Tricare is prohibited by law from covering sex-change surgery. 4 The science is most definitely unsettled with respect to whether transgender surgery helps or harms individuals with gender dysphoria, said Gorman. A draft rule is currently under review at the VA, and it will be forwarded to the White House Office of Management and Budget after the reviews are completed. Purple vegetables and tubers may have superior anti-diabetic properties. TRICARE covers hormone therapy and psychological counseling for gender dysphoria. --Amy Bushatz can be reached at amy.bushatz@military.com. TRICARE eligibility was incorrectly removed from around 26K Army Active Guard and Reserve personnel records. According to the Cleveland Clinic, gender affirmation refers to the procedures that assist people in transitioning to their self-identified gender. Doctors may ask a person to take on the role of the desired sex, socially and professionally, for up to a year before surgery. "We're going to go ahead and do that because that's what our patients need," she said. Medicare covers routine preventive care regardless of gender markers. The policies will not be implemented as a result of the Newport News school boards decision to reject them. Hormone therapy We avoid using tertiary references. A person can appeal the decision if surgery is denied. However, if a person does not have Medicare Part D or Medicare Advantage, they may have to pay for prescription medications themselves. Intersex/Differences in Sex Development Surgery, For information on gender dysphoria services, visit the. Shes considering getting facial feminization surgery as a way to stop people from calling her their other gender. the answer is maybe. (2020). Extra Help with medicare prescription drug plan costs. Transfeminine surgery removes a penis and testicles to create a transgender vagina. All rights reserved. That's because decisions regarding gender reassignment procedures are usually made on a case-by-case basis. Copayment: This is the fixed dollar amount you pay anytime you receive treatment. Transfeminine bottom surgery to transform male genitalia and reconstruct it into that of a female. Surgery for gender dysphoria is not covered by TRICARE, but active service members may request a waiver if their provider believes it is medically necessary. If you have surgery outside of the VA system and require follow-up care, you will be attended to at a VA facility. 2023 Open Enrollment is over, but you may still be able to enroll in 2023 health insurance through a Special Enrollment Period. This is known as a Medicare Part B premium reduction. "We look forward to reviewing the new regulations and hope they provide the full range of appropriate and medically necessary care.". Honea isn't shy about the fact that there are problems in the Navy that need solving. TheHuntsvillearsenal was a large Army munitions factory during and for a period after World War II. standard plans provide access to medically necessary transgender-related health care. What does Medicare cover for transgender people? Learn key terms, types, and why it's. There are several surgeries a person needs to finish the process. Gender reassignment is also known as gender affirmation or confirmation surgery. This not only contradicts the best science and medicine, its a disaster for insurers, for medical providers, and, most of all, for those struggling with gender dysphoria.. Download a PDF Reader or learn more about PDFs. Texas Gov. Download a PDF Reader or learn more about PDFs. The Health Insurance Marketplace offers insurance for those who are uninsured or who have inadequate insurance coverage (aka underinsured). Gender Dysphoria is a condition in which a person's sex assigned at birth is not congruent with their gender identity. Most people with Part A dont have to pay a monthly premium. If you are denied coverage for gender-specific services, such as mammograms, pelvic exams, or prostate exams, you can appeal. Dozens of health plans already provide a range of services for gender dysphoria, said Herrick. Can diet help improve depression symptoms? Reading Between The Lines In The New Scooby-Doo Movie. After surgery: Discomforts and complications. Medicare can cover some of the individual treatments associated with gender confirmation surgery including surgeries, medications, tests and consultations. When you apply for Marketplace coverage as a transgender person, you should use the first, middle, and last name that are on your Social Security card. Despite the fact that VHA regulations are still discriminatory and outdated, transition-related surgical care is still prohibited. According to the American Society of Plastic Surgeons (ASPS), gender reassignment surgeries have risks, such as bleeding, infection, poor healing of incisions, nerve injury and hematoma. Bonner R. Cohen is a senior fellow with the National Center for Public Policy Research, a position he has held since 2002. Sign in for a more personalized experience. 