How do you cope? Low income + trans

[AgentVermont052]

Ever since understanding and realizing I identified as transgender, I then immediately got faced with the inevitable pessimism about my transition. I earn a low income, just above the national poverty line. My employer doesn't offer benefits aside from paid time off/vacation days. Therefore I am on specialized medicaid plan in my state. This health coverage isn't accepted at all health care providers so my options for care are limited.

Unfortunately I pay out of pocket for my therapist. This isn't too big of a payment which is nice. The downside is that my health coverage does not cover any kind of gender confirming procedures (HRT or surgery). So I'd have to pay for T out of pocket every time I go to the pharmacy to fill the prescription. As well as paying out of pocket for surgery.

Due to my personal circumstances, the outlook I have to transition is grim because of my income and lack of health coverage.

I have been looking for improved employment over the past year and a half with no results. So hope for an increased income and hope for better health coverage is also dwindling.

So my question is, how do you cope when you just can't afford to transition? Any suggestions from those who have or are currently going through a similar experience? I'm so happy and I support and care for everyone who has the opportunities, but sometimes just wonder when it will be my turn and when I'll have those same opportunities.

[invisiblemonsters]

i don't know how it is there, but here (canada) my testosterone is about $70 every three months without insurance. i hear it's around the same for the states? i could be wrong though. the biggest hit i feel like someone would take while transitioning is probably surgery. fortunately, i did not have to experience any of the financial hardship because my surgery and therapy was covered under OHIP here and i have benefits which covers half of my testosterone cost. i think also blood tests might run you up a few hundred but again, i only got mine once every 6 months. it's more if you would have to go more often because of unstable levels, etc. i believe it's manageable but i can see how you would feel stressed and overwhelmed. i wish i could provide more insight.

[Pao]

I know how disheartening it can be. I felt much the same at the beginning. I still have lots of doubts. Turns out my doctors appointments are coded as regular office visits. And I don't know if my doc is coding it in a way my T is covered or if it is just that cheap, but my T is only $10 a month. I have a friend on disability, and his Medicare is covering his T.

T can do so much on its own. I would worry about that at first. My friend on Medicare has never had any surgeries, but lives and is recognized as male. The only issues are his documents, 'cause we live in a state that requires bottom surgery.

[widdershins]

There are clinics in many places that offer a sliding scale based on your income, and because they're deliberately meant to help low-income people they tend to take Medicaid. It could be worth seeing if you have anything like that where you live. It doesn't necessarily have to be an LGBT specific clinic, since technically any GP can write the prescription (if they're comfortable doing so.)

Shopping around at different pharmacies and using manufacturer's coupons can make the monthly cost for testosterone more manageable out of pocket. I got it for about $30 a month when I was between jobs.

Most of the trans people I know in person are poor. It may be more doable than you think. Surgeries are more difficult to swing than HRT, obviously, but like Pao said, T is probably the most important thing in terms of passing.

[plastic-mayhem]

Be very resourceful, study endocrinology, learn to make the best use of your resources.  Rules are rules, I cant say much more than that

[Morgan78]

I'm low income as well. Not low enough to qualify for any state aid, but low enough that ends don't meet if I don't work overtime/a second job. Thankfully, T seems to be cheap (my HRT consult is in a week). For the foreseeable future, there will be endless OT at work so I plan to work my butt off and hoard as much money as I can over the summer, bank my tax refund, etc.

My health insurance yearly plan max is $6000 for medically necessary procedures, so I know I'll need to squirrel away at least $6000 + a couple months living expenses before top surgery--assuming it is deemed medically necessary by insurance. I've seen it suggested that a 'breast reduction' can sometimes be considered medically necessary for large-breasted women if top surgery is denied by insurance for transgender men, so fingers crossed with my ginormous breasts it'll be approved one way or another. 

Although most of my dysphoria involves not having a penis, at this point if I can just pass as a male without having boobs screaming to everyone that I was born female and getting in the way of everything, I'll be thrilled. I'll worry about saving for bottom surgery after my top surgery is done. I know I'll have to have been on T for a least 2 years before having bottom surgery (meta) anyway, and it's anyone's guess what health insurance is going to be like in 2020 and later.

[AgentVermont052]

I've been away from the forums due to work and doing boring real life nonsense haha but I really appreciate your input.

I know how disheartening it can be. I felt much the same at the beginning. I still have lots of doubts. Turns out my doctors appointments are coded as regular office visits. And I don't know if my doc is coding it in a way my T is covered or if it is just that cheap, but my T is only $10 a month. I have a friend on disability, and his Medicare is covering his T.

