Gender Affirming Care Guide for Friday Members

Navigating health insurance as a transgender or gender non-conforming person adds another layer of complication and sometimes fear that is an unfortunate reality. At Friday, we strive to provide the best care for all our members, and that includes our transgender and gender non-conforming members. As a Friday Health Plans member, these are the things to know to successfully navigate your health insurance plan and care.

Navigating your State’s Exchange

When applying for Marketplace coverage as a transgender person, you need to use the first, middle, and last name on your Social Security card. When applying, you should select the sex that appears on your legal documents, such as your driver’s license or Social Security card. While we know this may trigger dysphoria, anxiety, or other responses, that is currently how the application works. Make sure you take proper steps to care for your mental health during this process.

If you change your name and/or sex after you enroll in a plan, you should be able to update the information when you log in. If you have trouble updating this information, contact the Marketplace Call Center.

Sex-specific Preventive Services

When receiving care for services regarding your sex assigned at birth, marketplace health plans must cover these. This entails services like shots, screenings, and preventative services. For example, health insurance companies must cover a transgender man (female to male) with residual breast tissue or an intact cervix who needs a mammogram or a pap smear. Your doctor determines the necessity of these services.

Updating Your Name/Pronouns:

To update your name, contact our Care Crew. This can be done by emailing questions@fridayhealthplans.com or visiting this page to find your state’s contact number. If you have health insurance through your state’s exchange, you will need to contact them to change it there too.

Currently, Friday Health Plans does not have the ability to update your pronouns. We are working on it. Be sure to tell your doctors and care providers when you visit. We understand that this can be difficult, so please take the appropriate steps to take care of your mental health.

Coverage by State

Every state is different. For what Friday offers, this information can be found in EOCs (Evidence for Coverage).

Colorado, Nevada, Georgia, North Carolina, Oklahoma, and Texas:

The Plan assures Member and Providers that any request for treatment for gender dysphoria is reviewed in a consistent manner and in accordance with accreditation agency standards, state and federal regulations and statutes. See EOCs for specific coverage on surgeries/medications.

New Mexico:

The Plan will not deny or limit coverage, deny or limit coverage of a
claim, or impose additional cost sharing or other limitations or restrictions on coverage, for any health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that an individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. Transgender protections rules do not restrict an issuer, in consultation with a provider, from determining whether a particular health service is medically necessary or otherwise meets applicable coverage requirements in any individual case. Coverage of preventive care for transgender individuals shall be based on the treating provider's determination and not the insurance company. See more specifics here.

Getting HRT (Hormone Replacement Therapy) Through the Friday Exchange:

Great news: as a Friday member, you have access to prescription coverage. See our Rx Resources Page here.

If you find that the hormone you’ve been prescribed isn’t a generic drug, ask your doctor about switching to something you can get for a lesser cost. If that isn’t possible, the costs for the drugs will go towards your deductible on most plans.

Finding a Primary Care Physician You’re Comfortable with:

Trusting and feeling supported by your doctor is vital when it comes to taking care of your health.

The 2015 U.S. Transgender Survey, published by the National Center for Transgender Equality, found that a third of trans respondents who’d seen a specialist in the previous year reported a negative experience related to being trans and that 23 percent of respondents had not gone to the doctor when they needed one in the last year because they feared being mistreated as a trans person.

So, how can you make sure you’re going to a doctor who is the right fight? Here are some strategies.

  • Ask around- Facebook support groups or friends may know a provider in the Friday Health Plans network if they’re also a member.
  • Check trusted sources such as the World Professional Association for Transgender Health (WPATH)’s provider search tool or the Human Rights Campaign’s (HRC) Healthcare Equity Index to see which health facilities are best in your state.
  • Look for signs of welcome in the office, such as brochures on LGBT+ issues health, visibly posted non-discrimination statements, or posters. Notice how the staff respects pronouns or your name too.
  • Once you’re in the waiting room, pay attention to the forms you fill out. Is there just room for male/female? Any place for a preferred name?
  • Ask questions.
    • Try something like, “I have some concerns around gender identity and affirming my identity. Is that something you have any experience in or that you’d be comfortable helping me manage and care for?”
      • If the provider expresses openness or has experience working with trans patients, that’s a good sign. If they fumble or don’t give you an answer, it may be time to hit the drawing board again.

Transitioning (Surgeries, Hormones, and Preventative Care):

Social transitioning: going by different pronouns, changing one’s style, adopting a new name, etc., to affirm one’s gender.

Medical transitioning: taking hormones and/or surgically removing or modifying genitals and reproductive organs.

Transgender individuals do not need to undergo medical intervention to have valid identities.

When transitioning to affirm your gender identity, there are many options depending on what you’re looking for. To get these surgeries or hormones, most places require:

  • A mental health evaluation: looks for any mental health concerns that could influence an individual’s mental state and assess a person’s readiness to undergo the physical and emotional stresses of the transition.
  • A clear and consistent documentation of gender dysphoria, often with a WPATH (World Professional Association for Transgender Health) letter.
  • A confirmation that you are healthy and won’t have any health risks related to going on hormones or completing surgeries.

How your insurance covers these may vary, but what isn't covered will go towards your deductible on most plans.

Preventative Care:

It’s essential to communicate with your doctor about your body. Even if you’ve had gender-affirming surgeries, there are still risks associated with things like breast and prostate tissues that you should check for. If you’re comfortable, be sure to check with your doctor about proper testing and preventative care you can do to make sure you stay healthy and thrive! This also includes birth control methods and sexual health preventatives, which are covered under your Friday Health Plan. Learn more about that here.

Navigating health insurance and caring for yourself is hard enough. Every transgender person, like every cisgender (identifies with their assigned sex at birth) person has their own journey. We’re here to help you through yours, no matter your treatment plan or lack of one. Your transition is your choice.

As always, if you have any questions about your plan, services, or benefits, please reach out to the Friday Care Crew at our contact page

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