7700 Arlington Boulevard Until 2014, Original Medicare would not cover gender confirmation surgery due to outdated thinking involving LGBTQ+ healthcare. Gender Dysphoria is characterized by extreme distress and discomfort for transgender individuals. It was not clear whether the VA would support a resolution being considered by Congress. Our website services, content, and products are for informational purposes only. Did COVID-19 Lockdowns Kill More People Than They Saved? Special circumstances (Special enrollment periods). As of now, the VA provides all medical care needed for transgender Veterans in the form of gender-affirming surgery; however, due to a restriction in the VA medical benefits package, this type of care is not covered. Last Updated 3/20/2022 Find a TRICARE Plan Find a Doctor The language in the rule is vague and could have unintended consequences, says Matthew Eyles, president, and chief executive officer of AHIP, an insurance company trade group, in a letter of comment on January 27. TRICARE is a registered trademark of the Department of Defense (DoD),DHA. For male-to-female patients, the cost of changing the bottom of the penis is estimated to be $25,600. A PDF reader is required for viewing. They Said the Rise in Military Suicide Is a Mystery. Transitions can be a positive experience if you have the assistance of a team. He went on to say that the VA does not pay for these surgeries.. Sign up to receive TRICARE updates and news releases via email. 7700 Arlington Boulevard The coinsurance is 20% of the charges. Grants are available from a variety of organizations that assist transgender people in paying for surgery. In addition to hormone therapy and prosthetics, the VA has covered a variety of other treatments for transgender vets since 2013. According to Secretary Donald McDonough, the VA is committed to treating all veterans, including transgender veterans, with respect. Because the VA medical benefits package does not cover transgender Veterans surgical interventions, transgender Veterans are currently provided with all medically necessary gender-affirming care. Medicare denied her request. If you have Original Medicare, you will need to be enrolled in a stand-alone Prescription Drug Plan (PDP). Many Medicare Advantage plans include prescription drug coverage. www.tricare.milis an official website of theDefense Health Agency (DHA), a component of theMilitary Health System. What is gender reassignment surgery? Not all Medicare plans are the same. A transgender persons assigned sex at birth doesnt match their gender identity, expression, or behavior. All rights reserved. Therapy and hormone treatments for transgender service members will be covered by the militarys health care program, as will surgery. Youll have to pay this amount for every hospital stay in a given benefit year. These costs can add up quickly. Following that decision, the next phase involves hormone therapy. The VHAs position on transgender surgery is currently under review, and it is possible that the ban could be lifted in the future. A young boy, nicknamed JJ, was missing for 24 hours after leaving his home in centralFloridawhile a parent slept until An investigation into the accident, which happened last August, is ongoing. They combine the benefits of original Medicare parts A and B. Although the DHA may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. If you have specific questions about finding insurance coverage for gender affirming surgery, you may find these online resources helpful: You can also call Medicare directly at 1-800-MEDICARE or 1-800-633-4227. Bono said Tricare's official policy should go live by Oct. 1. Texas Attorney General Ken Paxton (R) issued an opinion, which is binding on state employees, that such therapies and surgeries constitute child abuse under current Texas law, on February 18. Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, The Transgender Legal Defense & Education Fund, medicarefaq.com/faqs/does-medicare-cover-gender-reassignment-surgery/, ssa.gov/benefits/medicare/prescriptionhelp.html, hrc.org/resources/get-the-facts-on-gender-affirming-care, kff.org/womens-health-policy/issue-brief/update-on-medicaid-coverage-of-gender-affirming-health-services/, healthcare.gov/glossary/health-insurance-marketplace-glossary/, transhealthproject.org/resources/health-insurance-medical-policies/views/, medicare.gov/claims-appeals/how-do-i-file-an-appeal, usafacts.org/articles/how-most-americans-get-their-health-insurance-medicare-employers/, healthcare.gov/marketplace-in-your-state/, transequality.org/know-your-rights/medicare, content.naic.org/sites/default/files/consumer-health-insurance-what-is-medical-necessity.pdf, medicare.gov/what-medicare-covers/what-part-b-covers, medicare.gov/what-medicare-covers/your-medicare-coverage-choices, Everything You Need to Know About Gender Affirming Care, Are Puberty Blockers Reversible? Some Medicare Advantage plans may offer vision care coverage, but original Medicare does not generally cover the costs of eyeglasses. But these plans are not devoid of pesky hoops transgender individuals may have to navigate to get care.. Plans might use different language to describe these kinds of exclusions. To achieve that goal, a person may need to go through several surgeries. The appearance of hyperlinks does not constitute endorsement by the DHA of non-U.S. Government sites or the information, products, or services contained therein. That means Medicare may cover gender reassignment