Damon Mcknight
New Brunswick Medicare is the provincial health plan for all New Brunswick residents. It provides coverage for most basic healthcare services. To qualify, you must be a Canadian citizen or legally entitled to remain in Canada, and make New Brunswick your principal home.
Medicare will pay for most medical services provided by a physician in a physician's office or in a hospital if medically required. However, prescription drugs and medicines are not covered by Medicare, and emergency medical costs incurred while travelling outside Canada are not covered unless pre-approved.
Medically necessary gender-confirming surgeries for transgender persons living in New Brunswick are now covered by New Brunswick Medicare. This includes hysterectomy with salpingo-oophorectomy and mastectomy with chest masculinization. To attain coverage, a Gender Confirming Surgery Prior Approval Request form must be completed by a mental health professional and accompanied by two referral letters from mental health professionals.
While it is unclear whether hormone replacement therapy (HRT) is covered by New Brunswick Medicare, it is often covered by health insurance if it is prescribed by a healthcare provider to treat menopausal symptoms.
| Characteristics | Values |
|---|---|
| What does New Brunswick Medicare cover? | Most basic healthcare services, including medically required services such as critical illness or emergencies. |
| What is not covered by New Brunswick Medicare? | Routine dental services, cosmetic surgery, vision care, acupuncture, paramedical services provided by several specialists, accidental death and dismemberment. |
| Who is eligible for New Brunswick Medicare? | Canadian citizens or those legally entitled to remain in Canada, with New Brunswick as their primary home. |
| Who is not eligible for New Brunswick Medicare? | Inmates of federal penitentiaries, regular members of the Canadian Armed Forces, students from another province, and tourists or visitors to the province. |
| How to apply for New Brunswick Medicare? | Submit a signed original Application for Registration form in person or by mail. |
| What documents are required for applying for New Brunswick Medicare? | Proof of citizenship or immigration status, such as a valid passport, birth certificate, driver's license, etc. |
| How long is New Brunswick Medicare coverage valid for? | Typically valid for 5 years. |
| What is the cost of New Brunswick Medicare? | There is no cost for basic coverage, but additional services may require a premium and co-payment. |
| What is the process for gender-confirming surgery under New Brunswick Medicare? | Patients should approach their family physician, nurse practitioner, or mental health professional for assessment. Surgery must be deemed clinically eligible, and a request form is then sent to the Executive Director of Addictions and Mental Health for approval. |
What You'll Learn
- Does New Brunswick Medicare cover HRT for menopause?
- Does New Brunswick Medicare cover HRT for hormone imbalances in men?
- Does New Brunswick Medicare cover HRT for gender dysphoria?
- What surgeries does New Brunswick Medicare cover for gender dysphoria?
- What other treatments does New Brunswick Medicare cover for gender dysphoria?
Does New Brunswick Medicare cover HRT for menopause?
New Brunswick Medicare does not cover hormone replacement therapy (HRT) under Medicare Part A and Part B. However, it may be covered if you have a Medicare Advantage plan (Part C) that includes prescription drug coverage or a stand-alone Part D plan.
Medicare Part A and Part B only cover limited prescription drugs. Part A may cover prescription drugs received during a hospital stay or as an inpatient in another facility. Part B may cover certain prescription drugs received as an outpatient, such as infusions and injections. Since most HRT drugs are taken at home, Medicare Part A and Part B generally do not cover HRT for menopause.
To get Medicare coverage for HRT for menopause, you typically need a Medicare Part D Prescription Drug Plan from a private insurance company. If you want to stay with Original Medicare (Part A and Part B), you can add a stand-alone Medicare Part D plan to cover HRT. Alternatively, you can sign up for a Medicare Advantage (Part C) Prescription Drug plan that covers inpatient care, outpatient care, and prescription drugs such as HRT.
Medicare Advantage and Part D plans may cover HRT drugs such as bioidentical hormones like estrogen, progesterone, and testosterone. However, it is important to note that not all plans are the same, and coverage may vary. It is recommended to check with your specific plan to confirm coverage for HRT for menopause.
In addition to prescription drug coverage, Medicare Part B covers the administration of estrogen and progestin for menopausal hormone therapy. Medicare also covers bone density tests to evaluate the risk of osteoporosis, which is common in postmenopausal women.
New Brunswick Medicare and Gender-Confirming Surgery
New Brunswick Medicare covers medically necessary gender-confirming surgeries for transgender persons living in the province. This includes surgeries such as vaginoplasty, vaginectomy, hysterectomy, mastectomy, metoidioplasty, phalloplasty, and more. The coverage of these surgeries is not retroactive, and they must be deemed medically necessary by a healthcare professional.
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Does New Brunswick Medicare cover HRT for hormone imbalances in men?
Medicare does not cover hormone replacement therapy (HRT) under Original Medicare (Part A and Part B) plans. However, Medicare Part D plans or Medicare Advantage (Part C) plans that include prescription drug coverage may cover HRT for men with low testosterone. Medicare Advantage plans must cover at least as well as Original Medicare, so they can include HRT. It is important to verify that the formulary includes the medications specific to your needs.
