For Consumers

Transgender 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.

Your rights to coverage

If a health insurer covers medically necessary services for its enrollees, it cannot exclude or deny those services for a transgender person because of the person's gender identity.

Health insurers are required to cover procedures that are part of a gender transition process if they're covered for other policyholders for different reasons. Examples include:

  • Hormone therapy
  • Counseling services
  • Mastectomy
  • Breast augmentation and reconstruction

If you believe that you have been unfairly denied coverage for medical services, file a complaint and we'll look into it for you, or you can file an appeal with the health insurance company.