Here in Australia hrt is mostly handled by Medicare with an out of pocket fee for most endocrinologist appointments and medication.

Neither Medicare or private healthcare will pay for surgery so we have to pay out of pocket. There's also only one surgeon in the country that does grs and none that do ffs (although some do partial ffs, such as rhinoplasty etc). Lots of Australians can't afford surgery (I probably won't be able to afford grs anytime in the near future or ffs ever), and those that can afford it often go overseas where it's cheaper or can get the best surgeons in the world for a similar price and with similar length waiting lists.