Health Insurance and Transition-Related Care

We at SBC wanted to touch on a pressing issue pertinent to the LGBTQIA+ community. Although the value of equal protection in the eyes of the law has been underlined by several legal precedents over the years, it is still challenged far too often. Insurance, in particular, is one aspect in which regulation has lagged behind the progressivism of the new age. It is crucial to bring attention to the discriminatory practices of insurance companies, 365 days of the year.

After someone has transitioned, there is a lot of transition-related care that may be medically necessary. Still, not all insurance companies take this into consideration and do not always cover these costly necessities. This type of transition-related care cannot be explicitly excluded, according to 24 states and the District of Columbia. This consensus is based on a broad-but-controversial interpretation of the Americans with Disabilities Act and Title VII of the Civil Rights Act. Still, this means over half of states allow transgender exclusions in health care coverage for health insurance plans.

Insurance companies may attempt to word these exclusions in many different ways, but in almost all cases, these exclusions are considered discrimination in the eyes of the law. Some examples of discriminatory wording include categorical exclusions and limits for transition-related care or a transition-related procedure. Also, they cannot change one’s rates or cancel their coverage due to one’s transgender status. The final and arguably most frequent discriminatory practice engaged in by insurance companies is denying coverage for care that is typically associated with a specific gender. For example, a transgender woman could be recommended for anything from gynecological care to a prostate exam, and neither one should be denied by her insurance company on the basis of gender. Ultimately, she is entitled to whatever care her provider deems medically appropriate.

Luckily, healthcare plans on the Health Insurance Marketplace from www.healthcare.gov are required to cover all sex-specific preventive services deemed medically appropriate. This means that for those who struggle to find coverage that matches their needs, the Health Insurance Marketplace may be one of the many options to consider!

Resources:

“Health Care.” Know Your Rights, National Center for Transgender Equality,

Landman, Keren. “Fresh Challenges To State Exclusions On Transgender

Health Coverage.” NPR, 12 Mar. 2019,