What are my rights in insurance coverage?
Federal and state law prohibits most public and private health plans from discriminating against you because you are transgender. This means, with few exceptions, that it is illegal discrimination for your health insurance plan to refuse to cover medically necessary transition-related care.
Here are some examples of illegal discrimination in insurance:
- Health plans can’t have automatic or categorical exclusions of transition-related care. For example, a health plan that says that all care related to gender transition is excluded violates the law.
- Health plans can’t have a categorical exclusion of a specific transition-related procedure. Excluding from coverage specific medically necessary procedures that some transgender people need is discrimination. For example, a health plan should not categorically exclude all coverage for facial feminization surgery or impose arbitrary age limits that contradict medical standards of care.
- An insurance company can’t place limits on coverage for transition-related care if those limits are discriminatory. For example, an insurance company can’t automatically exclude a specific type of procedure if it covers that procedure for non-transgender people. For example, if a plan covers breast reconstruction for cancer treatment, or hormones to treat post-menopause symptoms, it cannot exclude these procedures to treat gender dysphoria.
- Refusing to enroll you in a plan, cancelling your coverage, or charging higher rates because of your transgender status: An insurance company can’t treat you differently, refuse to enroll you, or limit coverage for any services because you are transgender.
- Denying coverage for care typically associated with one gender: It’s illegal for an insurance company to deny you coverage for treatments typically associated with one gender based on the gender listed in the insurance company’s records or the sex you were assigned at birth. For example, if a transgender woman’s health care provider decides she needs a prostate exam, an insurance company can’t deny it because she is listed as female in her records. If her provider recommends gynecological care, coverage can’t be denied simply because she was identified as male at birth.
What should I do to get coverage for transition-related care?
Check out NCTE’s Health Coverage Guide for more information on getting the care that you need covered by your health plan.
If you do not yet have health insurance, you can visit our friends at Out2Enroll to understand your options.
Does private health insurance cover transition-related care?
It is illegal for most private insurance plans to deny coverage for medically necessary transition-related care. Your private insurance plan should provide coverage for the care that you need. However, many transgender people continue to face discriminatory denials.
To understand how to get access to the care that you need under your private insurance plan, check out NCTE’s Health Coverage Guide.
Does Medicaid cover transition-related care?
It is illegal for Medicaid plans to deny coverage for medically necessary transition-related care. Your state Medicaid plan should provide coverage for the care that you need. However, many transgender people continue to face discriminatory denials. Some states have specific guidelines on the steps you have to take to access care. You can check if your state has specific guidelines here.
To understand how to get access to the care that you need under your Medicaid plan, check out NCTE’s Navigating Insurance page.
My plan has an exclusion for transition-related care. What should I do?
There are many reasons why your plan might still have an exclusion for transition-related care in general or for a specific procedure. This does not mean that your plan will not cover your care. Sometimes plan documents are out of date, or you can ask for an exception by showing that this care is medically necessary for you.
If you get insurance through work or school, you can advocate with your employer to have the exclusion removed.
NCTE’s Health Coverage Guide has more information on how to access care and remove exclusions.
Does Medicare cover transition-related care?
It is illegal for Medicare to deny coverage for medically necessary transition-related care.
For many years, Medicare did not cover transition-related surgery due to a decades-old policy that categorized such treatment as "experimental." That exclusion was eliminated in May 2014, and there is now no national exclusion for transition-related health care under Medicare. Some local Medicare contractors have specific policies spelling out their coverage for transition-related care, as do some private Medicare Advantage plans.
To learn more about your rights on Medicare, check out NCTE’s Medicare page.
Does the Veterans Health Administration (VHA) provide transition-related care?
The Veterans Health Administration (VHA) provides coverage for some transition-related care for eligible veterans. However, VHA still has an arbitrary and medically baseless exclusion for coverage of transition-related surgery.
For more information about VHA and transition-related care, check out NCTE’s VAH Veterans Health Care page.
Does TRICARE cover transition-related care?
TRICARE provides coverage for some transition-related care for family members and dependents of military personnel. However, TRICARE still has an exclusion for coverage of transition-related surgery.
What are my rights in receiving health care?
Which health providers are prohibited from discriminating against me?
Under the Affordable Care Act, it is illegal for most health providers and organizations to discriminate against you because you are transgender. The following are examples of places and programs that may be covered by the law:
- Physicians’ offices
- Community health clinics
- Drug rehabilitation programs
- Rape crisis centers
- Nursing homes and assisted living facilities
- Health clinics in schools and universities
- Medical residency programs
- Home health providers
- Veterans health centers
- Health services in prison or detention facilities
What types of discrimination by health care providers are prohibited by law?
