FAQ: Gender-affirming care

The chart below is intended to provide general information on services that are covered by MIT-sponsored health insurance plans. Note that certain covered services require an initial out-of-pocket payment that is later reimbursed. For complete details, see Gender Affirming Services [PDF] from Blue Cross Blue Shield of Massachusetts (BCBSMA). For more information, students on MIT SHIP can contact BCBSMA Member Services at 1-800-262-2583. Employees may contact MIT Benefits at benefits@mit.edu or call 617-253-6151.

MIT Health will not release information about your medical care or laboratory testing to anyone without your written consent, including parents or other family members. However, your insurance company will send you an explanation of benefits, which may include some of that information. It will be addressed to you, but it will be sent to the mailing address associated with your insurance plan, which might be your parents’ home address or the address of another family member. 

If you want these documents sent to a different address, you need to make sure that the insurance company has your preferred mailing address on file. For more information about the specific documents your insurance company sends out and where they will be sent, call the insurance company’s billing department.

In addition to routine primary care, MIT Health offers the following specialized services:

• Medical treatment and associated monitoring for gender affirmation
• Mental health counseling for undergraduate and graduate students with concerns around gender identity and/or gender dysphoria
• Mental health counseling through MIT’s MyLife Services for faculty, staff, postdocs, and family members with concerns around gender identity and/or gender dysphoria
• Mental Health and Primary Care consultation for supportive documentation and referral for surgical treatment as required by insurance plans and accepted standards of care
• Supporting documentation for name and gender-marker changes as designated by state and federal standards.

All MIT-sponsored health plans include coverage for gender-affirming surgery. For complete details, see Gender Affirming Services [PDF] from Blue Cross Blue Shield of Massachusetts (BCBSMA). For more information, students on MIT SHIP can contact BCBSMA Member Services at 1-800-262-2583. Employees may contact MIT Benefits at benefits@mit.edu or call 617-253-6151.

Start by discussing your plans with your primary care provider (PCP), reviewing the Blue Cross Blue Shield of Massachusetts (BCBSMA) guidelines for surgery, and selecting a surgeon. If you haven’t already found a surgeon, your PCP can provide recommendations.

Once you have found a surgeon, confirm that they will accept BCBSMA insurance. If a surgeon does not accept BCBSMA insurance, you may have to pay for care out of pocket.

Once you’ve confirmed that the surgeon accepts BCBSMA insurance, ask your PCP to submit a referral to that surgeon. Once the referral is approved, you may schedule an appointment for a surgical consultation. Depending on the type of surgery, the surgeon may need letters from your PCP and/or a mental health provider attesting that the surgery is “medically necessary.” (Surgical letter requirements are detailed in the BCBSMA guidelines.) Once the surgeon has agreed to proceed with surgery, the surgeon must submit a request for coverage directly to BCBSMA. 

There are surgeons who perform gender-affirming surgery at several hospitals in Massachusetts: 

• Massachusetts General Hospital Transgender Health Program
• Boston Children’s Hospital Gender Multispecialty Service (GeMS)
• Boston Medical Center Transgender Medicine and Surgery
• Beth Israel Deaconess Medical Center Gender-Affirming Services

Your PCP can provide recommendations.

Based on the type of surgery, your surgeon may require letters of medical necessity from your PCP and/or a licensed mental health clinician before they can submit the request for coverage to Blue Cross Blue Shield of Massachusetts (BCBSMA). Surgical letter requirements are detailed in the BCBSMA guidelines. 

• A PCP letter can be written by your MIT Health PCP or a primary care clinician you have seen outside of MIT Health.
• A mental health letter could come from a mental health provider outside of MIT, even one you have seen in the past. Just give the provider a copy of the BCBSMA guidelines and ask them to write the letter. If you are a student and haven’t already seen a mental health provider who can provide this letter, you can see a provider in MIT Health’s Student Mental Health & Counseling Services.

Insurance provides limited coverage for sperm banking and egg freezing. Associated costs such as STD screening and semen analysis will be covered by your insurance and can be done at MIT Health.

There are several sperm banks in the area. The one closest to campus and most frequently used by MIT is New England Cryogenic Center. Egg freezing must be done by a reproductive endocrinologist (fertility specialist). IVF New England is the fertility group in this area with the most experience caring for transgender persons. 

Students should contact the MIT Student Insurance Office at stuplan@med.mit.edu and employees should contact MIT Benefits at benefits@mit.edu or 617-253-6151. They will either answer your questions or direct you to someone who can provide answers. Do not contact the MIT Health Billing Office with questions about insurance coverage.

Sometimes you might need to call Blue Cross Blue Shield of Massachusetts (BCBSMA) to get an answer. If you call BCBSMA, make sure to tell them you are from MIT, so they can refer to MIT’s coverage guidelines. Always ask for the name of the person you speak to and get a reference number for your conversation. Write this information down in case you need to refer to it in the future.

For questions about medical care, contact MIT Health’s Primary Care service at 617-258-9355.