Health Insurance Discrimination for Transgender People

This page is part of a set of resources for employers to implement transgender-inclusive health insurance coverage.  See "Transgender-Inclusive Benefits for Employees and Dependents" for the complete set of resources.

Due to the way that most health insurance contracts are written, transgender people can be denied health insurance coverage, often irrespective of whether those needs are related to transitioning. Not all transgender people have the same medical needs — they may have already transitioned, or they may not transition at all. Transgender people may even be denied medical treatment as fundamental as mental health counseling, which can lead to stress, depression, suicide attempts, poor work performance and over-utilization of unrelated services and benefits that do not address the root causes of a person's health status.

Discrimination in health insurance generally takes one of the following forms:

  • Denial of health insurance coverage, where someone is denied any health insurance on the basis of gender identity. The Transgender Law Center has documented cases in which health insurance companies and medical providers have denied coverage to transgender people when they became aware of an applicant's transgender status or prior treatment and medical history related to gender transition. In 2007, the American Medical Association declared its opposition to this practice.[Source 1]
  • Denial of coverage for claims related to gender transition, including claims arising from complications from medical treatment for gender transition.
  • Denial of coverage for claims for gender-specific care based on the person's gender marker on insurance. For example, a male-to-female person who develops prostate cancer, or a female-to-male person who develops ovarian cancer.
  • Denial of coverage for claims unrelated to gender transition. For example, an insurer argues that a medical concern is the direct or indirect result of transgender-related treatment such as hormone therapy.

According to a 1999 study by the San Francisco Department of Public Health, more than 50 percent of transgender people did not have any form of health insurance.[Source 2] According to a 2003 survey conducted by the National Center for Lesbian Rights and the Transgender Law Center, more than 30 percent of transgender San Franciscans indicated that they had been discriminated against while trying to access healthcare.[Source 3]

Growing Support for Health Insurance Coverage

The American Medical Association recently joined the movement to end discrimination in health insurance for transgender people by passing the following resolution at their annual meeting in June 2008:

"RESOLVED, That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by a physician."[Source 4]
Transgender Insurance Exclusion

The vast majority of commercial health insurance plans in the United States exclude all or most coverage for treatment related to gender transition. This "transgender exclusion" denies coverage for claims for treatments such as psychological counseling for initial diagnosis and ongoing transition assistance, hormone replacement therapy, doctor's office visits to monitor hormone replacement therapy and surgeries related to sex reassignment.[Source 5] Sometimes the exclusion's language is sufficiently broad to even deny coverage to a transgender person for treatments unrelated to transitioning.

Exclusions are generally found in a benefits plan summary document, which is available to all employees and applicants. Some examples of exclusionary language that should be removed include:

  • "Coverage is not provided for the following charges: ...Those for or related to sex change surgery or to any treatment of gender identity disorders."[Source 6]
  • "For all Medical Benefits shown in the Schedule of Benefits, a charge for the following is not covered: ... Care, services or treatment for transsexualism, gender dysphoria or sexual reassignment or change, including medications, implants, hormone therapy, surgery, medical or psychiatric treatment."[Source 7]
  • "Exceptions and Exclusions. No benefits are provided under this Plan for the following: ... Services and supplies for the treatment of and/or related to gender dysphoria or reverse sterilization."[Source 8]

[Source 1] "H-180.980 Sexual Orientation and/or Gender Identity as Health Insurance Criteria." American Medical Association, GLBT Advisory Committee, 2007.

[Source 2] Kristin Clements, "Transgender Community Health Project Descriptive Results," San Francisco Department of Public Health.

[Source 3] Minter, Shannon and Christopher Daly, Trans Realities: A Legal Needs Assessment of San Francisco's Transgender Communities, (San Francisco: National Center for Lesbian Rights; San Francisco: Transgender Law Center), 2003.

[Source 4]"H-185.950 Removing Barriers to Care for Transgender Patients," American Medical Association, GLBT Advisory Committee, 2008.

[Source 5] Most private insurance plans expressly exclude services related to sex reassignment. While sex reassignment surgery is excluded from Medicare coverage, there is no exclusion under the federal Medicaid statute. As a result, according to the National Center for Lesbian Rights, "almost every court that has ever considered the issue has concluded that states cannot categorically exclude sex reassignment surgeries for Medicaid coverage." Nonetheless, many Medicaid statutes exclude procedures related to sex reassignment, and it is difficult for many people to obtain Medicaid reimbursement for medical procedures related to sex reassignment. — Shannon Minter, "Representing Transsexual Clients: Selected Legal Issues," National Center for Lesbian Rights. (accessed February 25, 2008 ).

[Source 6] RehabCare Group insurance benefits plan summary for 2007 (obtained 2008).

[Source 7] State of Connecticut Teachers' Retirement Board Health and Prescription Drug Benefits Plan for 2006 (obtained 2008).

[Source 8] Governmental agencies of the State of Louisiana, Preferred Provider Organization Plan Document for July 2007 (obtained 2008).