Breast forms or trans tape. Maybe a hair prosthetic or makeup or a packer? A prescription written for equipment that supports your gender expression may qualify as DME, or Durable Medical Equipment, and your insurance may help pay for it!
What’s DME?
The Healthcare.gov definition of DME is
Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.
So, yeah, your health insurance might cover some or all of the costs associated with tools used in gender affirming care. Some very common examples of DME in gender care are syringes and compression garments worn after surgery, but patients have successfully gotten items such as home IPL devices, binders, packers, and breast forms approved.
Check Your Policy:
A brief description of your DME benefits should be included on your Summary of Benefits. If you don’t have one at hand, you should be able to request or download a copy from your insurance provider.
Here’s an example:
The important bits of information for this particular policy are:
The prescription has to be made by an in-network provider (this plan is an HMO plan.)
Preauthorization is required – so the prescription will be approved or denied by insurance administration, and there is a list of what items are covered (the formulary.)
The patient in this policy pays 20% of the cost of the item. In many cases, you’ll need to purchase the item and submit the receipt for reimbursement.
Equipment that supports gender care may not be on your insurance’s formulary, so getting it covered may take some time and effort. But, many insurance policies contain a clause allowing coverage for “non-standard DME”. You’ll likely need a letter from your prescribing physician explaining why the equipment is needed and how the equipment will benefit you.
If you’re a QueerDoc patient with DME coverage, consider discussing how a DME prescription might support your gender journey. Note: due to the time and paperwork involved, we may need you to book an appointment specifically to discuss DME options.
Some of our related articles about gender expression and tools:
- Express Yourself: Tips and Tools for Gettin’ Curvy Without A Prescription
- Express Yourself: Resources for Gettin’ Square Without a Prescription
- 11/6 QueerDoc Handout: Safer Binding
- 10/30 Tucking Safely: Tips and Tape
- Gettin’ Curvy: Workouts for Flexibility, Strength, and BOOTY
- Building a Broader Physique: Exercises For Angles
- Safely Changing Pitch: Finding Your Voice
- Safely Changing Pitch: Exercises to Change Your Pitch
- Say It Out Loud: List of Transgender Voice Training Resources
- Community and Characters: Voice Transition With Undead Voice Lab
How Else To Pay For Gender Affirming Items?
Do you have an HSA or FSA?
HSA – Health Savings Account
FSA – Flexible Spending Account
Both accounts may be bundled with your health insurance and may be administered by your employer.
Both allow you to set aside part of your earnings before employment taxes into a special savings account. This account can be used for approved medical expenses such as prescriptions, over the counter items, copays and insurance deductibles, and QueerDoc appointments!
What’s the difference?
A Health Savings Account is attached to a high-deductible health insurance plan, and is owned by the individual.
HSAs:
- Rollover to the next year if not used up in a calendar year.
- Can earn interest or be invested.
- May have a higher contribution limit.
- Can only be used after the money is placed into the HSA.
- Can go with you if you leave a job.
- Self-employed individuals can get a HSA-eligible health insurance plan.
A Flexible Spending Account is offered by and owned by the employer. Self-employed individuals are not eligible for FSAs.
FSAs:
- Must be used in the year earned.
- The full amount of funds are available at the beginning of the year, before they are taken out of your paycheck. Your employer may contribute part of the funds (if you leave a job and have used your FSA funds, you may end up owing some money back to your employer.)
There are a couple of different types of FSAs:
- Health Care FSA (HCFSA)
- Covers eligible medical expenses not covered by insurance
- Limited Expense Health Care FSA (LEX HCFSA)
- Covers eligible dental and vision expenses for individuals with a high-deductible health plan and an HSA
- Dependent Care FSA (DCFSA)
- Covers eligible dependent care services for dependents who are 12 and under or disabled dependents of any age.
- More information on the differences and what each type of plan covers here
Many HSA and FSA accounts will provide a debit card that can be used for eligible items. You may also be able to submit receipts for purchases made using cash or other cards to be reimbursed. Many plans also have a dedicated online store where everything is HSA/FSA eligible.
If purchasing online at non-specialty retailers, look for a tag indicating if an item is HSA or FSA-eligible. Some retailers will allow you to search for HSA/FSA items.
What kinds of things are covered?
KT Tape! (See binding blog.)
Sharps containers!
Alcohol wipes!
Syringes!
Surgical Recovery and Personal Care Supplies!
Gauze pads, bandages, paper tape, Neosporin or other antibiotic ointments, ice packs, wet wipe towelettes, lotion, silicone tape, absorbent pads, body pillows and donut pillows, peri bottles, shower chairs, and accessibility tools such as reachers and dressing sticks. (See our surgery checklist blogs for lists of recovery items that you might be able to get covered as DME or by an HSA or FSA.)
Hand Physical Therapy Supplies like putty and squeeze balls.
Dilators!
Wigs and other hair prostheses.
You can find a list of Medicaid-approved HSA items here (if they’re approved by Medicaid, they’re likely approved by most insurance plans. Remember that you may be able to get additional items covered by special request!
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