Gender Reassignment Surgery Coverage in Canada

If you are a Canadian who feels strongly about having gender reassignment surgery you may be interested to learn that coverage varies from province to province. 

There are 3 areas of surgery:

• Removal of the internal and external organs associated with the current sex
• Reconstruction of the external characteristics of the desired sex
• Procedures to enhance the appearance and more closely match the desired sex

There is a wait list to consider when getting referred for surgery. Unfortunately your family doctor can’t provide this type of referral it must come from a special assessment centre. You may have to travel out of province for this appointment in order to be referred.

When it comes to funding the surgery you will have to look at whether your province offers any type of coverage. Eight provinces, all but New Brunswick and PEI, fund some combination of gender-confirming surgeries. 

The CanadianProfessional Association for Transgender Health (CPATH) can provide you with the information you require. British Columbia, Alberta, Ontario, Quebec and Nova Scotia fund all seven of the following procedures:

• hysterectomy (uterus removal)
• oophorectomy (ovary removal)
• metaoidioplasty and phalloplasty (bottom surgery for female-to-male trans people)
• penectomy (penis removal)
• orchiectomy (testes removal)
• vaginoplasty (the creation of a vagina)

Mastectomies are funded by some of the provinces but there is no chest contouring coverage. Nipple grafting can cost on average an extra $1,500.

Provinces such as Newfoundland and Saskatchewan require trans people seeking surgery to get a referral from the Centre for Addiction and Mental Health’s (CAMH) Gender Identity Clinic in Toronto.

Trans people often don’t have the time to wait the sometimes five-plus years to begin the surgical process to change their gender, they can suffer from gender dysphoria, a mental health disorder caused by having to live in a body they feel doesn’t belong to them. 

Private Health Insurance
If you have private health insurance you might be covered for hormones and certain surgeries. Some insurance companies have exclusions for gender identity related procedures, claiming SRS is "cosmetic," "elective" or "experimental." However, some insurance does cover gender reassignment surgery. Check your insurance manual to see if gender identity procedures and medications are excluded. 

List of Businesses with Transgender-Inclusive Health Insurance Benefits

Dealing with and Affording a Mental Illness Diagnosis

My son is twenty years old and suffers from depression. For the longest time he has been in a very dark place, not willing to accept that he could possibly be suffering from a mental illness. What are his options for treatment? Well for starters, he works in a local fast food chain, earning minimum wages, and doesn’t have health insurance coverage to be able to seek the services of a psychiatrist of his choosing. He doesn’t have a family doctor so he either has to go a hospital emergency room or visit the local walk-in clinic in order to get a referral slip to see a psychiatrist, which could take months due to the long wait lists. No matter what, it will be a long time before he sees a doctor and receives treatment.

Statistics Canada released a study in September, 2014 that revealed the following data with regard to young people with mental illnesses.

• Since 2002 there has been an increase of about 10% of Canadians aged 15 and older who are experiencing a mental health issue.
• The total number of 12 to 19 year olds in Canada who are at risk for developing depression is a staggering 3.2 million.

The study also revealed how inaccessible it is in Canada to get psychiatric and/or psychological treatment. Only 1 out of 5 children needing mental health services receives them. 

A diagnosis entails both psychiatric and psychological assessments. Psychiatric services are covered under the public health insurance program, but psychological services are not, unless the doctor works from a hospital. That is, services from a psychologist practicing in a private office, outside the hospital, are not covered by the public health insurance program; therefore, patients must pay out-of-pocket.  However; with a private health insurance plan, a patient can afford counselling sessions as well as any prescribed medications.

When I think of the troubling issues my son is facing, I also think about the many others who, like him, will not have easy access to treatment. While Canada’s health care system has many advantages, there are areas where it falls short, and too many young people pay the price. 

A good healthinsurance plan can go a long way in allowing you treatment options and helping with the costs of prescribed medications should you need them.

Aging Canadians and the Impact on Health Care Costs

In 2010, 4.8 million Canadians were seniors. Based on the established growth rate, that number will steadily climb to about 10.4 million in the next 20 years.

By 2031, all members of the baby boom generation will have reached the age of 65. The issue of whether or not Canada’s health care system will be able to meet their medical needs as time goes on is a significant concern. Canada’s health care system may very well have to change and adapt itself to adequately fulfill the needs of seniors.

Even though the elderly make up only 14% of the population, they incur about 45% of provincial and territorial health care expenditures. Today’s seniors are living longer than those of previous generations, a fact that has shifted the Canadian demography to an older population. Aging brings about limitations and chronic conditions that increase health care costs.

We need to think about how well we’ll do in the future under the existing public health care system. More and more seniors are relying on retirement savings and other income sources to help pay for medicines, treatments and/or services not covered by the government program.

Fortunately, there are health insurance plans available that focus on fulfilling the needs of baby boomers and seniors. Such policies include coverage for things like orthotics, home care, medical equipment, hearing aids, and hospital benefits.

Where is Health Insurance on your List?

20% of Canadians don’t have any type of health insurance, be it group insurance, personal insurance or even personal savings put aside in the event of a health crisis. Many Canadian families feel overextended financially taking into account the general cost of living.

Between managing child care costs, mortgage and vehicle payments, utilities, investing in a retirement fund, as well as other common expenses, the idea of planning for potential future health care costs might be at the bottom of the list for many busy families.

The scary truth is that a serious health issue such as a heart attack, stroke, cancer, or other serious illness/accident can result in very high medical bills. Having health insurance coverage can help to absorb the costs. 

Health insurance can be customized to meet your needs. There are plans specifically designed for families with children, individuals, students, and seniors. It’s a matter of doing your homework and obtaining a plan that suits your particular needs and budget.

Canadians need to put health insurance higher on the list!

For more information about customized plans for CAA members, go to  CAAhealth.ca.