Health insurance: Difference between revisions

Many insurance plans exclude coverage for "services, drugs, or supplies related to sex transformation".<ref name="CAP">{{Cite web |title=FAQ: Health Insurance Needs for Transgender Americans |last1=Cray |first1=Andrew |last2=Baker |first2=Kellan |work=Center for American Progress |date=3 October 2012 |access-date=13 April 2020 |url= https://www.americanprogress.org/issues/lgbtq-rights/reports/2012/10/03/40334/faq-health-insurance-needs-for-transgender-americans/}}</ref> When prescribing [[HRT]], some healthcare providers will get around this exclusion by entering the diagnosis as a hormone imbalance.

Even when gender transition care is covered, it may be covered only for binary trans people. For example, some insurance plans will only cover [[top surgery]] if the patient reports their [[gender identity]] as male.<ref name="Guajardo">{{Cite web |title=Community rallies behind transgender person seeking breast removal to feel whole |author=Guajardo, Adi |work=KMGH |date=21 April 2021 |access-date=22 April 2021 |url= https://www.thedenverchannel.com/news/local-news/community-rallies-behind-transgender-person-seeking-breast-removal-to-feel-whole |quote=“My insurance doesn’t cover top surgery for nonbinary people,” Taylor said. “The language they have is very male-specific, and they say they need letters from your therapists saying that you identify as male, and I wasn’t going to lie.” }}</ref>

Some U.S.A. states have banned insurance companies from excluding transition-related care.<ref name="HRCmap">{{Cite web |title=State Maps of Laws & Policies: Transgender Healthcare |work=Human Rights Campaign |date=2 January 2020 |access-date=13 April 2020 |url= https://www.hrc.org/state-maps/transgender-healthcare}}</ref> Additionally, Medicare covers necessary transition-related care since May 2014 when the exclusion was removed.<ref name="tran_Heal">{{Cite web |title=Know Your Rights: Health Care |author= |work=National Center for Transgender Equality |date= |access-date=13 April 2020 |url= https://transequality.org/know-your-rights/health-care }}</ref>

Even when transition-related services are meant to be included in insurance coverage, nonbinary individuals can have a harder time than binary trans people getting those services covered. "The 2015 U.S. Transgender Survey found that 31 percent of nonbinary respondents had experienced an issue with their insurance coverage for hormone therapy in the previous year, compared to 24 percent of the general transgender population."<ref name="Compton2019">{{Cite web |title=Neither male nor female: Why some nonbinary people are ‘microdosing’ hormones |last=Compton |first=Julie |work=NBC News |date=13 July 2019 |access-date=6 October 2020 |url= https://www.nbcnews.com/feature/nbc-out/neither-male-nor-female-why-some-nonbinary-people-are-microdosing-n1028766}}</ref>

The Affordable Care Act and other USA laws prohibit sex-based discrimination, and in 2012, the Department of Health and Human Services clarified in a letter that this provision also covers "discrimination based on [[gender identity]] or failure to conform to stereotypical notions of masculinity or femininity".<ref>https://www.scribd.com/document/102169872/HHS-Response-1557-7-12-12</ref>

Starting January 1, 2019, the Blue Shield of California insurance company allows members to mark their gender identity as female, male, or nonbinary (in addition to marking their [[AGAB|sex assigned at birth]]).<ref name="Knauss">{{Cite web |title=Blue Shield Implements Non-Binary Gender Option |last=Knauss |first=Kevin |work=Insure Me Kevin |date=25 June 2019 |access-date=13 April 2020 |url= https://insuremekevin.com/blue-shield-implements-non-binary-gender-option/ }}</ref>

In April 2018, new cards were issued to all Medicare beneficiaries, and the new cards no longer have a gender indicator.<ref name="Levine">{{Cite web |title=Starting In April: New Medicare ID Cards |last=Levine |first=Carol |work=Forbes |date=6 March 2018 |access-date=16 May 2020 |url= https://www.forbes.com/sites/nextavenue/2018/03/06/starting-in-april-new-medicare-id-cards/#41449f234192}}</ref> However, Medicare's internal records will list the gender from beneficiary's Social Security data.<ref name="NCTE-medicare">{{Cite web |title=Know Your Rights - Medicare |author=National Center for Transgender Equality |work= |date= |access-date=16 May 2020 |url= https://transequality.org/know-your-rights/medicare}}</ref>

For decades, Medicare did not cover transition [[surgery]] due to a policy that categorized such treatment as "experimental." That exclusion was eliminated in 2014<ref name="NCTE-medicare" />, and now Medicare covers certain transition services that are deemed "medically necessary".<ref name="pointofpride">{{Cite web |title=Does Medicare Cover Gender-Affirming Surgery? |author= |work=Point of Pride |date=5 October 2018 |access-date=16 May 2020 |url= https://pointofpride.org/does-medicare-cover-gender-affirming-surgery/}}</ref> However, depending on where you live, your Medicare local contractor may have specific guidelines for coverage of transition-related care, and the beneficiary may have to file an appeal for services to be covered.<ref name="NCTE-medicare" />

As of June 2020, Tricare (insurance for USA's military service members) "covers [[hormone therapy]] and psychological counseling for gender dysphoria", but generally does not cover gender-affirming [[surgery]] unless a special waiver is obtained. It is unknown if being nonbinary affects these coverages, as the Tricare website only mentions "born one gender, but feels they are the opposite".<ref name="tric_Gend">{{Cite web |title=Gender Dysphoria Services |work=tricare.mil |date=June 18, 2020 |access-date=October 10, 2020 |url= https://tricare.mil/CoveredServices/IsItCovered/GenderDysphoriaServices}}</ref>