare under item number 31519 while MTF Top Surgery isn’t
Always check in with your private health fund to learn whether they will cover the cost of your procedure or not
Generally, if you are eligible for a Medicare Rebate, most private health funds will also offer coverage
Medicare will not pay for your TOP Surgery entirely even if you are eligible. There are certain costs which you will have to pay out of your own pocket
Top Surgery is a permanent change. Always do significant research before making the final decision

Medical References about Gender Affirmation Surgery

About Dr Jeremy Hunt – Plastic Surgeon

Dr Jeremy Hunt is one of Australia’s leading specialist plastic surgeons for breast, body, face and nose surgery.

He is a member of FRACS & ASPS and has over 20 years of experience providing expert cosmetic and plastic surgery in Sydney.

Careful, considerate and honest, Dr Jeremy Hunt works with you to find a solution that is best for your body and your lifestyle. Every patient is unique and, through his expert guidance,

Dr Hunt’s personal, one-on-one service and attention to detail has given thousands of women and men from the Sydney & Wollongong NSW area and across Australia the confidence and body shape they desire.

Dr Hunt’s qualifications and education

Dr Jeremy A Hunt MBBS FRACS graduated with a Bachelor of Medicine degree from Sydney University in 1990 and is a Fellow of the Royal Australasian College of Surgeons and member of the Australian Society of Plastic Surgery. He completed a Fellowship at the prestigious University of Texas in the United States, where he learnt from some of the world’s very best plastic surgeons.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health professional.