The WA state legislature passed a law in 2021 that required state-regulated insurance to cover gender affirming care as of January 1, 2022.
Unfortunately, this law does not apply to all insurance in the state of Washington. It is not correct that all insurance plans in Washington State must cover gender affirming care.
As open enrollment season is coming up, let’s talk about the details.
Which Insurance Plans Are Required to Cover Gender Affirming Care?
State-Regulated Plans Are Required to Cover Gender Affirming Care
These plans include:
- All plans available on the ACA marketplace: all plans listed at https://www.wahealthplanfinder.org/ are required to cover gender affirming care.
- Washington Medicaid: Apple Health Plans.
- Some employer plans (most small and medium-sized employer plans.)
Plans That Are Not Required To Cover Gender Affirming Care
- Self-funded plans
Self-funded plans are generally only offered by large employers. In a self-funded plan, the company pays all of the medical claims, although they may hire a third party such as an insurance company to administer the plan. These plans are not required to cover gender affirming care in Washington State.
What If My Employer Is Based In Another State?
Employers based in another state are still required to follow Washington laws for insurance plans offered in Washington. Large employers in other states who have self-funded plans do not need to cover gender affirming care, but employers who have state-regulated plans do need to cover gender affirming care.
How Do I Find Out If My Employer’s Insurance Plan is State-Regulated or Self-Funded?
- Ask your benefits department
- Contact the Washington State Insurance Commission (they’re really nice!) They may be able to help you even if your employer isn’t based in WA.
- Contact the insurance commission in your employer’s home state (the office may be named something else.) Here’s a directory of state insurance offices.
What Can I Do If My Employer Only Offers Self-Funded Insurance Plans And Those Plans Don’t Cover Gender Affirming Care?
- Work with insurance navigators such as Trans Family Support Services, or Transcend Legal to see if you can get care covered.
- Ask your providers to submit a prior authorization and go through the appeal process.
- Ask your employer to cover gender affirming care. TransEquality has a guide!
- Consider filing a complaint with your state insurance commissioner or the federal Office of Civil Rights.
Information on Insurance Requirements In Other States
The Movement Advancement Project is an excellent resource for up-to-date information on equality measures across the United States.
Screenshot from their Healthcare Laws and Policies page accessed 10/10/23:
Finding an Insurance Plan That Covers Gender Affirming Care
In other states, Out2Enroll can help you identify affirming plans and get you signed up.
Open Enrollment Dates for ACA Marketplace plans for 2024 starts on November 1st, 2023.
- Key dates for Marketplace coverage
- November 1: Open Enrollment starts.
- December 15: Enroll for coverage that starts January 1.
- January 15: The last day to enroll; Open Enrollment for 2024 coverage ends.
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