Aging bodies, future technologies: Health insurance coverage and stratified biomedicalization

Tara Gonsalves

Social Science & Medicine, 2025, vol. 383, issue C

Abstract: How do insurers adjudicate coverage for politically controversial treatments? How do these decisions shape access to care for older women? I address these questions by studying two types of care that have seen wide variation in health insurance coverage over the past two decades: gender-affirming surgery and fertility treatments. Drawing from an analysis of archival materials and insurance coverage decisions, I theorize the temporal aspect of biomedical stratification by analyzing how insurers adjudicate coverage for transgender women seeking facial feminization surgery and non-transgender women seeking invitro fertilization (IVF) and Intrauterine Insemination (IUI) services. I argue that the delayed process through which health insurers expand coverage for politically controversial treatments stratifies access to care. Advances in technological development have enabled the expansion of both types of treatments and insurance coverage has brought treatment to a wider array of people. At the same time, because insurers take longer to greenlight politically controversial treatments, older women who may have sought and benefited from these technologies in earlier years are now deemed too old for care.

Date: 2025
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DOI: 10.1016/j.socscimed.2025.118348

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