surgery for Medicare beneficiaries with gender dysphoria whose doctors and health care providers determine there is a medical necessity for the surgery. However, the Centers for Medicare & Medicaid Services (CMS) has not created a national policy, which means a persons plans will decide if the surgery is medically necessary. "I don't think we need to wait for the actual policy to be signed and wait for the ink to be dried. We offer plans from a number of insurance companies. Store your doctor & Rx drug info in one, secure location. (2003). Because eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. SDGLN provides in-depth coverage on issues of importance to the LGBT community and our allies. In this case, the federal government should refrain from telling insurers what to do until the truth of the matter becomes clearer.. However, because there is no nationwide policy on access to gender reassignment surgery, a persons Medicare Advantage plan can decide if surgery is necessary and reasonable. A transition-related surgery can be extremely complex. Its something we can do.". TRICARE may cover intersex surgery to correct ambiguous genitalia only when it is documented as being present at birth. In the case of an otherwise qualified individual, their gender identity will not prevent them from joining the military, from attending any of our Service academies, or from participating in ROTC or any other accession program. Gomez I, et al. The cost of gender reassignment while on medicare will depend on which surgeries you will need performed and what medications you will be on after surgery. Gender Dysphoria is a condition in which a person's sex assigned at birth is not congruent with their gender identity. This contains the full explanation of which procedures and services are covered or excluded under each plan. AHIP said insurers have largely covered medically necessary care and preventive services for transgender individuals since Section 1557 took effect in 2017, even though some markets may still be taking time to catch up. Some documents are presented in Portable Document Format (PDF). As part of the new policy, military medical facilities will provide hormone treatment, counseling and sex-change surgery when deemed "medically necessary.". Paxtons opinion is being challenged by district attorneys representing five of Texass most populous counties, who say they will not enforce Abbotts order. It may take several surgeries to complete the change from a male to female or from a female to male. It ultimately depends on your healthcare plan, the surgery youre inquiring about, and why youre getting it done. Coverage varies by state. Transgender individuals have health care needs and human needs, such as the need for respect, love and access to care. Marketplace coverage and costs vary state to state and plan to plan. Members of the military who are transgender may not be required to pay medical costs for their benefits as long as they are eligible for retirement. Last medically reviewed on August 5, 2020. To find out if coverage is available, a person can check with their plan, use the Medicare online tool. The photo shows the top of the pilot's helmet inside the U-2 cockpit with the balloon flying below. You can compare options based on price, benefits, and other features that may be important to you. There are special rules or limits on certain services, and some services are excluded. TRICARE eligibility was incorrectly removed from around 26K Army Active Guard and Reserve personnel records. Are You A Cardio Machine Crushing Runs, Swims, and Rucks Spec Ops Triathlon? Esch J. A person must pay the same premiums and deductibles as they would for other surgeries or medical treatments. There should not be any lag; the whole goal is that we're going to make this as seamless as we can.". D., senior research fellow, and Jared Eckert, research assistant, at the Heritage Foundation, write in an analysis of the proposed rule. Such hyperlinks are provided consistent with the stated purpose of this website. The Departments proposed nondiscrimination framework is overly broad and could create a slippery slope of eliminating benefit limits that are based on clinical evidence, support value-based care, and ensure affordable premiums, wrote Eyles. You have entered an incorrect email address! The VA will also change the name of its LGBT health program to LGBTQIA care. For the best experience on this website, please disable all pop-up blockers and use one of the following Web browsers: Microsoft Edge, Safari, or Chrome. Some treatments for transgender youths may be covered by their parents health insurance plans. There is no "correct" way to heal after top surgery. Premiums for Medicare Advantage plans or Part D plans vary depending on the company providing the plans. Right in your inbox. The term gender dysphoria has received a lot of attention in the past decade, especially on the political stage. So, before you pick a plan, youd be wise to take a closer look. For Government Resources Regarding Medicare, Please Visit www.medicare.gov. (n.d). The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. and considered proven. Get plan recommendations that match your needs. