Trans Canadians face costly health care costs

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Trans Canadians face costly health care costs

In August 2022, Magan Carty and his team had roughly four months to pull together about $4,500, they said.

The approval came in June. While OHIP covers the surgery to remove breast tissue, it doesn't cover the $3,500 procedure for chest maleization. Carty also paid $300 for a chest compression Vest and $500 in taxes on the procedure, and he must pay the full amount before the procedure.

Trans and non-binary Canadians seeking gender-affirming care often must navigate a complex path to approval and wait times for provincially covered surgery 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 to put off care indefinitely.

Having access to publicly funded gender-affirming health care depends largely on where a person lives. All provinces and territories provide transition-related surgery, but most require authorization and referral from one or two medical professionals.

Even though all provinces cover breast 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.

There can be more to a person'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 cost of facial feminization can range from $10,000 to $15,000. The cost of electrolysis or laser hair removal can reach hundreds of dollars. Language trainers usually charge $60 to $150 a hour to complete a voice training course. The Aesthetic Society, a California-based association of plastic surgeons and cosmetic medicine professionals from the United States and Canada, says body contouring procedures like liposuction cost more than US$2,000 each. Yukon pays for all of these, but most public plans cover only some or none.

OHIP reverses the course, will fund gender-affirming surgery for Ottawa public servants.

The provinces have the power to decide what medically necessary means they want to use, which are seen as cosmetics. Gender-affirming care that is not currently publicly funded should fall under Medicare, as research has shown that access to such care improves mental health and reduces suicide risk.

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

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 British Columbia, Toronto and Montreal - and travel and accommodation costs are rarely covered. Many surgeries require a few days or weeks off work to recover.

However, not all provinces provide the cost of 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 begun bringing in financial support for gender-affirming care as part of diversity, equity, and inclusion initiatives and to attract top talent. Twenty-one percent of Canadian employers cover gender-affirmation benefits and a further 33 percent are interested in covering them, according to a 2022 survey of more than 500 employers and other benefits-plan sponsors by trade publication Benefits Canada.

Employers like Toyota Motor Manufacturing Canada, the University of Toronto, KPMG Canada, Molson Coors and the University of Toronto have added coverage to their plans. The 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 plan covers federal employees, with one of the most generous plans, covering 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, chief executive of total health management at employee benefits consulting firm Mercer Canada.

Lue-Kim has seen more companies show interest in such benefits. '' s needs, one of which is gender affirming care,'' she said.

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

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