Insurance Coverage for Transgender Care

Trans Insurance Roadmap video series

The era of routine exclusion of transgender-related care is over. No one should be paying for hormones, surgeries, or puberty-delaying treatment out of pocket anymore.

Our Trans Insurance Roadmap videos are the place to start learning about your health care rights. The videos cover the basics of learning what your plan will cover, how to apply for coverage, and what your options are if you are denied.

does my plan cover trans care

How do I know what my plan covers?

If you watched Video 1, you know you need two documents to start to determine what is covered under your plan:

  1. Your insurance plan document (your health insurance policy)
  2. Generic insurance company medical policy on gender reassignment

Learn more about what the plan document it is and how to get it: How do I get a copy of my health insurance policy?

Find your insurance company's policy on gender reassignment here: Transgender Insurance Medical Policies

Challenging insurance denials and exclusions

Many laws prohibit discrimination in insurance, so if you've received a denial. Here are some examples of things that can be readily challenged:

  • Denials saying facial feminization or breast augmentation is "not medically necessary"
  • Denial of puberty delay treatment (GnRH)
  • Denial of hormones or surgery because the patient is under 18
  • Explicit exclusion for all trans care in a plan
  • Special cap (such as $75,000) for trans-related care
  • Being on hormones before FTM top surgery

Many states have issued insurance bulletins prohibiting bans on transgender health care. Virtually all insurance companies cover transgender-related health care in some of their plans, but you need to know if your specific plan is one of them.

Note: Transcend Legal is not taking on new individual health insurance clients at this time while we prepare self-help resources that will help many people at the same time.