Large private companies that pay their workers’ claims directly can decide whether they want to provide benefits aimed at transgender employees. It’s tougher to customize coverage when employers buy off-the-shelf insurance plans. Many insurance policies specifically exclude coverage for transgender health services, says Fidas.
On the individual market, insurers may deny coverage to transgender people altogether, sometimes claiming they have a preexisting condition. Under the new health law, beginning in 2014, health plans will no longer be able to deny coverage on that basis.
But for some transgender people, such as Nakoa Nelson, a full-time college student in Hawaii, getting coverage isn’t the problem. Nelson has insurance through Med-Quest, a state Medicaid program for low-income people, but it doesn’t cover all the services he needs. Nelson, 44, has been taking testosterone hormones for the past couple of years. He pays the roughly $60 monthly charge out of pocket. He’d like to get a double mastectomy and chest contouring, but insurance doesn’t cover that, either. So far he’s saved about half of the $13,500 he needs for the procedure.
Like many transgender people, Nelson faces problems that go beyond insurance coverage. Two years ago, he had a severe allergic reaction to something in a cookie he ate at church. His partner drove him to the fire station five minutes away, where the town’s ambulance service is located.
Nelson, who says he looks “like a dude with breasts,” says that when the firefighters saw him, they became rude. They opened his shirt to check his heart and then said there was nothing they could do to help him.
Nelson and his partner raced to a clinic, where he was given oxygen and steroids and eventually began to feel better.
Nelson’s experience is hardly unusual, says Levasseur. “It’s one of the main issues we see,” he says. “People go to the doctor, and they say, ‘We don’t treat your kind.’ ”
Advocates say they hope that the HHS letter will help reduce incidents like the one Nelson faced.
This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.