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See these resources for more information about your rights during COVID-19:

Know Your Rights in Health Care

Federal and state laws - and, in many cases, the U.S. Constitution - prohibit discrimination in health care and insurance because you're transgender. That means that health plans aren’t allowed to exclude transition-related care, and health care providers are required to treat you with respect and according to your gender identity.

Actualizado octubre 2021 

What are my rights in insurance coverage?

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.

If you are an active military member and want to understand your coverage while serving, check out the resources from our friends at ESPARTA y la página OutServe.
 

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
  • Hospitales
  • 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.

¿Qué puedo hacer si me enfrento a la discriminación?

Seek preauthorization for care and appeal insurance denials

You shouldn’t be denied the care that you need just because you’re transgender. That's illegal.

To access transition-related care, we recommend applying for preauthorization before any procedures to understand whether your plan will cover it. You should also consider appealing insurance denials that you believe are discriminatory. We recommend you consult an attorney before filing any appeals.

See these resources for more information about your rights during COVID-19:

Check our NCTE’s Health Coverage Guide for more information on how to get the care that you need covered.

 

Póngase en contacto con un abogado u organización legal

If you face discrimination from a health care provider or insurance company, it may be against the law. You can talk to a lawyer or a legal organization to see what your options are. A lawyer might also be able to help you resolve your problem without a lawsuit, for example by contacting your health care provider to make sure they understand their legal obligations or filing a complaint with a professional board.

While NCTE does not take clients or provide legal services or referrals, there are many other groups that may give you referrals or maintain lists of local attorneys. You can try your local legal aid or legal services organization, or national or regional organizations such as the National Center for Lesbian Rights, Lambda Legal, the Transgender Law Center, the ACLU, and others listed en nuestra  Additional Resources page y en el Trans Legal Services Network.

 

File discrimination complaints with state and federal agencies

Now transgender people are encouraged to report any discrimination they experience while seeking health care services. The U.S. Department of Health and Human Services has encouraged consumers who believed that a covered entity violated their civil rights may file a complaint. If you face any of ther kind of discrimination or denial of care based on your gender, disability, age, race, or national origin, or if your health care privacy was violated, you can still file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.

Here are some other places you can file health care complaints:

Other state and local agencies: If you face discrimination, you may be able to file a complaint with your state’s human rights agency. You can find a list of state human rights agencies here: http://www.justice.gov/crt/legalinfo/stateandlocal.php.

¿Qué leyes me protegen?

Federal protections

  • The Health Care Rights Law, as part of the Affordable Care Act (ACA) prohibits sex discrimination, including anti-transgender discrimination, by most health providers and insurance companies, as well as discrimination based on race, national origin, age, and disability. Under the ACA, it is illegal for most insurance companies to have exclusions of transition-related care, and it is illegal for most health providers to discriminate against transgender people, like by turning someone away or refusing to treat them according to their gender identity. On May 5th, 2021, the Biden Administration and HHS announced that the Office for Civil Rights will interpret and enforce Section 1557 and Title IX’s prohibitions on discrimination based on sex to include: 
  1. Discrimination on the basis of sexual orientation.
  2. Discrimination on the basis of gender identity.

Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in covered health programs or activities.  The update was made in light of the U.S. Supreme Court’s decision in Bostock v. Clayton County and subsequent court decisions. Now transgender people are encouraged to report any discrimination they experience while seeking health care services. The HHS has encouraged consumers who believed that a covered entity violated their civil rights may file a complaint at: https://www.hhs.gov/ocr/complaints

  • La Ley de Portabilidad y Responsabilidad de Seguros de Salud (HIPAA) protege la privacidad de los pacientes cuando se trata de cierta información de salud, incluida la información relacionada con el estado y la transición de personas transgénero. También les da a los pacientes el derecho de acceder, inspeccionar y copiar su información de salud protegida en hospitales, clínicas y planes de salud.
  • Ley de Americanos con Discapacidades prohibits discrimination in health care and other settings based on a disability, which may include a diagnosis of gender dyshoria.
  • Medicare and Medicaid regulations proteger el derecho de los pacientes del hospital a elegir sus propios visitantes y tomadores de decisiones médicas independientemente de su relación legal con el paciente. Esto significa que los hospitales no pueden discriminar a las personas LGBT ni a sus familias en las visitas y en el reconocimiento del responsable de la toma de decisiones designado por el paciente.
  • The Joint Commission hospital accreditation standards exigir que los hospitales tengan políticas internas que prohíban la discriminación por identidad de género y orientación sexual.
  • Ley de reforma de la residencia de ancianos establece un conjunto de derechos de los residentes de hogares de ancianos que incluyen el derecho a la privacidad, incluso en visitas de amigos o seres queridos; el derecho a estar libre de abuso, maltrato y negligencia; el derecho a elegir su médico; el derecho a la dignidad y autodeterminación; y el derecho a presentar quejas sin represalias.

Leyes estatales y locales de no discriminación. prohibit health care discrimination against transgender people in many circumstances.

