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Majority of ACA Silver Plans, Medicaid Do Not Cover Gender-Affirming Neurotoxin, Filler


A poster presented at AAD 2022 dives into one of the largest barriers in obtaining gender-affirming neurotoxin and filler treatment for patients—the cost.

An iPoster at the American Academy of Dermatology (AAD) Association Annual Meeting, held March 25 to 29, in Boston, Massachusetts, aimed to highlight the importance of gender-affirming facial procedures for transgender and nonbinary individuals. However, the largest barrier to access of this care remains the cost of treatment and insurance difficulty.

The poster, “Health Insurance Coverage of Injectable Fillers and Neurotoxins for Gender Affirmation,” assessed the extent of coverage through health insurance of gender-affirming neurotoxin and filler procedures.

The study authors created a cross-sectional study of all Medicaid and Affordable Care Act (ACA) silver plans performed in 2021. Through this, clinical policies, plan-specific certificates of coverage, and Medicaid documents were evaluated for coverage of filler and neurotoxin treatment for gender affirmation.

In total, 915 plans were reviewed, including 51 Medicaid policies and 864 silver private plans. Of that number, only 1 Medicaid plan and 71 silver plans explicitly mentioned the potential of injectable filler coverage. However, of the 71 silver plans, 69 had plan-specific general cosmetic exclusions enclosed, possibly nullifying the coverage. No plans included in the study explicitly covered neurotoxins specifically for gender affirmation.

A total of 81 plans broadly excluded the coverage of gender-affirming care, filler was excluded in 410 plans and not mentioned at all in 353. Neurotoxins were excluded in 132 plans and not mentioned in 701.

With these data, the authored explained, the majority of Medicaid and ACA silver plans do not cover gender-affirming neurotoxin and filler procedure. Additionally, Medicaid plans proportionally offered less coverage compared to the silver plans. However, the general cosmetic exclusions in silver plans likely further limit coverage.

The ambiguity of these insurance plans may restrict medically necessary gender-affirming care for patients unable to afford comprehensive insurance plans or the out-of-pocket expenses that some along with these treatments, the authors concluded. These exclusions could potentially increase the mental health impact of gender dysphoria.


1. Roszell K, Wang F. Health insurance coverage of injectable fillers and neurotoxins for gender affirmation. Presented at: American Academy Dermatology Association 2022 Annual Meeting; March 25-29, 2022; Boston, MA.

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