For Consumers

Gender-affirming medical coverage rights

Both state law and the federal Affordable Care Act prevent health insurance companies from discriminating against someone based on their gender identity and related medical conditions. These rights apply to youth and adults.

Your rights to coverage

In Washington state, health insurers generally cannot exclude, deny or limit medically necessary gender-affirming treatment. 

Examples of treatments insurers must cover when medically necessary include:

  • Hormone therapy
  • Counseling services
  • Mastectomy and chest reconstruction
  • Breast augmentation 
  • Hair removal procedures
  • Gender-affirming facial procedures
  • Tracheal shaves

If your insurer denies services, they must provide you with a reason for the denial. The denial must be reviewed by a health provder with gender-affirming treatment experience. Insurers must use evidence-based clinical review criteria for prior authorization of treatment and services.

If you believe you've been unfairly denied coverage for medical services, file an appeal with the health insurance company. For help with writing an appeal, see our example for a gender-affirming care appeal letter.

In addition to filing an appeal, you can also file a complaint with our office and we'll look into it for you.