A large number of states also have explicit policies that prohibit anti-transgender discrimination in private insurance and Medicaid, like exclusions of transition-related care.

Remember: Just because your state isn’t listed here doesn’t mean you’re not protected. Check out NCTE’s Health Coverage Guide for more information about getting coverage for the care that you need. 

¿Cómo te puedo ayudar?

  • Diríjase a NCTE’s Health Action Center to see the latest on health care and how you can help fight for transgender people’s right to get the health care they need
  • Comparte tu historia. If you are facing discriminatory treatment, consider Compartiendo tu historia with NCTE so we can use it in advocacy efforts to advance public understanding and policy change for transgender people. If you successfully resolved a health care situation, we want to hear about that as well.

Recursos adicionales

Agencias gubernamentales

Departamento de Salud y Servicios Humanos Oficina de Derechos Civiles:
http://www.hhs.gov/ocr/office/index.html

Enlaces a agencias estatales y locales de derechos humanos:
http://www.justice.gov/crt/legalinfo/stateandlocal.php

HealthCare.Gov:
https://www.healthcare.gov/transgender-health-care/

 

Partner resources, best practices and standards of care

Creating Equal Access to Quality Health Care for Transgender Patients: Transgender-Affirming Hospital Policies, Lambda Legal, HRC, & New York Bar:
http://www.lambdalegal.org/publications/fs_transgender-affirming-hospital-policies

Índice de Igualdad en Salud, Campaña de Derechos Humanos.
http://www.hrc.org/campaigns/healthcare-equality-index

Centro Nacional de Educación para la Salud LGBT:
http://www.lgbthealtheducation.org/

Centro Nacional de Recursos sobre Envejecimiento LGBT:
http://www.lgbtagingcenter.org

RAD Remedy Guía para brindar atención competente a las personas trans.

Centro de Derecho Transgénero Guía para organizar clínicas comunitarias.

Estándares clínicos de atención a personas transgénero.

 

Recursos de Salud Mental

Trans LifeLine

National suicide prevention hotline

US: 877-565-8860Canada: 877-330-6366

https://www.translifeline.org/

Alianza Nacional de Enfermedades Mentales (NAMI)

Red nacional de proveedores de atención de salud mental, así como una base de datos de proveedores

http://www.nami.org/Find­-Support/LGBTQ
Help Line   800­-950-­6264

Consejo Nacional de Salud del Comportamiento

Red nacional de centros comunitarios de salud conductual, así como una base de datos de proveedores

http://www.thenationalcouncil.org/

SAMHSA (Administración de Servicios de Salud Mental y Abuso de Sustancias)

A national database for local professionals and agencies that provide addiction recovery services and mental health care.

https://findtreatment.samhsa.gov/

800-662-HELP (4357)

 

Health provider resources

Asociación Nacional de Clínicas Gratuitas y Caritativas (NAFC)
Clínicas en los Estados Unidos que ofrecen atención médica básica para personas sin seguro o sin hogar.
http://www.nafcclinics.org/

Remedio RAD
Lista de proveedores de atención médica transafirmantes de origen comunitario
https://www.radremedy.org/

 

Insurance resources

Out2Enroll

Resources to help transgender people select and enroll in insurance 

https://out2enroll.org

TransHealth
Salud y orientación para los proveedores de atención médica, así como una lista de clínicas de salud transafirmantes en Canadá, Estados Unidos e Inglaterra.
http://www.trans-­health.com/

Trascender legal
Transcend Legal ayuda a las personas a obtener atención médica relacionada con personas transgénero cubiertas por el seguro.
https://transcendlegal.org/

Salud transfronteriza
Helps transgender people navigate health care and insurance to receive respectful, high-quality care, and get transition-related care covered  

https://www.transchancehealth.org/

Salud justa
Lidera el trabajo para lograr la equidad en la salud para diversas comunidades de género, sexuales y culturales en Minnesota, incluida la Proyecto Trans Envejecimiento y un Guía de seguros de salud trans
https://www.justushealth.mn

 

Transition-related financial support

Fundación Jim Collins
Apoyo financiero para gastos relacionados con la transición para personas sin seguro o que han sido excluidas por el seguro
http://jimcollinsfoundation.org/apply/

Fondo de Cirugía Anual Transgénero de Point of Pride
Brinda asistencia financiera directa a las personas trans que no pueden pagar su cirugía de afirmación de género
https://pointofpride.org/annual-transgender-surgery-fund/

Beca de cirugía de parentesco en la vida de la comunidad
Brinda asistencia a la comunidad trans al tener un sentido de comunidad y parentesco
http://cklife.org/scholarship/

Fondo transformador de la libertad (Colorado)
Admite la identidad auténtica de los coloradenses transgénero mediante la eliminación de barreras financieras para la atención médica relacionada con la transición
https://transformativefreedomfund.org/

Kentucky Health Justice Network Trans defensora de la salud
Trabaja para ayudar a los residentes de Kent Kent a acceder a la atención médica que necesitan, así como a reafirmar nuestra autonomía y comunidad.
http://www.kentuckyhealthjusticenetwork.org/trans-health.html

 

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