Examples of discriminatory treatment prohibited by federal law include (but are not limited to):
- Refusing to admit or treat you because you are transgender
- Forcing you to have intrusive and unnecessary examinations because you are transgender
- Refusing to provide you services that they provide to other patients because you are transgender
- Refuse to treat you according to your gender identity, including by providing you access to restrooms consistent with your gender
- Refusing to respect your gender identity in making room assignments
- Harassing you or refusing to respond to harassment by staff or other patients
- Refusing to provide counseling, medical advocacy or referrals, or other support services because you are transgender
- Isolating you or depriving you of human contact in a residential treatment facility, or limiting your participation in social or recreational activities offered to others
- Requiring you to participate in “conversion therapy” for the purpose of changing your gender identity
- Attempting to harass, coerce, intimidate, or interfere with your ability to exercise your health care rights
What are my rights related to privacy of my health information?
The Health Insurance Portability and Accountability Act (HIPAA) requires most health care providers and health insurance plans to protect your privacy when it comes to certain information about your health or medical history. Information about your transgender status, including your diagnosis, medical history, sex assigned at birth, or anatomy, may be protected health information. Such information should not be disclosed to anyone—including family, friends, and other patients—without your consent. This information should also not be disclosed to medical staff unless there is a medically relevant reason to do so. If this information is shared for purposes of gossip or harassment, it is a violation of HIPAA.
What Can I Do If I Face Discrimination?
Seek preauthorization for care and appeal insurance denials
You shouldn’t be denied the care that you need just because you’re transgender. To access transition-related care, we recommend applying for preauthorization before any procedures to understand whether your plan will cover it. You should also consider appealing insurance denials that you believe are discriminatory. We recommend you consult an attorney before filing any appeals (you can find a list of organizations that might be able to help at NCTE’s Health Care Issues page and at the Trans Legal Services Network).
Check our NCTE’s Health Coverage Guide for more information on how to get the care that you need covered.
Contact an attorney or legal organization
If you face discrimination from a health care provider or insurance company, it may be against the law. You can talk to a lawyer or a legal organization to see what your options are. A lawyer might also be able to help you resolve your problem without a lawsuit, for example by contacting your health care provider to make sure they understand their legal obligations or filing a complaint with a professional board.
While NCTE does not take clients or provide legal services or referrals, there are many other groups that may give you referrals or maintain lists of local attorneys. You can try your local legal aid or legal services organization, or national or regional organizations such as the National Center for Lesbian Rights, Lambda Legal, the Transgender Law Center, the ACLU, and others listed on our resource page.
File discrimination complaints with state and federal agencies
Typically, complaints of discrimination are filed with the U.S. Department of Health and Human Services, Office for Civil Rights. As of spring 2019, however, the Trump Administration is ignoring most complaints of anti-transgender discrimination. While filing a complaint with US HHS can help build pressure on the Administration, it may not get you help with your care. Here are some other places you can file health care complaints..
- Private insurance: File a complaint with your state insurance department. You can find information about your state department here: https://www.naic.org/state_web_map.htm
- Hospitals: File a complaint with the Joint Commission, which accredits most hospitals. You can find more information or submit a complaint online at http://www.jointcommission.org.
- Nursing home, board and care home, or assisted living facility: Contact your local long-term care ombudsman. You can locate an ombudsman here: http://www.ltcombudsman.org/ombudsman.
- HIPPA violations: file a complaint with the U.S. Department of Health and Human Services (HHS): https://www.hhs.gov/hipaa/filing-a-complaint/index.html
- Federal Health Employee Benefits Program: File a complaint with the Office of Personnel Management (FEHB@opm.gov) or the Equal Employment Opportunity Commission (https://www.eeoc.gov/federal/fed_employees/complaint_overview.cfm).
- Veterans Health Administration: File a complaint with the Veterans Administration’s External Discrimination Complaints Program or contact a Patient Advocate at your VA Medical Center. Find out more here: http://www.va.gov/orm/ and http://www.va.gov/health/patientadvocate.
- Employee health plan: File a complaint with the Equal Employment Opportunity Commission (https://www.eeoc.gov/federal/fed_employees/complaint_overview.cfm).
- TRICARE: File a complaint with TRICARE (http://tricare.mil/ContactUs/FileComplaint.aspx).
Other state and local agencies: If you face discrimination, you may be able to file a complaint with your state’s human rights agency. You can find a list of state human rights agencies here: http://www.justice.gov/crt/legalinfo/stateandlocal.php.
What Laws Protect Me?
- The Affordable Care Act (ACA) prohibits sex discrimination, including anti-transgender discrimination, by most health providers and insurance companies, as well as discrimination based on race, national origin, age, and disability. Under the ACA, it is illegal for most insurance companies to have exclusions of transition-related care, and it is illegal for most health providers to discriminate against transgender people, like by turning someone away or refusing to treat them according to their gender identity.
- The Health Insurance Portability and Accountability Act (HIPAA) protects patients’ privacy when it comes to certain health information, including information related to a person’s transgender status and transition. It also gives patients the right to access, inspect, and copy their protected health information held by hospitals, clinics, and health plans.
- Medicare and Medicaid regulations protect the right of hospital patients to choose their own visitors and medical decision-makers regardless of their legal relationship to the patient. This means that hospitals cannot discriminate against LGBT people or their families in visitation and in recognizing a patient’s designated decision-maker.
