One Colorado, the state’s leading advocacy organization for lesbian, gay, bisexual, transgender, and queer (LGBTQ) Coloradans and their families released their open enrollment buyer’s guides updated for 2020.
The three buyer’s guides, Transgender Health Insurance Guide, Hormone Therapy Prescription Coverage Guide, and PrEP and HIV Prescription Coverage Guide, review the plans available on the Colorado marketplace for coverage for transition-related care or a person living with HIV that needs specific prescription drug coverage.
These guides not only look at whether the eight plans on the marketplace cover behavioral health services, hormone therapy, and medically-necessary affirming surgery, but also review the availability of an LGBTQ health navigator, coverage of puberty blockers for minors, quality of hormone therapy coverage, and HIV prescription and prevention coverage.
“Despite the incredible progress we’ve made to advance public policy that will benefit and protect LGBTQ Coloradans, the ability to access health care that meets your needs has stagnated – or in some cases worsened – for LGBTQ Coloradans. All patients should have access to inclusive, affirming, medically-necessary care,” stated Daniel Ramos, Executive Director of One Colorado. “Under federal and state laws, including the Affordable Care Act, it is illegal for doctors, hospitals, and insurance companies to discriminate against transgender people. That means that health plans aren’t allowed to exclude transition-related care. These guides help to illustrate what plans will best fit the needs of LGBTQ Coloradans looking to purchase health insurance through the marketplace.”
According to One Colorado’s 2018 health report, Closing the Gap: The Turning Point for LGBTQ Health, which surveyed over 2,500 LGBTQ Coloradans and their families, 32 percent say they do not have sufficient choice of and access to LGBTQ competent providers who are in-network
with their insurance carrier. In 2018, 34 percent of transgender respondents have been denied coverage for an LGBTQ-specific medical service, like HIV medications, hormones, PrEP, PEP, HPV vaccine, medically-necessary affirming care.
About 59 percent of respondents report taking some sort of hormone therapy. Of those, 78 percent are able to get it in the form that works best for them, whether that is an oral tablet or capsule, transdermal patches, injections, anti-androgens, implants, or another form. Of the four in ten respondents who do not use hormone therapy, 66 percent either do not have or do not know if they have access to it. Cost is the most common barrier to getting hormone therapy. Additional barriers to getting hormone therapy include issues finding a health care provider who will accept one’s insurance, an insurance plan not covering hormone therapy, and a health care
provider either not knowing how or refusing to cover it.
If you are wrongfully denied medically necessary services from your health insurance carrier, it’s your right to:
Appeal the decision directly with your insurance carrier. If your health plan ID card has a
“CO-DOI” designation on it, your plan is subject to Colorado’s insurance laws and rules, including Colorado Code of Regulations 4-2-62 Concerning Insurance Unfair Practices Act Prohibition on Discrimination Based Upon Sexual Orientation or Gender Identity.
File a complaint with the Colorado Division of Insurance at www.dora.colorado.gov/
File a complaint with the Colorado Civil Rights Division at www.colorado.gov/pacific/dora/