HRC Blog

Questions about Insurance Coverage for Transition Related Surgeries Remain

HealthSince President Obama signed the Affordable Care Act (ACA) in 2010, transgender individuals have been forced to navigate the complex world of state and federal insurance programs in order to fully access the benefits and coverage they need.

The Department of Health and Human Services issued guidance last year ensuring that gender identity discrimination is prohibited under Obamacare. But what exactly that means is still coming into focus, as illustrated in a recent story by Kaiser Health News featuring Devin Payne, HRC governor-elect. 

Payne was recently featured in a Kaiser Health News article about her experience using Covered California, the state’s new insurance marketplace, for reassignment surgery.  California insurance regulators now require that companies must treat transgender patients the same as other patients.  This means that if plans cover hormones for other women, other transgender patients must also receive coverage for hormones related to their gender transition.  Despite having coverage through the California exchange, Payne anticipates that she will not receive a complete reimbursement for her gender transition surgery earlier this summer. 

Jenny Taylor, a longtime HRC volunteer and friend of Payne’s, is facing even steeper obstacles to coverage for her transition related care. 

Taylor purchased her policy in Tennessee and discovered her doctor wasn’t in the plan’s network. With no hope of reimbursement, she had to pay for everything in cash.

“My insurance, even though I finally got it, was useless,” she told Kaiser Health News.

Disparities in access to quality, culturally competent healthcare continue to burden the transgender community. 

In fact, in 2011 as many as one in five transgender patients report being refused care because of their gender identity.  ACA's protections for transgender people based on gender identity status or any pre-existing conditions will go a long way to close this gap.

The following insurance carriers have available plans without blanket exclusions for transgender-related healthcare. Click here for a list of direct links to the carriers’ websites where major guidelines for transgender-related treatments are openly available. 

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