Aetna agrees to expand gender-affirming coverage for transgender women

Eliza Fawcett, Hartford Courant
·3 min read

Hartford-based health insurer Aetna has agreed to expand its coverage of gender-affirming surgeries to include breast augmentation for qualifying transgender women.

The decision is a result of a collaboration between Aetna, the Transgender Legal Defense & Education Fund, a civil rights organization; Cohen Milstein Sellers & Toll, a national civil rights law firm; and four women who were denied coverage for the surgery, which Aetna previously viewed as cosmetic. The group first contacted Aetna in 2019, hoping to resolve the issue collaboratively, in lieu of filing a lawsuit.

Dr. Jordan Pritzker, senior director of clinical solutions for Aetna, said in written a statement that the company’s decision to revise its policy “is consistent with many changes we have made over the years to better serve the needs of the LGBTQ community.”

The revised policy recognizes breast augmentation as a medically necessary procedure that will be covered for transgender women who demonstrate persistent gender dysphoria, completion of one year of feminizing hormone therapy and a referral from a qualified mental health professional.

“My hope is that being part of this groundbreaking collaboration helps other transgender and non-binary people have access to the health care we deserve,” Nancy Menusan, one of the women involved in the effort, said in a written statement. “By dropping exclusions for medically-necessary care like top surgery, Aetna is paving the way and setting an example for other health insurance providers, and I hope others will take note.”

Kalpana Kotagal, a partner at Cohen Milstein, said that Aetna’s decision could be “transformative,” signaling “the kind of industrywide effort that is needed to bring greater equity to the provision of health care.”

Breast augmentation surgery for transgender women has long been recognized in the medical community as medically necessary, but many people were unable to access the care they required due to insurance exclusions, said Noah E. Lewis, director of the Trans Health Project at Transgender Legal Defense & Education Fund.

“The women who could afford to pay out-of-pocket were able to get it but anyone who didn’t have that ability was going without care,” he said.

Allison Escolastico, another woman involved in the effort, needed the surgery in college — but had to wait a decade for the procedure to be covered by Aetna. Her surgery is now scheduled for next month.

“It’s primarily about comfort in your own body. People experience extreme distress by not having the body that their brain is expecting,” Lewis said. “And there’s also the secondary safety concerns and misgendering concerns that happen when someone is visibly transgender.”

The vast majority of insurance policies cover mastectomies and genital surgeries, Lewis said, but many procedures impacting transgender women, including breast augmentation, facial surgery and voice surgery are “still widely excluded.” Eighty-three health insurance companies currently cover breast augmentation surgery, though those companies tend to be on the smaller side and some larger health insurance providers still have exclusions.

“It’s been a really challenging time for trans people in the past four years and this illustrates the resilience the trans community and trans women who came forward and were willing to fight for what they knew was right,” Lewis added. “And we’re now in a climate where big insurance companies are stepping up and want to be proactive, want to support trans people, and that’s a big shift that I’ve seen in my many years of doing this work.”

Eliza Fawcett can be reached at