New Guidance Helps Ensure that Transgender Individuals Can Access Preventive Care

By: Andrew Shaughnessy
Manager of Public Policy, PROMO

New guidance issued by three federal agencies—the U.S. Departments of Labor, Health and Human Services, and Treasury—could make a huge difference in lives of transgender individuals seeking access to preventive services. The guidance clarifies the rights that consumers have when accessing preventive services under the Affordable Care Act and specifically addresses the needs of transgender people, who have long faced discrimination in the health care system.

In its answer to question five, the guidance states that insurers must provide “coverage for the recommended preventive service, without cost sharing, regardless of sex assigned at birth, gender identity, or gender of the individual otherwise recorded by the plan or issuer.” In effect, this means that insurance must cover free preventive care—such as mammograms, pap smears, and prostate exams—regardless of the gender listed in an individual’s health record or state-issued identification documents so long as the procedure is recommended by a physician. So, if recommended by his doctor, a transgender man with an intact cervix can get coverage for a pap smear without cost sharing.

The guidance applies to all preventive services available under the Affordable Care Act—including screenings, immunizations, and contraception—and many types of health insurance, including many of the plans offered by employers. By ensuring that transgender individuals have much-needed access to preventive services to stay healthy, federal regulators have taken a significant step forward to address one of our community’s concerns about health reform.

Despite this progress, there is still more work to do to ensure that our transgender friends and family have access to all of the health services they need. As part of this effort, LGBT health advocates in Missouri supported a complaint to end discriminatory health insurance exclusions after finding such exclusions in plans offered through the marketplace. After filing the complaint on behalf of over 150 Missourians, advocates have begun working with the U.S. Department of Health and Human Services’ Office of Civil Rights to address this issue and promote access to all medically necessary services for the transgender community.

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