Although some treatments, including particular surgical procedures, can add up to costs in the tens of thousands of dollars, these treatments generally represent a very small additional cost for insurance plans that cover large employers.

Making an insurance plane inclusive is generally inexpensive because:

• Only a small percentage of people undergo transgender-specific medical treatment
• Significant costs for surgical procedures are one-time costs that, again, apply to a small percentage of people
• The total costs of transgender-specific care for one person are often estimated between $25,000-$75,000; these costs are minimal compared to other expensive procedures such as defibrillator implants ($68,000 – 102,000) or colon cancer drugs ($250,000 per patient)
• Transgender people often present other medical issues as a result of being unable to transition; people who transition lead happy, healthier lives

When the City and County of San Francisco made its employee insurance plans transgender-inclusive in 2001, it set up an additional per-employee per-month surcharge to offset the expected additional expenditures. By 2006, it had only spent $386,417 of the $5.6 million it had collected from this surcharge. It ended the surcharge completely:

"Despite actuarial fears of over-utilization and a potentially expensive benefit, the Transgender Health Benefit Program has proven to be appropriately accessed and undeniably more affordable than other, often routinely covered, procedures."
— 2006 letter from San Francisco's Human Rights Commission

More information:

• Case Study: City and County of San Francisco Transgender-Inclusive Insurance Benefit
• Gender transitions: Medical Treatment Cost and Utilization
• Benefits for Transgender Employees and Dependents