How to Find Affordable Health Insurance (Health Insurance for LGBTQ Folks Ep. 7)

In the seventh episode of our Health Insurance for LGBTQ People series, we discuss some essential rights that all LGBTQ people have with regard to healthcare and health insurance and what to do if you experience harassment or discrimination from a doctor or insurance company.

Time stamps:

0:47: What is gender-affirming care?

1:33: Gender-affirming care is more than a list of surgeries.

2:16: Medical providers cannot refuse to treat you because you're trans.

2:43: Intentional misgendering or using the wrong name is harassment.

2:58: Being asked invasive questions is harassment.

3:17: Hospitals must assign you a room according to your gender identity.

3:45: Insurance companies cannot refuse to cover you or raise your rates because you're LGBTQ.

4:04: Any legally married couple filing joint taxes can get health insurance together.

4:40: Health insurance plans can't broadly exclude all gender-affirming care. (Though some do. Check out our Trans Health Insurance Guides at out2enroll.org/trans-guides.)

5:21: All preventive services (like cancer screenings) are FREE regardless of gender identity, sex assigned at birth, or gender marker.

6:27: An example scenario to recap

8:38: What to do if you experience discrimination or harassment from a healthcare provider or insurance company

Transcript:

Introduction

Welcome back to another episode in our series on Health Insurance for LGBTQ Folks. In our last episode, we discussed the process of getting set up with health insurance, finding a doctor, getting access to gender-affirming care, navigating the prior authorization process, and appealing denials of care.

In this episode, we're going to talk about one last, very important part of this experience, which is knowing your rights as a trans or LGBTQ person. I want to talk about the full breadth of what gender-affirming care really looks like, and everything that you should know about your rights under the Affordable Care Act, and how you deserve to be treated by a health care provider and by your insurance company. Let's get into it.

What Is Gender-Affirming Care?

So, when we use the term gender-affirming care, what do we really mean? Usually, we're talking about the services, procedures, and treatments that help bring a person's outward physical appearance in line with their inward sense of their gender identity. This is done to help trans people lower their feelings of gender dysphoria, feel more connected to themselves, and feel more content with the way that they're seen by other people in public.

This can include a number of things across different medical disciplines involving hormone therapy, gender counseling, voice therapy lessons, facial hair removal, and a number of different surgical procedures.

Gender-Affirming Care Is More Than A List of Surgeries

But this isn't all that's involved in gender-affirming care. Gender-affirming care is more than just a list of surgeries. It's about respect and dignity and equal access to lifesaving medical care.

It means having your doctor respect your name and gender pronouns. It means not being asked invasive and unnecessary questions during a basic medical checkup. It means not being refused treatment because you're trans or being treated unfairly or differently from any other patient.

In short, you should never face disrespect or discrimination from a health care provider or your insurance company.

Your Rights in Health Care Settings

Let's dive into each of these important rights that you should know about and then go over some examples.

Doctors Can't Refuse to Treat Trans Patients

Section 1557 of the Affordable Care Act prohibits medical providers from turning away patients just because they're trans. You have a fundamental right to basic medical care, and a facility or provider is not allowed to turn away a person based on their identity because they are LGBTQ, or because they believe that somehow your identity is the reason that you're sick or injured.

You Have the Right to Healthcare with Dignity

You also have the right to be treated with respect and not face harassment. If a provider is refusing to use the name and pronoun that you give them, even if it's not what's on your legal documentation, this is a form of harassment. If a provider asks you invasive questions about your medical history that's not relevant to the conversation at hand, that can be a form of harassment, too. You deserve access to medical care in which you're treated with respect and dignity, and in which you have a medical provider affirm your identity.

Room Assignments Must Match Gender Identity

Finally, the Affordable Care Act also requires that hospitals and facilities assign rooms in accordance with people's gender identity. So if you're a trans woman, you should be housed in a hospital ward with other women. If you're a trans man in a hospital with a single-gender room assignment, then you should be in a room with another man.

Your Rights with Health Insurance Companies

First, it's important to know that all LGBTQ people are protected from discrimination from health insurance companies. Health insurance companies aren't allowed to refuse to cover you because you're LGBTQ. They can't raise your rates because you're LGBTQ. And you're afforded the same amount of financial assistance as everyone else.

