Health Insurance Questions

[Lucky Peach]

Ok, a bit of background first. I'm in the USA, and in my 20s. My current health insurance is expiring at the end of the year and I'm looking at private insurance plans to replace it (COBRA is just silly expensive, I've been quoted in the $450/month range). I've got a plan through a group with Aetna (a PPO) and I'm definitely looking to keep a PPO. I'm kind of interested in knowing if anyone who's had experience with this in the states can give me a few pointers in terms of going about this search, and potentially if anyone can answer a few questions for me. I know that some of these questions may be a bit specific and I may have to ask on my own

• First of all, are there any private insurance policies that cover SRS? If I'm spending this much a month, then I may as well get something out of it I feel.
  Second, what about hormones?
• I can't be denied coverage because of my 'pre-existing condition' (trans status) with some of the new healthcare reforms, right? Or is this only with HIPAA policies?
• Would coverage relating to any conditions that they deemed preexisting be subject to a waiting period?
• Would this matter if I changed from a plan with Aetna to a plan with BCBS for example?

If anyone could answer any of these questions for me, I would be ever so grateful. Thank you in advance

[Brooke777]

Sorry, I don't have many answers for you. But, there are a couple of insurance threads here that might be of assistance. I don't remmember the names, but if you search for insurance you should be able to find them. Also, I think BCBS covers SRS in some of it's policies.

Hope this helps a little.

[Lucky Peach]

Thanks for the reply Brooke. It does help. I'll definitely take a look around later for some of the other threads.

I called BCBS and got the number for a product specialist, so hopefully during the week once I have some time (and they're open, sheesh) I'll be able to get some answers from them, and I'll try to remember to post my findings

[Brooke777]

I am glad I at least helped a little. Please, definitely post your findings. I am always interested in learning which companies do/don't cover our care.

[Kelli]

HRC.org lists Aetna as being one of the insurance carriers that DO cover SRS in some of it's policies.

Also, BCBS Mass does cover it... However, I'm unsure of other BCBS's that also cover it.

I recommend checking out HRC.org and the insurance index they have,

[Adabelle]

I am not aware of any individual (ones you can purchase on your own) health insurance policy in the United States that covers SRS.

The only health insurance policies that I'm aware of in the US that cover SRS are ones that you get through a place of work. These are not available for individuals to purchase, but any company can call their insurance provider and have it added to their group plan.

The HRC has an index of companies that do include SRS in their group plan, but you can't go out and buy that plan and get SRS covered. So Aetna, Cigna, Blue Cross/Sheild all have SRS inclusive plans - but they are group plans only available to certain companies to pay for that coverage for their employees.

If you're interested in SRS inclusive care, the HRC list is a great place to look for a job and apply at those companies that are inclusive. Otherwise as an individual so far as I know it's impossible to find an individual plan that covers it. I fortunately work for a company that does pay for SRS (through their Cigna plan), however it's not available for purchase. If I was to lose my job I'd certainly pay for COBRA until my surgery is complete.

I hope this is helpful even though I don't have good news.

[Stephe]

• I can't be denied coverage because of my 'pre-existing condition' (trans status) with some of the new healthcare reforms, right? Or is this only with HIPAA policies?

I think this happens 2014.

I haven't been "denied coverage" but they instead quote me obscenely high rates, which I can't afford. I'll just say they were higher than the $450 a month quote you posted.  And no, they didn't cover SRS, they explained "You are high risk because of the metal health issues involved." Back to why I hate that therapy is required as part of trans health care. I would take a plan that didn't cover HRT or anything related to being trans but I keep running into this "pre-existing mental condition" because one of the questions they always ask are "Have you ever seen a mental health therapist" and the only reason I have is to get an HRT letter. They don't care why you saw one, it throws up a red flag as high risk. At least that has been my experience.

[Lucky Peach]

I think this happens 2014.

I haven't been "denied coverage" but they instead quote me obscenely high rates, which I can't afford. I'll just say they were higher than the $450 a month quote you posted.  And no, they didn't cover SRS, they explained "You are high risk because of the metal health issues involved." Back to why I hate that therapy is required as part of trans health care. I would take a plan that didn't cover HRT or anything related to being trans but I keep running into this "pre-existing mental condition" because one of the questions they always ask are "Have you ever seen a mental health therapist" and the only reason I have is to get an HRT letter. They don't care why you saw one, it throws up a red flag as high risk. At least that has been my experience.

I'm finding I'm running into this too. I spent a bit of time on the phone trying to research and get an idea of what the rate quotes might be, and well, they're not great. I think that I've pretty much settled on extending my coverage with COBRA under my mother's policy. They actually gave me two options when I spoke to them earlier, one at $340/month and the other at $580 (the latter being the continuation of current plan that I have). I'm getting the plan documents together to choose, but even $580 is better than what I was hearing today, and with a much lower deductible.

I'm still waiting to hear back about SRS coverage from both Aetna Individual and BCBS for where I am, but when I was speaking to the rep, she said a lot of the plans have exclusions for such. If I get answers, I'll make sure to post them here, as maybe they'll be of use to someone else looking, but it didn't leave me to sound hopeful.

In order to apply for the HIPPA plans where they can't ask about prior medical history you have to exhaust all the COBRA benefits anyway, at least until more of the ACA goes into effect in the beginning of 2014.

This all has me convince that our healthcare system is totally broken and full of crooks /rant

[Stephe]

The current system only works if you are full time employee of a large company that actually supplies insurance. If you try to do something like start your own small business etc, you will never be able to afford health coverage for yourself or your employees.

[arbon]

I was denied by a couple of carriers with gender identity disorder listed as the reason  and could only be eligible for high risk plans

but if you are denied, or if you refuse a policy because it will not cover a preexisting condition,  you may be eligible for this:

http://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/index.html


I did apply and am waiting to see if I was accepted or not. It does not cover srs, but it is a lot lower deductible and lower premiums  then the only other option i had. 

[Stephe]

that is great info, thanks!