1Center or American Progress | FAQ: Health Insurance Needs or Transgender Americans
FAQ: Health Insurance Needs for Transgender Americans
Andrew Cray and Kellan Baker October 3, 2012
ransgender people ace ough realiies across he Unied Saes in rouine areas o lie ha mos people ake or graned, including righs o employmen, housing, andpersonal saey. Healh care, paricularly healh insurance coverage, is anoher area where ransgender people rouinely experience serious and poenially lie-hreaeningdiscriminaion on he basis o gender ideniy.
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ransgender people are more likely o be wihou healh insurance han nonransgen-der people.
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ransgender people o color are especially impaced by insurance discriminaion—one in every hree black ransgender respondens in a naionwide survey o more han6,400 ransgender people repored being uninsured.
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Nearly hal o ransgender survey respondens repored delaying seeking care whenhey were sick or injured because o inabiliy o aord reamen.
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Even i ransgender people have healh insurance coverage, mos policies conainransgender-specic exclusions ha deny hem coverage rouinely provided o non-ransgender people.
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o ensure ha ransgender people can access he care hey need o say healhy, insurersneed o be held o appropriae sandards o nondiscriminaion, and healh plan benedesigns mus be based on medical science and sound acuarial daa raher han on ou-daed assumpions.Tis FAQ provides inormaion on ransgender healh issues and he obsacles haransgender people ace in accessing insurance coverage or even he mos basic healhcare needs.
2Center or American Progress | FAQ: Health Insurance Needs or Transgender Americans
Who are transgender people?
A ransgender person is someone whose inernal sense o gender, also known as “genderideniy,” is dieren rom wha is ypically associaed wih his or her assigned sex a birh. Le’s ake, or example, a person who was assigned emale a birh bu who livesand idenies as male: Tis person is a ransgender man.Some ransgender people need o ake social, legal, and/or medical seps o ouwardly arm heir gender ideniy. Tese seps migh include changing heir name, changing hesex designaion on personal idenicaion documens, dressing in a way ypically associaed wih a dieren gender, or undergoing medical reamen o ransiion rom one gender oanoher. Tese medical services may include menal healh services, hormone herapy, andsurgery, bu he exac seps involved in ransiion are dieren or every person.
What are the health care needs of transgender people?
ransgender people require much o he same medical care ha is provided o nonrans-gender people. ransgender people need acue care when hey are sick and prevenive careo keep rom becoming ill, including services ha are radiionally considered o be genderspecic—such as Pap smears, prosae exams, and mammograms. ransgender paiensmay require a mix o such screenings. Medically necessary prevenive screenings or aransgender woman, or example, may include boh a mammogram and a prosae exam.ransgender people who use medical reamens as par o gender ransiion also requireaccess o many o he same services ha are regularly provided o nonransgenderpeople.Te same hormone herapy used in gender ransiion, or example, is providedo paiens wih endocrine disorders and o women wih menopausal sympoms.
Are services related to gender transition medically necessary?
Yes. Major exper associaions agree ha ransiion-relaed medical services, includingmenal healh services, hormone herapy, and surgery, are medically necessary or many ransgender people. Te American Medical Associaion; he American Psychological Associaion; he American Psychiaric Associaion; he American Academy o Family Physicians; he American Congress o Obsericians and Gynecologiss; he EndocrineSociey; he Naional Associaion o Social Workers; and he World Proessional Associaion or ransgender Healh have all issued public saemens o his eec. According o hese exper associaions, deerminaion o he medical necessiy o any paricular ransiion-relaed service or an individual paien properly ress wih medicalproviders, no insurance companies.
3Center or American Progress | FAQ: Health Insurance Needs or Transgender Americans
Do insurance plans usually cover care for transgender people?
Unorunaely, despie signican advances, many insurers coninue o rely on oudaedassumpions abou ransgender people o jusiy discriminaory ransgender-specicexclusions in heir policies.Sill, he rend o oering nondiscriminaory, comprehensive coverage or ransgenderpeople is growing. An increasing number o healh insurers are oering plans wihouransgender-specic exclusions, and many are also including armaive saemens o coverage or reamens needed or gender ransiion.Some o he insurers oering inclusive plans include Aena, Blue Cross Blue Shield,Cigna, Kaiser Permanene, and UniedHealhcare. Many employers are also oeringcomprehensive coverage o heir ransgender workers. Currenly, more han 25 perceno Forune 100 employers, including Kra Foods, Microso, and Nike, oer equal cov-erage or heir ransgender employees.
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What are transgender-specific exclusions?
Many healh insurers specically arge he ransgender populaion or denial o servicesprovided o nonransgender people under he same plan. In some insances hese exclu-sions apply only o surgical reamens while permiting coverage or oher benes,such as menal healh services and hormone herapy. In many cases, however, he exclu-sions are sweeping, excluding, or example, coverage o any “services, drugs, or suppliesrelaed o sex ransormaion.”
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ransgender-specic exclusions are unaccepable on boh medical and ehical grounds.Tey arbirarily arge ransgender people or discriminaion by orcing hem o pay ou-o-pocke or he same medically necessary services provided o nonransgender people. As discussed above,many medical services needed by ransgender people during ransi-ion and a oher poins in heir lives are par o he course o care required or ohermedical condiions and are rouinely covered by healh insurance plans. Hormone her-apy, or insance, may be uilized or paiens wih low esoserone or esrogen levels oroher endocrine disorders. Prevenive care services such as pelvic or prosae exams arean imporan par o an overall healh regimen or all individuals, while various surgeriesand reconsrucive procedures are commonly covered or reaing injuries and inersex condiions, or or cancer reamen or prevenion.Moreover, insurers requenly expand such exclusions in pracice o deny ransgenderpeople coverage or basic services ha are unrelaed o gender ransiion. ake heourageous example o a ransgender woman in New Jersey who was denied coverage
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FAQ: Health Insurance Needs for Transgender Americans
Transgender health issues and the obstacles that transgender people face in accessing insurance coverage for even the most basic health care needs are widespread and must be addressed.
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