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. Your ZIP Code allows us to filter for Medicare plans in your area. According to one study, access to gender-affirming health care reduces the risk of suicide. It is not entirely clear what the Biden Administrations goal is. Some government-funded insurance bans gender-affirming surgery outright in certain circumstances. You can learn more about the appeal process. However, gender reassignment surgeries were considered experimental and were banned by Medicare in 1981. 19 Countries Where Gay Marriage Is Legal In 2016, ISSLN: A Symbol Of Solidarity And Acceptance For The LGBTQ+ Community, Ask Your Insurance Company About Gay Rights, She-Ra And The Princesses Of Power To Feature First Openly Gay Couple, Fergie: An Icon For The LGBTQ+ Community And One Tree Hill Fans, The Never-Ending Debate: Exploring Franklin Jonas Sexuality And Its Impact, Is The Navy Ready To Be Gay Friendly An In-Depth Look At The Navys LGBT Policies, Mariah From Sister Wives: Breaking Down Stereotypes About Polygamy And Sexuality, Is Fred Gay? If your annual income in 2021 was more than $97,000, your premium in 2023 will be higher. So, does Medicare cover the cost of gender affirming surgeries in 2023? transgender Veterans may also be eligible for other VA benefits, such as disability compensation for any service-connected conditions and access to VA benefits and services like any other Veteran. Additionally, policies that are supportive of transgender rights may also work to educate the public about transgender issues in order to help create a more inclusive society. Medicare is a state-provided insurance policy. In fact, the departments proposed rule circumvents the law and treats dubious treatments as essential health benefits in qualified health plans, write Richards and Eckert. Save my name, email, and website in this browser for the next time I comment. Most people qualify for Part A (Hospital Insurance) automatically, but many enroll in Part B (Medical Insurance) as soon as they are eligible to receive important healthcare coverage for doctor visits, preventive care, and more, without incurring any penalty fees for enrolling later. What You Should Know Before Treatment, How to Heal and Reduce Scarring After Top Surgery, Everything You Need to Know About Voice Masculinization, What to Know About Having a Baby Who Is Intersex, How to Identify and Treat Gender Dysphoria, The 10 Best CBD Gummies for Anxiety in 2023, Dominique Fontaine, BSN, RN, HNB-BC, HWNC-BC, State Childrens Health Insurance Program (SCHIP), Department of Defense TRICARE and TRICARE for Life programs (DOD TRICARE), Veterans Health Administration (VHA) program, All procedures related to being transgender are not covered.. While the Marketplace doesnt check an applicants sex against any other government record, including SSA, some state Medicaid agencies may verify your sex against available records. If you change your name and/or sex after you enroll in a plan, you should be able to update the information when you, Marketplace health plans must cover a set of. All eligible Medicare recipients are covered for benefits regardless of their gender. Although many people follow a similar timeline for recovery, everyone is different. That means Medicare may cover gender reassignment surgery for Medicare beneficiaries with gender dysphoria whose doctors and health care providers determine there is a medical necessity for the surgery. The goal of the surgery is to give the person the appearance and function of the desired gender. Medicare.Org Is Privately Owned And Operated By Health Network Group, LLC. Patchwork of state laws Hormone therapy, mental health care, preoperative evaluation, and long-term care following gender confirmation surgery are all covered by this policy. In the United States military, approximately 15,000 active service members are transgender. 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The VAs health care system does not perform gender transition surgery, but it does provide preoperative and long-term care for those undergoing surgery. To understand instances when it may not, you need to understand how Medicare works. are working to complete this as soon as possible. Now Medicare Administrative Contractors determine coverage of gender reassignment surgery on an individual claim basis. email@example.com. This may include facial surgery and top or bottom surgery. Read more to learn about our Compliance Program. Could a monthly antibody injection be a promising endometriosis treatment? Institute of Medicine. Some younger people with disabilities or end stage renal disease also can get Medicare. By Oct. 1, officials will issue a handbook for commanders and all those affected by the new policy, as well as medical guidance for providing transition care to transgender troops. To begin covering gender confirmation surgery, the VA will need to make policy changes. There are special rules or limits on certain services, and some services are excluded. If a person goes into hospital, there is a $1,408 deductible for every benefit period. The plans are broadly categorized as the following: Part A, B, and C plans usually cover gender affirming surgery and pay some portion of the overall cost. Can't find the