QUESTION

My plan refuses to cover services related to gender transition. Is this allowed?

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ANSWER

Coverage of gender transition services varies by insurer and state. The ACA prohibits health plans and providers from discriminating on the basis of sexual orientation or gender identity (the regulation implementing this provision is currently under litigation, but the law’s protections are still in effect). This means that plans must cover the services you need as long as those services are covered for other people on your plan. For instance, a plan may not deny coverage for preventive screenings (e.g., mammograms, pap smears, and prostate exams), mental health services, or surgical procedures related to gender transition based on a person’s sex at birth. For more information on state-specific requirements with regard to coverage of transgender and transition-related services, see Out2Enroll’s Trans Insurance Guides.

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