I have heard of doctors coding certain things in a way that it would be covered. My 'membership handbook' I was given after being accepted into the medicaid program of my state, wasn't too specific. It did say regular visits and specialist visits are covered (to a point but normal visits to an endocrinologist most likely might be covered). I will have to ask my doctor what she thinks would be best! She is a recommended doctor by my therapist, hopefully I can get a call to their office this week (again life is busy and work sucks ha).

There are clinics in many places that offer a sliding scale based on your income, and because they're deliberately meant to help low-income people they tend to take Medicaid. It could be worth seeing if you have anything like that where you live.

Hmmmm I may look into that! I know my friend in NY goes to Planned Parenthood for his prescription. And it helps him, unfortunately PP where I live don't offer trans related health services. I'd have to drive 6 hours to the nearest one that does. But thank you, this was something I wasn't considering!

It may be more doable than you think. Surgeries are more difficult to swing than HRT, obviously, but like Pao said, T is probably the most important thing in terms of passing.

Of course, the issue I have isn't so much passing is that my chest gives me away. Every time. I can't bind for a few reasons, so that's why I'm having a hard time accepting top surgery won't happen for a year or more. But I do know that T will definitely help with my face/visible areas at least! Thank you.

... assuming it is deemed medically necessary by insurance. - ... at this point if I can just pass as a male without having boobs screaming to everyone that I was born female and getting in the way of everything, I'll be thrilled. I'll worry about saving for bottom surgery after my top surgery is done.

The handbook I was given did say small bits about conducting an appeal for denied coverage if "medically necessary" and did state certain procedures to appeal the appeal if I'm continued to be denied. But I'm only using that as a last resort due to the potential legal battle of getting judges involved at later dates so that itself would be a financial burden.

And I feel you about the being given away by your chest. Even when I bind, it is very obvious I have breasts. I know bigger chests can't get flat, but even with a well made binder it doesn't flatten them or bind them at all due to how I'm shaped there. Also a few other reasons I can't/don't bind.

Right now I probably could get a hysterectomy covered for medical necessity due to regular non trans related issues (meaning dysphoria etc). So I may try to get that underway when I start seeing my new doctor.

[Quinn]

I have no idea if your insurance would cover it or what the rules on conditions necassary are but I have heard of Masectomy as preventive when a number of family members have had breast cancer. Just thought I would throw that out there
Paige

[King Malachite]

With my income, and bills, I seriously doubt that I'd be able to fully transition.  At best, I may be able to get top surgery under my insurance that does make provisions for trans people partially covered.  Right now, I'm just kind of putting it in the back of my mind.  Totally not the best solution, but I can't really think of anything else.

[AgentVermont052]

... I have heard of Masectomy as preventive when a number of family members have had breast cancer. Just thought I would throw that out there.

They do have a stipulation (I think is the word...) about 'medically necessary' procedures being covered if I am initially denied. Which kind of gives me hope for a hysterectomy. I don't think she had exactly PCOS but my mother has had major issues with cysts on her overies/uterus and just overall issues with her stuff. She's had multiple surgeries for them too. So discussing that history with my doctor may get me approved for an insurance covered hysto! Just as a cancer and major cyst preventative to avoid potential issues.

At best, I may be able to get top surgery under my insurance that does make provisions for trans people partially covered.

I hope you are able to get some of it covered! That would be any x amount you wouldn't have to pay out of pocket

With my current plan, I could probably get top surgery covered by getting my therapist and doctor saying it is medically necessary for my mental health (idk if that's even a way to do it or if the insurance would even accept that reason).

[The Flying Lemur]

There's always Good Rx, which is an app that lets you know about coupons major drugstore chains take for certain medications.  You can get tens or sometimes even hundreds of dollars off your un-covered prescriptions that way.  You can also write a drug manufacturer (or have your dr. or therapist do it for you) and ask to be part of their patient assistance program.  This site lists the manufacturers and PAP applications for a ton of drugs (the site is free): https://www.needymeds.org/program-apps

[kylen kantari]

I would advise trying your doctor anyway, even if your health insurance doesn't cover anything transition related. If you get a good doctor, sometimes they will code the hormones in their system as treatment for an "endocrine disorder" or "hormone imbalance" without saying that it's HRT. This lets the insurance cover it without them knowing it's for transition.

If that doesn't work, depending on where you live, there may be clinics, or lgbt centers that offer hormones on an informed consent, with greatly reduced prices for those without insurance.

Unfortunately, surgery will most likely still have to be out of pocket.