Health insurance

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"Action for Trans Health" banner at Trans Pride Brighton 2014.

Health insurance often doesn't cover gender-validating surgeries or therapies for transgender people, including nonbinary people who want a physical transition. It can be difficult to find an insurer that does, or to persuade one to do so. This is because insurance companies often think transgender health care is merely cosmetic and optional. They don't understand that, for many transgender people, it is life-saving and not optional. This transgender rights issue needs to be addressed by activism, so that it will someday be standard for insurance to cover transgender health care.

Many insurance plans exclude coverage for "services, drugs, or supplies related to sex transformation".[1] 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.[2]

USA[edit | edit source]

Some U.S.A. states have banned insurance companies from excluding transition-related care.[3] Additionally, Medicare covers necessary transition-related care since May 2014 when the exclusion was removed.[4]

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."[5]

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".[6]

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 sex assigned at birth).[7]

Medicare[edit | edit source]

In April 2018, new cards were issued to all Medicare beneficiaries, and the new cards no longer have a gender indicator.[8] However, Medicare's internal records will list the gender from beneficiary's Social Security data.[9]

For decades, Medicare did not cover transition surgery due to a policy that categorized such treatment as "experimental." That exclusion was eliminated in 2014[9], and now Medicare covers certain transition services that are deemed "medically necessary".[10] 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.[9]

Tricare[edit | edit source]

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".[11]

See also[edit | edit source]

External links[edit | edit source]

References[edit | edit source]

  1. Cray, Andrew; Baker, Kellan (3 October 2012). "FAQ: Health Insurance Needs for Transgender Americans". Center for American Progress. Retrieved 13 April 2020.
  2. Guajardo, Adi (21 April 2021). "Community rallies behind transgender person seeking breast removal to feel whole". KMGH. Retrieved 22 April 2021. “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.”
  3. "State Maps of Laws & Policies: Transgender Healthcare". Human Rights Campaign. 2 January 2020. Retrieved 13 April 2020.
  4. "Know Your Rights: Health Care". National Center for Transgender Equality. Retrieved 13 April 2020.
  5. Compton, Julie (13 July 2019). "Neither male nor female: Why some nonbinary people are 'microdosing' hormones". NBC News. Retrieved 6 October 2020.
  7. Knauss, Kevin (25 June 2019). "Blue Shield Implements Non-Binary Gender Option". Insure Me Kevin. Retrieved 13 April 2020.
  8. Levine, Carol (6 March 2018). "Starting In April: New Medicare ID Cards". Forbes. Retrieved 16 May 2020.
  9. 9.0 9.1 9.2 National Center for Transgender Equality. "Know Your Rights - Medicare". Retrieved 16 May 2020.
  10. "Does Medicare Cover Gender-Affirming Surgery?". Point of Pride. 5 October 2018. Retrieved 16 May 2020.
  11. "Gender Dysphoria Services". June 18, 2020. Retrieved October 10, 2020.