Health Insurance - Know Your Rights

For the most part, health insurance plans cannot legally deny coverage for medically necessary transgender-related care. Depending on the type of plan someone has, there are many different laws that can apply. For example:

• Different laws apply to employer plans versus individual plans purchased on the Marketplace.
• Medicaid and Medicare have laws that apply just to them.
• Military and Veterans Administration plans also have their own laws and regulations.
• Government-sponsored plans are subject to constitutional protections that don't apply to private health plans.
• State insurance law applies to some health plans, but not ones that are "self-funded."

Knowing exactly which laws apply to which plans can be confusing. That's why it's important to consult with a legal advocate who can help you to understand the protections that apply to your specific plan. But the important thing to know is that virtually all denials can be challenged—often successfully!

While denials and exclusions for transgender-related care are unlawful in most instances, that doesn't mean that care isn't still being (wrongly) denied. This is because policies rarely change on their own—someone needs to bring a denial to the attention of whomever is in charge of the plan and ask for the policy to be fixed. Legal action may be required, but often a simple appeal or letter to an employer can result coverage.