Canada's gender-affirming care costs rise

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Canada's gender-affirming care costs rise

When Magan Carty got her surgery date in August 2022, they had roughly four months to pull together about $45,000.

The agreement came into effect in June. While OHIP covers the surgery to remove breast tissue, it doesn't cover the $3,500 chest maleization procedure, which costs $6,500. Carty paid $300 for a chest compression vest and $500 in taxes before the procedure, the official statement said.

Trans- and non-binary Canadians seeking gender-affirming care often need to navigate a complicated path to approve and wait times for provincially covered surgeries but also potentially plan for out-of-pocket health care costs, which can range from hundreds to tens of thousands of dollars, prompting them to dig into their own savings, launch crowdfunding campaigns or take out medical loans, or put off care indefinitely.

Inability to access publicly funded gender-affirming health care is mainly determined by where a person lives. All provinces and territories cover transition-related surgical operations, but most require approval and referral from one or two medical professionals.

While all provinces cover breast tissue removal surgery, many do not cover the contouring procedures that make a chest look more masculine. Most public plans do not fund breast augmentation or only cover it under certain circumstances.

But there can be more to someone's transition than just those surgeries, including facial feminization surgery, vocal surgery or voice training, liposuction and other body contouring, or hair transplants or removal.

The process of feminization can range from $10,000 to $15,000. The cost of hair removal or electrolysis can be hundreds of dollars. The cost of voice training ranges from $60 to $150 a hour. According to 2021 figures from the Aesthetic Society, a California-based association of plastic surgery and cosmetic medicine professionals from the US and Canada, body contouring procedures such as liposuction cost more than US$2,000 each. Yukon pays for all of these, but most public plans cover only some or none.

OHIP will reverse its course and will fund gender-affirming surgery for Ottawa public servants.

However, provinces have the authority to decide what medically necessary means are needed, even though procedures seen as cosmetic are not covered. Advocates argue that gender-affirming care that is not currently public funded should fall under medicare because research has shown that accessing such care improves mental health and reduces suicide risk.

Better provincial coverage would also contribute to trans- and non-binary Canadians' economic security 'if people are no longer trying to privately fund their own procedures' and could instead focus on other financial goals, Nielson-Baker said.

Even for surgeries covered by the public system, other expenses crop up, Whiteland said. There are only three clinics that perform surgery like vaginoplasties and phalloplasties - in Montreal, Toronto and British Columbia - and travel and accommodation costs are rarely covered. The recovery process is often difficult due to the days or weeks of work required to recover from surgical operations.

In addition, not all provinces fund mental-health professionals or hormone therapy, despite some requiring an assessment from a psychiatrist or a certain amount of months on hormone therapy to be approved for surgery.

Canadian employers have incorporated financial support for gender-affirming care as a part of their organizational diversity, equity and inclusion initiatives and to attract highly skilled employees. Twenty-one per cent of Canadian employers cover gender-affirmation benefits and 33 per cent are interested in covering them, according to a survey of more than 500 employers and other benefits-plan sponsors by trade publication Benefits Canada.

The last few years, employers such as Toyota Motor Manufacturing Canada, KPMG Canada, Molson Coors and the University of Toronto have added coverage to their plans. Toronto Dominion Bank and Accenture were among the first to offer such coverage, dating back more than a decade ago.

The Public Service Health Care program, which covers federal employees, offers a generous plan, which covers gender-affirming procedures up to a lifetime maximum of $75,000.

The benefits generally fill in the gaps of provincial or territorial health plans, said Stephanie Lue-Kim, principal of total health management at employee benefits consulting firm Mercer Canada.

Lue-Kim has seen companies show interest in such benefits. a need for gender affirming care, one of which she said is gender affirming care.

Carty said the teams have known they wanted top surgery since they were 19 years old. If they had actually tried it at that time, the cost would have been an insurmountable barrier.

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