Health Coverage Guide | Learning What Your Plan Covers | National Center for Transgender Equality

Health coverage guide

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Learning What Your Plan Covers

Step 1. Find out what your plan says about transition-related care

What does your plan say about the treatment you need? What does it say about transition-related care in general?

To find out, you will need a copy of your member handbook.

Watch: How to find your insurance plan booklet and understand your coverage (video source: Transcend Legal)

Some insurance plans don’t specifically mention transition-related care in the member handbook, but will have a separate document called a medical policy that lists specific criteria you need to meet in order to qualify for coverage for a particular procedure. Make sure to ask for a copy of any medical policies on gender dysphoria treatment that are applicable to your plan.

Some insurance plans still have exclusions for transition-related care overall or certain types of care—even though those exclusions may be illegal. For example, the plan could limit surgical coverage to people over a certain age, or exclude coverage for particular procedures, like facial feminization surgery.

If you receive free insurance from your state, you might be on Medicaid.

If you are on Medicaid, head over to NCTE's Health Care page to see if your state has Medicaid coverage guidelines that will help you understand what is covered.

Your plan might have a name that is specific to your state, such as Medi-Cal, Badgercare, or Medical Assistance. You can look for your state's Medicaid name on this website.

Once you know what you plan says about coverage, go to step 2 to find out what type of plan you have.

 

GO TO STEP 2: Find out if your plan is fully insured or self-funded

 

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