Frequently asked questions about Health Insurance

Transgender

If you are Transgender, there are important details to consider when applying for coverage.

Applying for Marketplace coverage

When you apply for coverage, you should use the first, middle, and last name that are on your Social Security card to avoid any delays due to 'inconsistencies' or 'data matching issues'

On your Marketplace application, you should select the sex that appears on your legal documents such as social security card or driver's license. While the Marketplace doesn’t check an applicant’s sex against any other government record, including SSA, some state Medicaid agencies may verify your sex against available records.

Note: The information you put on your Marketplace application will go to your health insurance company.

If you change your name and/or sex after you enroll in a plan, you should contact your insurance agent for further assistance or drop us a line and we'll contact them for you.

Sex-specific preventive services

Marketplace health plans must cover a set of preventive services — like shots and screening tests — at no cost to you when delivered by a doctor or other provider within your plan’s network.

Your health insurance company can’t limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender — for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear.

Coverage varies by state but generally, if your doctor determines that the preventive service you are trying to avail is medically appropriate for you and you meet the criteria for this recommendation and coverage requirements, your plan must cover the service without charging you a copayment or coinsurance even if you haven't met your yearly deductible. It is recommended that you take a good look at the complete terms of coverage that are included in the contract of Insurance.

Coverage varies by state but generally, if your doctor determines that the preventive service you are trying to avail is medically appropriate for you and you meet the criteria for this recommendation and coverage requirements, your plan must cover the service without charging you a copayment or coinsurance even if you haven't met your yearly deductible. It is recommended that you take a good look at the complete terms of coverage that are included in the contract of Insurance.

Many health plans are still using exclusions such as “services related to sex change” or “sex reassignment surgery” to deny coverage to transgender people for certain health care services. Coverage varies by state.

Before you enroll in a plan, you should always look at the complete terms of coverage that are included in the “Evidence of Coverage,” “Certificate of Coverage,” or contract of insurance. This contains the full explanation of which procedures and services are covered or excluded under each plan. Plans might use different language to describe these kinds of exclusions. Look for language like “All procedures related to being transgender are not covered. ” Other terms to look for include “gender change,” “transsexualism,” “gender identity disorder,” and “gender identity dysphoria.”

These transgender health insurance exclusions may be unlawful sex discrimination.The health care law prohibits discrimination on the basis of sex, among other bases, in certain programs and activities. If you believe a plan unlawfully discriminates, you can file complaints of discrimination with your state's Department of Insurance or the US Department of Health & Human Services.

These transgender health insurance exclusions may be unlawful sex discrimination.The health care law prohibits discrimination on the basis of sex, among other bases, in certain programs and activities. If you believe a plan unlawfully discriminates, you can file complaints of discrimination with your state's Department of Insurance or the US Department of Health & Human Services.

Once you’re enrolled in a plan, if your health insurance company refuses to pay a claim or ends your coverage, you also have the right to appeal the decision and have it reviewed by an independent third party