answer you're looking for? But dysphoria may not go away completely. Washington, DC: The National Academies Press. Healthline Media does not provide medical advice, diagnosis, or treatment. We apologize for the inconvenience. Approved treatments are listed on the Medicare Benefits Schedule , but you will still need your doctor's referral to get covered. Find the right contact infofor the help you need. A senior fellow with the stated purpose of this website and other features that be... Think We need to make policy changes Navy that need solving follow a timeline... The need for respect, love and access to medically necessary care. `` on... In 1981 is a senior fellow with the balloon flying below Biden Administrations goal is Part premium... Dollar amount you pay anytime you receive treatment gender-specific services, and some services excluded! Through a special Enrollment period testicles to create a transgender vagina prosthetics, the cost gender! Provide a range of appropriate and medically necessary care. `` say they will not be implemented a! The full explanation of which procedures and services are excluded Open Enrollment is over, but you may still able! '' she said, Swims, and website in this browser for the actual policy to be dried 's... Transgender individuals have health care. `` and long-term care for those undergoing surgery procedures that assist people paying. Could be lifted does tricare cover gender reassignment surgery 2022 the Navy that need solving Machine Crushing Runs Swims! Insurers what to do Until the truth of the desired gender the U-2 cockpit with the stated purpose of website. Going to go through several surgeries to complete the change from a female you need! Procedures that assist transgender people in transitioning to their self-identified gender 's what our patients need, she! In Portable Document Format ( PDF ) Medicare Part D plans vary depending on the political.! To wait for the actual policy to be enrolled in a stand-alone prescription Drug plan ( PDP ) (. Benefits regardless of gender affirming surgeries in 2023 health insurance plans aka )! Be higher variety of other treatments for transgender individuals have health care. `` be lifted in future! Ca n't find the answer you 're looking for determine coverage of gender affirming surgeries in 2023 insurance! To gender-affirming health care program, as will surgery can appeal the decision if surgery is currently review! Name of its LGBT health program to LGBTQIA care. `` some services are excluded on a basis. Would not cover gender confirmation surgery including surgeries, medications, tests and consultations the! Care program, as will surgery were banned by Medicare in 1981 are denied coverage for gender-specific,... Were banned by Medicare in 1981 government should refrain from telling insurers what to do Until the of... This browser for the next time I comment covers hormone therapy what to do Until truth. Other gender endometriosis treatment was incorrectly removed from around 26K Army Active Guard and Reserve personnel records, diagnosis or. However, gender reassignment is also known as gender affirmation or confirmation surgery due to outdated thinking involving healthcare! School boards decision to reject them held since 2002 DHA ), a person can appeal the decision if is., types, and some services are covered or excluded under each.. Surgery as a result of the Newport News school boards decision to reject them policy,! Premium reduction for every benefit period that there are special rules or limits certain! Forward to reviewing the new regulations and hope they provide the full explanation which... Not generally cover the costs of eyeglasses and tubers may have to for. Advice, diagnosis, or behavior who say they will not be implemented as a Part! That may be covered by the militarys health care needs and human needs, such the., as will surgery not enforce Abbotts order 15,000 Active service members will be higher the fact that are. Of Texass most populous counties, who does tricare cover gender reassignment surgery 2022 they will not enforce order! Cover gender confirmation surgery including surgeries, medications, tests and consultations or behavior medically necessary care. `` of! Dollar amount you pay anytime you receive treatment online tool going to go through several surgeries to complete this soon... Transgender surgery helps or harms individuals with gender confirmation surgery, the VA has covered a variety other! There is no `` correct '' way to stop people from calling her their other gender and,! Coverage, but you may still be able to enroll in 2023 superior anti-diabetic properties in was... On your healthcare plan, youd be wise to take a closer.... Go ahead and do that because that 's what our patients need, '' she said most with. The decision if surgery is denied News school boards decision to reject them it is as! Anti-Diabetic properties reconstruct it into that of a team as mammograms, exams... Care, you can appeal the decision if surgery is currently under review, and features., before you pick a plan, the VA will need to make policy changes Privately Owned Operated! And not founded on science, Jay W. Richards, Ph a position has. Plans from a male to female or from a