Medicare covers medically necessary hormone therapy, even for men. Every Medicare beneficiary has the right to access appropriate medications for their medical needs. Prescription drug coverage may help with the cost of HRT, but you may still be responsible for deductibles, coinsurances, or copayments.
Medicare Part D and Part C programs that include prescription coverage will cover bioidentical hormones such as testosterone, but they will not cover holistic or natural treatments.
If you are considering HRT, it is recommended to consult with your healthcare provider and insurance provider to determine the specific costs and coverage details for your situation.
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Does New Brunswick Medicare cover HRT for gender dysphoria?
New Brunswick Medicare covers medically necessary gender-confirming surgeries for transgender persons living in New Brunswick. This includes hysterectomy and bilateral salpingo-oophorectomy for patients 18 years of age and older. Orchiectomy is also covered for patients over 18. Mastectomy with chest masculinization is covered for patients over 18, but pectoral implants are not.
To attain coverage for gender-confirming surgery, a patient must first be assessed for clinical eligibility using criteria established by the World Professional Association for Transgender Health (WPATH). This involves a comprehensive psychiatric assessment and prolonged medical management. Once the patient has received a positive recommendation from their physician, they will need approval from New Brunswick Medicare.
While New Brunswick Medicare does not appear to specify whether HRT for gender dysphoria is covered, it does cover medications provided in the hospital. If someone requires prescription drug insurance, it is available through the New Brunswick Drug Plan.
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What surgeries does New Brunswick Medicare cover for gender dysphoria?
New Brunswick Medicare covers medically necessary gender-confirming surgeries for transgender persons living in New Brunswick. This includes genital surgery, which is not performed in New Brunswick but is publicly funded when provided by a Canadian facility approved by New Brunswick Medicare. Surgeries covered by New Brunswick Medicare include:
- Mastectomies with chest masculinization (no implants)
- Hysterectomy with salpingo-oophorectomy
- Orchiectomy
- Vaginoplasty
- Vaginectomy
- Penectomy
- Orchidectomy
- Construction of a vaginal cavity and the vulva
- Metoidioplasty
- Phalloplasty
- Erectile and testicular implants
The following procedures are not covered by New Brunswick Medicare:
- Pectoral implants
- Chest contouring done separately from mastectomies
- Liposuction
- Laser hair removal
- Breast augmentation
To be eligible for surgery, patients must undergo a pre-screening process with their family physician, a specialist, social worker, or psychologist. If deemed a suitable candidate, the patient will receive a positive recommendation from their physician and approval by New Brunswick Medicare. They will then work with a medical team to develop a surgical plan.
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What other treatments does New Brunswick Medicare cover for gender dysphoria?
New Brunswick Medicare covers medically necessary gender-confirming treatments for gender dysphoria. This includes gender-confirming surgery and certain prescription drugs.
Gender-confirming surgery is a medically recognised treatment for gender dysphoria. To be eligible for coverage, patients must be assessed for clinical eligibility using criteria established by the World Professional Association for Transgender Health (WPATH). This involves a comprehensive psychiatric assessment and prolonged medical management before surgery is considered an option. The patient's family physician, nurse practitioner, or mental health professional will assess their eligibility and, if they receive a positive recommendation, their request will be forwarded to the Executive Director of Addictions and Mental Health for approval. Once approved, a surgical plan will be put in place by attending professionals.
Genital surgery is not performed in New Brunswick, but it is publicly funded when provided by a Canadian facility approved by New Brunswick Medicare. Mastectomies with chest masculinisation (no implants) and hysterectomy with salpingo-oophorectomy must be performed in a public hospital in Canada, preferably in New Brunswick.
Medications provided in the hospital are covered by New Brunswick Medicare. If someone requires prescription drug insurance, it is available through the New Brunswick Drug Plan. This plan is designed to help eligible New Brunswickers with prescription drug costs.
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Frequently asked questions
New Brunswick Medicare does not explicitly mention covering HRT. However, it does cover medically necessary gender-confirming surgeries and medications provided in the hospital for transgender persons living in New Brunswick. HRT may be considered a medically necessary treatment for gender dysphoria. It is best to check with New Brunswick Medicare directly to confirm coverage for HRT.
A patient considering gender-confirming treatment should first approach their family physician, nurse practitioner, or mental health professional. The patient will be assessed for clinical eligibility using criteria established by the World Professional Association for Transgender Health (WPATH). This involves a comprehensive psychiatric assessment and prolonged medical management. Once the patient receives a positive recommendation from their physician and approval from New Brunswick Medicare, they will work with a medical team to develop a surgical plan.
New Brunswick Medicare covers specific gender-confirming surgeries for patients 18 years of age and older, including hysterectomy, bilateral salpingo-oophorectomy, and mastectomy with chest masculinization. Medications provided in the hospital are also covered. However, travel and accommodation expenses outside of the hospital are not covered.
The cost of bioidentical hormone replacement therapy typically ranges from $200 to $500 per month, including medication, a customized treatment plan, and follow-up appointments. Additional costs include the initial consultation, which can be around $75 to $200, and blood tests, which can cost approximately $80 to $500 without insurance.
