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Transgender Health   

Do Marketplace plans cover benefits and services related to gender transition?

The coverage of transition-related care continues to vary by insurer and state. However, you have the right to expect that your plan will cover the services you need as long as those services are covered for other people on your plan. These services may include preventive screenings such as mammograms, Pap tests, and prostate exams; hormone therapy; mental health services; and surgical procedures related to gender transition. If your coverage is denied, learn how to appeal a decision with your insurer here. If you face discrimination by an insurer or health provider, contact a legal organization here.

However, some plans may still have transgender exclusions. These exclusions are discriminatory and deny coverage to transgender people for medically necessary health care. These exclusions were prohibited in most types of health insurance beginning in 2017, but be aware that some exclusions may still persist in many plans. To help you understand your options, we’ve created state-specific Transgender Health Insurance Guides and encourage you to make an appointment with an LGBT-friendly expert who can help you enroll for free.

For more information, visit this resource at

If you want more information on what your insurance company might cover, check out these medical policies from Transcend Legal – but make sure you look at your own policy too since that’s what will really determine what services are covered.

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