Navigating the Insurance Markets for Trans-friendly coverage

[Roll]

I'm wondering if anyone can offer some insight on how to find the best ACA plans for covering transition related expenses (obviously not specific plans, just general ideas on what I should look for). Currently I have Georgia medicaid, which is free and honestly not too bad at all. The problem is, as far as anyone will tell me, it won't cover crap for transgender issues so I am looking at thousands out of pocket on HRT alone (including appointments, the cheaper meds obviously not too bad). So with the 2018 ACA enrollment opening soon, I was considering purchasing insurance through it since it might actually save me money if enough is covered even with the monthly premium (and perhaps allow me a smoother transition for moving into working conditions after I finish school, since I'll be losing medicaid regardless then).

But yeah... I'm lost. I can't figure out what plans cover what based on healthcare.gov and the GA specific site, and I've never had to deal with non-medicaid insurance enough in the past to be able to tell what I need to look for. I found one site that talked about transgender coverage in the state, but it didn't really tell me anything that wasn't obvious.

Talk to me like I'm a 10 year old on this issue, I really don't know what I'm doing.

[DawnOday]

Kaiser Permanente has a good program at least here in Washington and Cali. 

https://healthy.kaiserpermanente.org/health/care/consumer/health-wellness/conditions-diseases/he2/!ut/p/a1/hZDRboIwFIafhkvpQVyF3aGLUDvUZWay3iwFOmCpLYEq4e0Hzl2YbPHcneT7v5zzI4YSxBQ_VwU3lVZcjjvDH6v163axcAIIw2gFJHoKHeqEU_AwOqA1YoXU6QV-L42pHy2wINPKCGUaoXLRiMYCxMquylHC0y8f4_k9mJu-FigpBZemnAiV9ZnUtcgrfi8pdcblEBVqcmpHOFCp6xWINeJzZOxTM5w6GtqLous6u9C6kMLO9HEw_BEpdWtQcksOr7PbdrYz3wMSL6Ml2VCAcHoFdgEQL4YHBwIXA8F7l87jjQPh7AqAS15--t1hGFi6p28-dQF-DfDPBIDqo9e78vwsDp7xSUW-AdF1uY8!/dl5/d5/L2dBISEvZ0FBIS9nQSEh/?region=GGA

[Izzy Grace]

Do you have a local equality group there? If so asking them might be an avenue worth giving a shot.

[Devlyn]

I'm wondering if anyone can offer some insight on how to find the best ACA plans for covering transition related expenses (obviously not specific plans, just general ideas on what I should look for). Currently I have Georgia medicaid, which is free and honestly not too bad at all. The problem is, as far as anyone will tell me, it won't cover crap for transgender issues so I am looking at thousands out of pocket on HRT alone (including appointments, the cheaper meds obviously not too bad). So with the 2018 ACA enrollment opening soon, I was considering purchasing insurance through it since it might actually save me money if enough is covered even with the monthly premium (and perhaps allow me a smoother transition for moving into working conditions after I finish school, since I'll be losing medicaid regardless then).

But yeah... I'm lost. I can't figure out what plans cover what based on healthcare.gov and the GA specific site, and I've never had to deal with non-medicaid insurance enough in the past to be able to tell what I need to look for. I found one site that talked about transgender coverage in the state, but it didn't really tell me anything that wasn't obvious.

Talk to me like I'm a 10 year old on this issue, I really don't know what I'm doing.

My HRT was coded as a male with a hormone disorder. That isn't transgender care. An LGBT friendly doctor or clinic will make sure your insurance goes through.

Beyond HRT, I was diagnosed transgender and insurance has to cover it in my state, Massachusetts. I know that varies from location to location.

Good luck navigating the maze!

Hugs, Devlyn

[Roll]

Do you have a local equality group there? If so asking them might be an avenue worth giving a shot.

I had found a list in the past made my a group, but I can't seem to find it again. It's driving me nuts. :/

This seems like it might be a bust though, the only affordable plans here are now just Blue Cross, and I believe I read somewhere that they wont cover transgender issues except for in states that mandate it. I also run into an issue with a super expensive psoriasis medication, in that I'm worried about rocking the boat on it. (That medicine alone is more expensive than pretty much all possible transition costs combined... so yeah. Fun! )

[Tiame]

I have been looking at plans too. Due to HRT cost and labs. I goto Planned Parenthood on informed consent. But, also with psoriasis too makes me wonder if both possable. If you find one let me know am in Washington.  Good luck on your search

[Roll]

I have been looking at plans too. Due to HRT cost and labs. I goto Planned Parenthood on informed consent. But, also with psoriasis too makes me wonder if both possable. If you find one let me know am in Washington.  Good luck on your search

I'm not sure where you are in transition, but as I've been doing more research over the past little bit I'm starting to come to the conclusion that until GCS is on the horizon this might be a wasted effort if you already have coverage for other things through another source (ie: medicaid or whatever). Even in the states that cover GCS, they seem to not cover much of anything else aside from it and HRT, so wouldn't put a dent in the other big costs like hair removal and what not (which a few people have said their workplace or premium plans do cover, so I had a tiny inkling of hope I could find something on the marketplace that would handle some of it). And for the most part, HRT would be cheaper than the premiums if that was the only immediate motivation.

