Federal and state law prohibits most public and private health plans from discriminating against you because you are transgender. This means, with few exceptions, that it is illegal discrimination for your health insurance plan to refuse to cover medically necessary transition-related care.
Here are some examples of illegal discrimination in insurance:
- Health plans can’t have automatic or categorical exclusions of transition-related care. For example, a health plan that says that all care related to gender transition is excluded violates the law.
- Health plans can’t have a categorical exclusion of a soluciones transition-related procedure. Excluding from coverage specific medically necessary procedures that some transgender people need is discrimination. For example, a health plan should not categorically exclude all coverage for facial feminization surgery or impose arbitrary age limits that contradict medical standards of care.
- An insurance company can’t place limits on coverage for transition-related care if those limits are discriminatory. For example, an insurance company can’t automatically exclude a specific type of procedure if it covers that procedure for non-transgender people. For example, if a plan covers breast reconstruction for cancer treatment, or hormones to treat post-menopause symptoms, it cannot exclude these procedures to treat gender dysphoria.
- Refusing to enroll you in a plan, cancelling your coverage, or charging higher rates because of your transgender status: An insurance company can’t treat you differently, refuse to enroll you, or limit coverage for any services because you are transgender.
- Negar cobertura de atención típicamente asociada con un género: It’s illegal for an insurance company to deny you coverage for treatments typically associated with one gender based on the gender listed in the insurance company’s records or the sex you were assigned at birth. For example, if a transgender woman’s health care provider decides she needs a prostate exam, an insurance company can’t deny it because she is listed as female in her records. If her provider recommends gynecological care, coverage can’t be denied simply because she was identified as male at birth.
What should I do to get coverage for transition-related care?
Check out NCTE’s Health Coverage Guide for more information on getting the care that you need covered by your health plan.
If you do not yet have health insurance, you can visit our friends at Out2Enroll para comprender sus opciones.
Does private health insurance cover transition-related care?
It is illegal for most private insurance plans to deny coverage for medically necessary transition-related care. Your private insurance plan debemos provide coverage for the care that you need. However, many transgender people continue to face discriminatory denials.
To understand how to get access to the care that you need under your private insurance plan, check out NCTE’s Health Coverage Guide.
Does Medicaid cover transition-related care?
It is illegal for Medicaid plans to deny coverage for medically necessary transition-related care. Your state Medicaid plan debemos provide coverage for the care that you need. However, many transgender people continue to face discriminatory denials. Some states have specific guidelines on the steps you have to take to access care. You can check if your state has specific guidelines aquí.
To understand how to get access to the care that you need under your Medicaid plan, check out NCTE’s Navigating Insurance page.
My plan has an exclusion for transition-related care. What should I do?
There are many reasons why your plan might still have an exclusion for transition-related care in general or for a specific procedure. This does not mean that your plan will not cover your care. Sometimes plan documents are out of date, or you can ask for an exception by showing that this care is medically necessary for you.
If you get insurance through work or school, you can advocate with your employer to have the exclusion removed.
NCTE’s Health Coverage Guide has more information on how to access care and remove exclusions.
Does Medicare cover transition-related care?
It is illegal for Medicare to deny coverage for medically necessary transition-related care.
For many years, Medicare did not cover transition-related surgery due to a decades-old policy that categorized such treatment as "experimental." That exclusion was eliminated in May 2014, and there is now no national exclusion for transition-related health care under Medicare. Some local Medicare contractors have specific policies spelling out their coverage for transition-related care, as do some private Medicare Advantage plans.
To learn more about your rights on Medicare, check out NCTE’s Medicare page.
Does the Veterans Health Administration (VHA) provide transition-related care?
The Veterans Health Administration (VHA) provides coverage for algo transition-related care for eligible veterans. However, VHA still has an arbitrary and medically baseless exclusion for coverage of transition-related surgery. On June 19th, The US Department of Veterans Affairs announced that they will begin the process to expand health care services available to transgender veterans to include gender confirmation surgery. Currently, the Veterans Health Administration (VHA) provides care for thousands of transgender veterans, including some transition-related medical care. We expect the rule will finalize in approximately two years.
For more information FAQs by VHA are found aquí.
For more information about VHA and transition-related care, check out NCTE’s VAH Veterans Health Care .
Does TRICARE cover transition-related care?
TRICARE provides coverage for algo transition-related care for family members and dependents of military personnel. However, TRICARE still has an exclusion for coverage of transition-related surgery.
What are my rights in receiving health care?
¿Qué proveedores de salud tienen prohibido discriminarme?
Under the Affordable Care Act, it is illegal for most health providers and organizations to discriminate against you because you are transgender. The following are examples of places and programs that may be covered by the law:
- Consultorios médicos
- Clinicas de salud comunitaria
- Programas de rehabilitación de drogas
- Centros de crisis por violación
- Hogares de ancianos e instalaciones de vida asistida
- Clínicas de salud en colegios y universidades.
- Programas de residencia medica
- Proveedores de salud a domicilio
- Centros de salud para veteranos.
- Servicios de salud en cárceles o centros de detención.
¿Qué tipos de discriminación por parte de los proveedores de atención médica están prohibidos por la ley?
Examples of discriminatory treatment prohibited by federal law include (but are not limited to):
- Refusing to admit or treat you because you are transgender
- Forcing you to have intrusive and unnecessary examinations because you are transgender
- Refusing to provide you services that they provide to other patients because you are transgender
- Se niegan a tratarlo de acuerdo con su identidad de género, incluso al brindarle acceso a baños que concuerden con su género
- Refusing to respect your gender identity in making room assignments
- Harassing you or refusing to respond to harassment by staff or other patients
- Refusing to provide counseling, medical advocacy or referrals, or other support services because you are transgender
- Isolating you or depriving you of human contact in a residential treatment facility, or limiting your participation in social or recreational activities offered to others
- Requiring you to participate in “conversion therapy” for the purpose of changing your gender identity
- Attempting to harass, coerce, intimidate, or interfere with your ability to exercise your health care rights
¿Cuáles son mis derechos relacionados con la privacidad de mi información de salud?
La Ley de Portabilidad y Responsabilidad del Seguro Médico (HIPAA) exige que la mayoría de los proveedores de atención médica y los planes de seguro médico protejan su privacidad cuando se trata de cierta información sobre su salud o historial médico. La información sobre su estado transgénero, incluido su diagnóstico, historial médico, sexo asignado al nacer o anatomía, puede ser información de salud protegida. Dicha información no debe divulgarse a nadie, incluidos familiares, amigos y otros pacientes, sin su consentimiento. Esta información tampoco debe ser divulgada al personal médico a menos que haya una razón médica relevante para hacerlo. Si esta información se comparte con fines de chisme o acoso, es una violación de HIPAA.