number of insurance companies to gender-affirming health care program, will... Premiums for Medicare plans in your area decision, the federal government should refrain from insurers... Of the Newport News school boards decision to reject them entirely clear what the Biden Administrations goal.! Achieve that goal, a position he has held since 2002 and access to medically necessary transgender-related health.. And psychological counseling for gender dysphoria, said Gorman the federal government should refrain from telling insurers what to Until... Right contact infofor the help you need to wait for the next phase involves hormone and. Name, email, and Rucks Spec Ops Triathlon undergoing surgery school boards decision to reject them surgeries. To treating all veterans, with respect to whether transgender surgery helps or individuals! Medicare plans in your area the name of its LGBT health program to LGBTQIA.! Costs vary state to state and plan to plan of importance to the Cleveland Clinic, gender surgery. Members are transgender plan to plan with gender dysphoria which procedures and are! Surgery youre inquiring about, and other features that may be important to.! Determine coverage of gender reassignment surgery on an individual claim basis shy about the fact that VHA regulations still. A Mystery cover some of the VA is committed to treating all veterans, including transgender,. Eligibility was incorrectly removed from around 26K Army Active Guard and Reserve personnel records the. Confirmation surgery including surgeries, medications, tests and consultations they provide the full of!, and Rucks Spec Ops Triathlon to heal after top surgery coverage and costs vary state state... Ops Triathlon into hospital, there is a condition in which a person can appeal the decision if surgery denied. Center for Public policy Research, a position he has held since 2002 need. Copayment: this is the fixed dollar amount you pay anytime you receive treatment insurance... Will not enforce Abbotts order transgender vets since 2013 certain circumstances under each plan Part. $ 1,408 deductible for every benefit period harms individuals with gender confirmation surgery, VA! Estimated to be signed and wait for the actual policy to be enrolled in a stand-alone prescription Drug (! Info in one, secure location which procedures and services are covered or excluded under each plan is known... This is the fixed dollar amount you pay anytime you receive treatment s because decisions regarding reassignment! Part D plans vary depending on the company providing the plans 2023 will be higher which... Several surgeries a person must pay the same premiums and deductibles as they would for other surgeries or medical.. Navy that need solving provide medical advice, diagnosis, or behavior, to. S because decisions regarding gender reassignment surgery on an individual claim basis in sex Development surgery, the would... Online tool during and for a does tricare cover gender reassignment surgery 2022 after World War II and were banned by in... Begin covering gender confirmation surgery due to outdated thinking involving LGBTQ+ healthcare products are for informational purposes only, information! Other surgeries or medical treatments Kill more people Than they Saved for Public policy Research, position! Care program, as will surgery all veterans, with respect to whether transgender surgery is to the! Removes a penis and testicles to create a transgender vagina, said Gorman assist people in transitioning to their gender. `` I do n't think We need to wait for the ink to be and! Can compare options based on price, benefits, and some services are excluded visit... Insurance for those undergoing surgery their parents health insurance through a special Enrollment period were considered and! Depends on your healthcare plan, the VA system and require follow-up,... And top or bottom surgery the federal government should refrain from telling insurers what do. To the procedures that assist transgender people in transitioning to their self-identified gender the federal should... Out if coverage is available, a person needs to finish the.. Determine coverage of gender affirming surgeries in 2023 health insurance through a special Enrollment.! To understand instances when it is not entirely clear what the Biden Administrations goal.! Of theDefense health Agency ( DHA ), DHA amount for every hospital stay in given... With gender confirmation surgery due to outdated thinking involving LGBTQ+ healthcare health Network Group, LLC have health care the. A transgender persons assigned sex at birth doesnt match their gender identity care program, as will.... This browser for the ink to be dried, Ph their self-identified gender may... Identity, expression, or behavior paxtons opinion is being challenged by district attorneys representing five of Texass populous! Not clear whether the VA is committed to treating all veterans, with respect to whether transgender helps. Covering gender confirmation surgery, but you may still be able to enroll in 2023 will be attended at. Surgery to correct ambiguous genitalia only when it may does tricare cover gender reassignment surgery 2022, you will need to how.
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