Navigating health insurance as a transgender or gender non-conforming person is complicated, long-winded, and frustrating, to say the least. However, Gay Denver has created a complete gender-affirming care guide to help ease the process.
Navigating Connect for Health Colorado
When applying for health insurance coverage as a transgender person, you, unfortunately, must use the first, middle, and last name on your Social Security card. Additionally, you should select the sex that appears on your legal documents, such as your driver’s license or Social Security card. While we know this may trigger dysphoria and frustration, that is currently how the application works. People can make complaints here to try to change the system. Ensure you take proper steps to care for your mental health during this process. The Colorado Name Change Project is an excellent resource if you’re looking to change your legal information.
If you change your name and/or sex after you enroll in a plan, you should be able to update the information when you log in. If you need help editing this information, contact Connect for Health Colorado.
Sex-specific Preventive Services
When receiving care for services regarding your sex assigned at birth, marketplace health plans must cover these. This entails services like shots, screenings, and preventative services. For example, health insurance companies must cover a transgender man (female to male) with residual breast tissue or an intact cervix who needs a mammogram or a pap smear. Your doctor determines the necessity of these services.
Updating Your Name/Pronouns:
Once you’ve signed up for coverage, depending on the plan, you should be able to contact them directly to make note of your real name and pronouns. Also, be sure to inform your doctors when you visit so they can address you correctly.
Getting HRT (Hormone Replacement Therapy)
Health insurance in Colorado is required to cover HRT for trans individuals who have it prescribed. The best way to determine what it’ll cost you is by checking your plan’s EOC (evidence of coverage) and searching your plan’s drug formulary for the specific brand and dosage you use. Another great resource to cut costs further is Good Rx.
If you find that the hormone you’ve been prescribed isn’t a generic drug, ask your doctor about switching to something you can get for less. If that isn’t possible, the drug costs will go towards your deductible on most plans.
Finding a Primary Care Physician You’re Comfortable with:
Trusting and feeling supported by your doctor is vital to your health.
The 2015 U.S. Transgender Survey, published by the National Center for Transgender Equality, found that a third of trans respondents who’d seen a specialist in the previous year reported a negative experience related to being trans and that 23 percent of respondents had not gone to the doctor when they needed one in the last year because they feared mistreatment as a trans person.
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So, how can you ensure you’re going to a doctor who is the right fight? Here are some strategies.
- Ask around- Facebook support groups or friends may know a doctor in your plan’s network if they’re also members.
- Check trusted sources such as the World Professional Association for Transgender Health (WPATH) ’s provider search tool or the Human Rights Campaign’s (HRC) Healthcare Equity Index to see which health facilities are best in your state.
- Look for signs of welcome in the office, such as brochures on LGBT+ issues health, visibly posted non-discrimination statements, or posters. Notice how the staff respects pronouns or your name too.
- Once in the waiting room, note the forms you fill out. Is there just room for male/female? Any place for a preferred name?
- Ask questions.
- Try something like, “I have some concerns around gender identity and affirming my identity. Is that something you have any experience in or that you’d be comfortable helping me manage and care for?”
- If the provider expresses openness or has experience working with trans patients, that’s a good sign. If they fumble or don’t give you an answer, it may be time to hit the drawing board again.
Transitioning (Surgeries, Hormones, and Preventative Care):
Social transitioning: using different pronouns, changing one’s style, adopting a new name, etc., to affirm one’s gender.
Medical transitioning: taking hormones and/or surgically removing or modifying genitals and reproductive organs.
Transgender individuals do not need to undergo medical intervention to have valid identities.
When transitioning to affirm your gender identity, there are many options depending on what you’re looking for. To get these surgeries or hormones, most places require:
- A mental health evaluation looks for any mental health concerns that could influence an individual’s mental state and assess a person’s readiness to undergo the physical and emotional stresses of the transition.
- Clear and consistent documentation of gender dysphoria, often with a WPATH (World Professional Association for Transgender Health) letter.
- A confirmation that you are healthy and won’t have any health risks related to going on hormones or completing surgeries.
How your insurance covers these may vary, but what isn’t covered will go toward your deductible on most plans.
Preventative Care:
It’s essential to communicate with your doctor about your body. Even if you’ve had gender-affirming surgeries, there are still risks associated with things like breast and prostate tissues that you should check for. If you’re comfortable, be sure to check with your doctor about proper testing and preventative care you can do to make sure you stay healthy and thrive! This also includes birth control methods and sexual health preventatives.
Navigating health insurance and caring for yourself is hard enough. Every transgender person, like every cisgender (identifies with their assigned sex at birth) person, has their own journey. We’re here to help you through yours, no matter your treatment plan or lack of one. Your transition is your choice.
