Health insurance nondiscrimination laws and policies in the United States aim to protect LGBTQ+ people. They ensure transgender people are safe from being denied health insurance coverage or from being excluded from coverage for specific procedures due to sexual orientation or gender identity.
This article explores the rights that transgender people have in the US for insurance coverage.
Transgender Rights in Insurance Coverage
Federal and state law does not allow most private and public health plans to discriminate against anyone due to their sexual orientation and gender. In other words, your health insurance plan cannot refuse to cover medically necessary transition-related care, or else it is illegal discrimination.
Examples of illegal discrimination in insurance include:
- Health plans can’t automatically or categorically exclude transition-related care. Essentially, a health plan that says care related to gender transition is excluded violates the law.
- Health plans can’t exclude specific transition-related procedures. For instance, a health plan should not categorically exclude coverage for facial feminization surgery.
- An insurance company can’t limit what they cover for transition-related care if their limits are discriminatory. In other words, an insurance company can’t exclude a certain type of procedure if it covers the same procedure for non-transgender people. For instance, if a plan covers breast reconstruction for cancer treatment or hormones for post-menopause symptoms, it cannot exclude these treatments if they are used to treat gender dysphoria.
- If you are transgender, a provider cannot refuse to enroll you in a plan, cancel your coverage, or charge you higher prices.
- You cannot be denied coverage for healthcare-associated with one gender. Essentially, it’s illegal for an insurance company to deny you coverage for procedures generally associated with one gender based on the sex you were assigned at birth listed in the company’s records. For example, suppose a transgender woman’s healthcare provider determines that she requires a prostate exam. In that case, an insurance company cannot deny coverage due to the sex assigned at birth that is listed in the previous records.
Health Insurance Policies
Mostly all major insurance companies acknowledge that transgender-related medical care is medically necessary. Many have written policies that explain their criteria for these plans.
The following list will provide more information about the policies of these major health insurance providers. Remember to review your policy to discover if transgender care is covered or excluded. The guidelines will only apply if you have coverage.
Check out the policies here: https://transhealthproject.org/resources/health-insurance-medical-policies/views/
Health Insurance Information
For those seeking out gender-affirming care, understanding insurance policies and coverage can be a daunting task. It’s important to note that there is no “best plan” for transgender care since every employer, school, or county has different plans and offerings. For example, some insurance plans are prohibited from excluding gender-affirming care in California, while others can exclude such care.
If you are looking for more information about your insurance, you can find more details on your specific plans’ website, your HR department from your company, or call the phone number on your insurance card. In addition, you can find resources and information from The US Department of Health and Human Services.
Does Health Insurance Ever Cover Gender-Affirming Surgery?
Sometimes health insurance coverage can provide gender-affirming surgery. However, it is not a requirement for a health insurance plan to cover a specific procedure.
For private insurers offering gender-affirming surgery, a patient must prove that the procedure is medically necessary, and for specific plans, the details may vary. For example, you may have to obtain one to two referral letters from a qualified mental health professional or provide a “persistent, well-documented” case of gender dysphoria and be approved that you’re able to make fully informed decisions.
This article explores Gender Affirmation Surgery.
According to a 2018 study in JAMA Surgery (published in the surgical journal of the American Medical Association), gender-affirming surgery accounted for only 11% of encounters with gender identity disorder codes between 2000 and 2014. However, the number of individuals receiving gender-affirming surgery is increasing. In addition, more than half of the people receiving gender-affirming surgery did not have health insurance coverage during that time. The number of patients who identified as self-payers decreased over that period. In other words, the number of people who did not have health insurance coverage for their gender-affirming procedure decreased.
How to Proceed if your Plan has Transgender Exclusions
The coverage of transition-related care varies between insurers and states. However, you have the right to receive a given service if others cover it on the same plan.
It’s important to keep in mind that you can appeal decisions when it comes to healthcare from your insurance company. You can appeal if you think you have been denied coverage and that it is discrimination or wrong. Also, check this list to learn what insurance plans cover and do not cover transgender-specific health services.
You can also work with your health plan to determine why they denied you. It’s essential to know that transgender health insurance exclusions may be unlawful sex or gender-based discrimination. The health care law forbids discrimination based on sex and gender in various health programs and activities. If you believe a plan is unlawfully discriminating, you can file a civil rights complaint with the US Department of Health and Human Services, Office for Civil Rights.
There are many insurance nondiscrimination laws and policies in the United States in place that help ensure LGBTQ+ people are receiving the healthcare they require.
If you are looking for additional resources and information, check out the following:
Department of Health and Human Services Office for Civil Rights:
Links to State and Local Human Rights Agencies:
Transgender Affirming Hospital Policies:
Healthcare Equality Index, Human Rights Campaign
National Center for LGBT Health Education:
National Resource Center on LGBT Aging:
RAD Remedy’s standards of care for trans people
Transgender Law Center’s guide to organizing community clinics
- WPATH Standards of Care
- Endocrine Society Clinical Guideline
- Center for Excellence for Transgender Health
Mental Health Resources
US: 877-565-8860Canada: 877-330-6366
National Association of Free and Charitable Clinics (NAFC)
Mental Health Resources, For You, For ALL. Post Your Business