- Joint Commission hospital accreditation standards require hospitals to have internal policies prohibiting discrimination based on gender identity and sexual orientation.
- The Nursing Home Reform Act establishes a set of nursing home residents’ rights that include the right to privacy, including in visits from friends or loved ones; the right to be free from abuse, mistreatment, and neglect; the right to choose your physician; the right to dignity and self-determination; and the right to file grievances without retaliation.
State and local nondiscrimination laws prohibit health care discrimination against transgender people in many circumstances.
A large number of states also have explicit policies that prohibit anti-transgender discrimination in private insurance and Medicaid, like exclusions of transition-related care.
- California private insurance (PPO regulation, HMO general guidelines and HMO guidelines on surgery coverage) and Medicaid
- Colorado private insurance and Medicaid
- Connecticut private insurance and Medicaid
- Delaware private insurance
- District of Columbia private insurance and Medicaid
- Hawaii private insurance and Medicaid
- Illinois private insurance (regulations and bulletin)
- Maine Medicaid
- Maryland private insurance and Medicaid
- Massachusetts private insurance and Medicaid
- Michigan Medicaid
- Minnesota private insurance and Medicaid
- Montana private insurance and Medicaid
- Nevada private insurance and Medicaid
- New Hampshire Medicaid
- New Jersey private insurance and Medicaid
- New Mexico private insurance
- New York private insurance (coverage, code mismatches, updated policy) and Medicaid (general Medicaid policy, criteria for authorization of procedures)
- Oregon private insurance and Medicaid (general policy--refer to Guideline Note 127--and facial feminization policy)
- Pennsylvania private insurance and Medicaid
- Rhode Island private insurance and Medicaid
- Vermont private insurance and Medicaid
- Washington State private insurance and Medicaid
Remember: Just because your state isn’t listed here doesn’t mean you’re not protected. Check out NCTE’s Health Coverage Guide for more information about getting coverage for the care that you need.
How Can I Help?
- Head to NCTE’s Health Action Center to see the latest on health care and how you can help fight for transgender people’s right to get the health care they need
- Share your story. If you are facing discriminatory treatment, consider sharing your story with NCTE so we can use it in advocacy efforts to advance public understanding and policy change for transgender people. If you successfully resolved a health care situation, we want to hear about that as well.
Department of Health and Human Services Office for Civil Rights:
Links to State and Local Human Rights Agencies:
Partner resources, best practices and standards of care
Creating Equal Access to Quality Health Care for Transgender Patients: Transgender-Affirming Hospital Policies, Lambda Legal, HRC, & New York Bar:
Healthcare Equality Index, Human Rights Campaign
National Center for LGBT Health Education:
- National LGBT Health Education Center’s guide to best practices for front-line health care staff
- National LGBT Health Education Center’s guide to providing health care to non-binary people
- National LGBT Health Education Center’s guide to making health care forms LGBT-inclusive
National Resource Center on LGBT Aging:
RAD Remedy’s guide to providing competent care for trans people
Transgender Law Center’s guide to organizing community clinics
Clinical standards of care for transgender people
- WPATH Standards of Care
- Endocrine Society Clinical Guideline
- Center for Excellence for Transgender Health
Mental Health Resources
National suicide prevention hotline
US: 877-565-8860Canada: 877-330-6366
National Alliance on Mental Illness (NAMI)
National network of mental health care providers, as well as a provider database
Help Line 800-950-6264
National Council for Behavioral Health
National network of community behavioral health centers, as well as a provider database
SAMHSA (Substance Abuse and Mental Health Services Administration)
A national database for local professionals and agencies that provide addiction recovery services and mental health care.
Health provider resources
National Association of Free and Charitable Clinics (NAFC)
Clinics around the United States that offer basic health care for those without insurance or experiencing homelessness.
Community-sourced list of trans-affirming healthcare providers
Resources to help transgender people select and enroll in insurance
Health and guidance for healthcare providers, as well as a list of transaffirming health clinics in Canada, the United States, and England.
Transcend Legal helps people get transgender-related health care covered under insurance.
Helps transgender people navigate health care and insurance to receive respectful, high-quality care, and get transition-related care covered
Leads the work to achieve health equity for diverse gender, sexual, and cultural communities in Minnesota, including the Trans Aging Project and a Trans Health Insurance guide
Transition-related financial support
Jim Collins Foundation
Financial support for transition-related expenses for people without insurance or who have been excluded by insurance
Point of Pride Annual Transgender Surgery Fund
Provides direct financial assistance to trans folks who cannot afford their gender-affirming surgery
Community Kinship Life Surgery Scholarship
Provides the trans community with assistance while having a sense of community and kinship
Transformative Freedom Fund (Colorado)
Supports the authentic selves of transgender Coloradans by removing financial barriers to transition related healthcare
Kentucky Health Justice Network Trans Health Advocacy
Works to help Trans Kentuckians access the healthcare they need, as well as reaffirm our autonomy and community