Equal Treatment for All Families

Equal treatment for all families means that all couples — straight, queer, same gender — are treated the same way by the health insurance marketplace and Medicaid. So if you're legally married in the United States and filing joint taxes, you can apply for health insurance together as a couple or a family. Regardless of you or your partner's gender identity, you can apply for spousal benefits through an employer-sponsored plan or the public marketplace. And you can also receive the Joint Advance Premium Tax Credit, which is the financial assistance we've talked about in previous episodes.

Plans Can't Deny All Gender-Affirming Care

Next, it's important to note that health insurance plans can't have broad categorical exclusions of all gender-affirming care. So this would mean saying something like, "We don't cover any services related to gender dysphoria," regardless of medical necessity. This is technically illegal under the Affordable Care Act, but some plans still do have this language in their policy contracts.

This is why every year we put out health insurance guides for trans folks to be aware of which health insurance plans may or may not cover gender-affirming care. You can take a look at those on our website at out2enroll.org/trans-guides.

Access to Preventive Services Is Free for Everyone

Finally, one of the most important hallmarks of the Affordable Care Act is the right to preventive services like cancer screenings for free. Notably for trans folks, these services have to be free regardless of gender identity, sex assigned at birth, or gender marker on your legal documents or your medical record.

What we like to say is, if you've got it, you've got to get it checked. This means that trans men who still have cervixes should be getting cervical pap tests, trans women who have prostates should be getting prostate exams, and everyone who has breast tissue should be getting mammograms.

If your insurance company initially refuses coverage of any of these screenings, it might just be a computer-generated error because of the mismatch between your gender marker and the service you're trying to get. However, if they still deny your claim, know that this is illegal.

You have a right to get access to preventive cancer screenings just like everyone else. Please go ahead and talk to your doctor about what screenings are appropriate for you, so that you can stay healthy and take care of yourself.

Real-Life Scenario

So to recap, let's go over an example. Say you break your arm, and you go to the emergency care department. When you first check in, you need to provide identification documents. If your name or gender doesn't match up with your legal documentation, you can tell the hospital that, and they have to respect your identity. If providers are intentionally misgendering you or using the wrong name, this is a form of discrimination.

Next, when a doctor comes to check out your arm, they're going to ask you some questions. These questions might include what medications you're taking and your surgical history. And those would be normal, appropriate questions. If you don't want to answer them, I wouldn't blame you. But do keep in mind that if your doctor is going to prescribe you medications, it's important to make sure that your medications don't interfere with one another.

However, if they keep asking you more invasive questions about your anatomy, your sexual preferences, and more details about your surgical history, this would be inappropriate. If a provider is making you feel uncomfortable at any time, you can ask, "Are these questions really relevant to my broken arm?" You can ask for a different provider, or you can let them know that you feel uncomfortable with the questions they’re asking.

Now, say that you do disclose your history to your doctor and let them know that you're transgender, and they no longer want to treat you. Maybe they feel uncomfortable based on their religion, or they say that they don't have the proper training to work with trans patients. Now, this is also a form of discrimination. You have a right to basic medical care. This injury has nothing to do with your needs in terms of gender-affirming care, and doctors can't refuse to treat you based on your gender identity.

How to Respond to Discrimination

Finally, surveys of trans folks have found that a disproportionate number of us have had negative interactions with health care providers, like being blamed for a medical problem we’re having, being condescended to, or being ignored when asking a direct question or request. You deserve to be treated with respect. And all of these instances would constitute discriminatory, inappropriate behavior.

If any of this happened to you, I recommend you go back and watch our last video in which we talked about the different ways that you can appeal denials of care, because a lot of these also apply. So, you can file a complaint with the Department of Health and Human Services, with your state's health department, or with your state's medical board, where the doctor is licensed. You could also report them directly to their hospital or facility.

Finally, go ahead and send us an email at info@out2enroll.org, and we can point you in the direction of some legal aid organizations that help folks with these health care or health insurance discrimination complaints.

Conclusion

In this episode, we talked about your rights under the Affordable Care Act, how you deserve to be treated with respect and dignity by health care providers, assigned rooms in a hospital based on your gender identity, and given access to preventive services and screenings regardless of your gender identity or sex assigned at birth.