Are you on a biologic for the psoriasis too? While I'm thinking this is a bust, in general it may be worth knowing that I was talking to someone about the plans (family member who is a doctor), not bringing up the trans coverage aspect of my motivation, and was told that switching shouldn't matter too much for psoriasis stuff. Basically, if one insurance deemed the meds necessary, the others will only put up a small fight or at worst have you try a different biologic they have a distribution deal with first. (For those unfamiliar, the biologics can run 5,000$ a month. So more expensive over a few years than all transition costs combined, so unfortunately a big issue to risk. )

[Tiame]

Are you on a biologic for the psoriasis too? While I'm thinking this is a bust, in general it may be worth knowing that I was talking to someone about the plans (family member who is a doctor), not bringing up the trans coverage aspect of my motivation, and was told that switching shouldn't matter too much for psoriasis stuff. Basically, if one insurance deemed the meds necessary, the others will only put up a small fight or at worst have you try a different biologic they have a distribution deal with first. (For those unfamiliar, the biologics can run 5,000$ a month. So more expensive over a few years than all transition costs combined, so unfortunately a big issue to risk. )

My end goal yet is unclear about GCS. I will decide that after a few years on HRT since it takes 3 to 8 years why rush. No not at this time no biologic there is a new trial coming i want in on and have to be 12 months or greater off it.  Yes they are very expensive.

I have not heard of any that covers more then labs, hormones, and therapy. GCS use to be covered on oregon medicaid but think that changed.

[KarynMcD]

If you haven't read the report here ( http://georgiaequality.org/2017/09/oices-equity-experiences-transgender-georgians-can-inform-implementation-nondiscrimination-provisions-affordable-care-act/ ) you might want to.
It may help.

[RobynTx]

BSBC Texas has paid 100% for my HRT but they haven't paid anything for my lab work. 

[DawnOday]

  As long as you are under 65

I'm 66 next week. Maybe a YMMV designation should be placed on my statement. When I showed my Doctors, literature from DESAction they no longer asked questions. I have seven or so symptoms they show on the list. There are not many left out.

[Izzy Grace]

My phone call with insurance today was not positive. Some claims have come through they said, but they had never seen one approved. Doctors can code things, but they look at medical records and investigate they said. After they came back from talking to someone else it was an awkward conversation. I asked, so they dont have any exclusionary statements but they deny. The rep was very reluctant to answer and stuttered alot and finally kept just saying: "it has to be medically necessary."

How much is HRT without insurance where any of you are? (not trying to hijack Roll, just figured I'd ask)

[Roll]

How much is HRT without insurance where any of you are? (not trying to hijack Roll, just figured I'd ask)

Totally on topic, and I wouldn't care if it wasn't. I am the queen of tangents.

My understanding is that it is on the cheaper side for most of the meds even without insurance, with some figures I saw going as low as $10 a month. But then if you get into the more convenient pellets and patches the price shoots up dramatically.

[Kara_Rae]

I currently don't have insurance due to being unemployed and I pay out around $20 for HRT. That is E pills and spiro.

[DawnOday]

Laurie      https://www.transequality.org/know-your-rights/medicare
               https://thrive.kaiserpermanente.org/care-near-you/southern-california/transgender/
To my knowledge this program has not changed.

Drug prices on Blinkhealth.com       Estradiol pill          $22.88 month
  Many local drugstore choices 
                                                    Semi weekly patch( $82.87
                                                    Weekly patch  (4)      $71.95
   Not a medical provider                  Injection  medication is hard to find      $224.38

                                                     Spiro                    $13.02

HRT is the process  estradiol, Spiro and finasteride are the medications. Spiro and finasteride Limit Testosterone production.  Estradiol are female hormones
                                                      finasteride            $19.96

[Izzy Grace]

I currently don't have insurance due to being unemployed and I pay out around $20 for HRT. That is E pills and spiro.

Whoa. Really. I was thinking like, $200!

[Dena]

  As long as you are under 65

Kalser has Medicare supplemental insurance but I am not sure how it works or what it covers. I leave that to somebody else to research. It is something you enroll in just like regular medicare supplemental coverage.

[Sarah_P]

Wow, where are you getting Spiro so cheap? I've got no insurance (but I do have a pharmacy discount card) and my total for HRT is $46 - around $42 for Spiro & $4 for E (pills) each month.

[jill610]

Ask your local pharmacy if they have any discount plans available. I have prescription insurance (costs me $20 each every 90 days for spiro and estradiol, but looks like $10 spiro, $20 estradiol monthly at cvs without insurance), but finesteride is not covered. Retail is $78 for a month supply, however wegmans got that down to $20 with a free in store plan. Never hurts to ask the pharmacist if help is available!

[Roll]

In that vein, Doctors will often have a slew of the GoodRx cards (they literally get shipped them in boxes of hundreds per month) that you can use for a discount most places, and I think their app offers the same discounts. Using GoodRx the Proscar equivalent generic finasteride only runs 26$ at CVS here and is actually free at Sam's Club if you have a membership. Which I think runs $50 for a year, so that math is obvious. (Numbers based on my local values, I have no clue if it varies with GoodRX based on individual store or not.)