1 in 8 LGBTQ Americans Report Discrimination by Health Insurance Provider

The results of a recent survey into the perceptions of health insurance within the LGBTQ community revealed some new insights. According to the survey, one in eight LGBTQ Americans report that they have been discriminated against by their health insurance providers. Gay and lesbian individuals were much less likely to report discrimination, compared bisexual, queer, transgender, pansexual, asexual, and questioning individuals. By generation, more Millennial and Gen Z individuals reported discrimination compared to older generations.

Although roughly 12% of individuals reported discrimination, 32% believe that health insurance coverage is improving for LGBTQ Americans. Forty-four percent of respondents, the largest portion of respondents, think that healthcare is neither improving nor worsening, while 13% think it is getting considerably worse. The positive view of improving health coverage extended across all groups who responded, particularly transgender individuals.

The largest portion of individuals reported that they were on Medicare (33%), followed closely by employer insurance (23%), Medicaid (18%), then private insurance (10%). Only 7% of respondents reported that they were uninsured. Gay, lesbian, and bisexual individuals were were the largest group on Medicare; while pansexual, queer, asexual, or questioning individuals were more likely to receive employer insurance. Among transgender individuals, 27% report being on Medicare, while another 27% have COBRA insurance, a continuation of employer-based insurance that one can keep after losing or leaving one’s job.

Largely, LGBTQ Americans are unsure about what kind of treatments are covered by their health insurance. Sixty percent of those who responded to the survey said they were unsure whether their insurance covered gender-affirming medications or procedures, PrEP (Pre-Exposure Prophylaxis), or fertility treatments. Twenty percent responded that their insurance does not cover any of these treatments, while only a small percentage reported coverage of gender-affirming or fertility treatments.

One concerning takeaway from the survey was from respondents who choose not to take PrEP. One-quarter of respondents say they do not take PrEP due to concerns about side-effects, while 20% said it was not covered by their health insurance provider; 16% did not know where to get it, and 14% said taking a pill every day is too difficult. Twenty-two percent of respondents said that they were not sexually active.

“The fact that so many people are still unsure about access and concerned about side effects, despite all the efforts that have been made for PrEP-promotion, is alarming,” says Rutgers Associate Professor Corina Lelutiu-Weinberger, PhD, an expert on LGBTQ health equity. “Some of the most prominent ones are stigma around PrEP use and discrimination within healthcare, which leads to missed prevention opportunities or increased patient distrust.” Dr. Lelutiu-Weinberger believes it is in the best interest of insurers to provide PrEP coverage for their clients, as it is more cost-effective to prevent HIV than it is to treat.

The survey also found that, like many Americans, LGBTQ individuals are concerned about or dealing with medical costs and debt. Thirty-nine percent of all respondents reported having some form of medical debt, with more than half of Millennial LGBTQ respondents reported medical debt. More than half of all respondents also said that they are concerned that a major medical event could lead to bankruptcy or debt.

The data collected from this survey highlights the importance of more research into healthcare for LGBTQ Americans. Comparison between groups made it hard to draw conclusions about which sexual or gender minorities are more likely to be insured. This survey is one of the first attempts to understand the health and health finances of the LGBTQ community. As a better understanding of LGBTQ healthcare emerges, more informed policies and actions can be taken to provide equitable health coverage.