Some of you may know I am moving out US/East coast, and I'll be signing up for insurance through the federal marketplace insurance.  I know that whoever I go with cannot deny my claims for HRT, doctors visits, and routine trans woman care as it is pre existing (about the only thing Obama did good with healthcare - pre existing conditions).  Anyways, I'll be full time female and my driver's license, social security card, birth cert, passport, and all that jazz will have my gender marker as female, although I not yet had SRS.  So my question comes, what do I put when I apply for insurance? The main issue is because all my gender markers will say female, and they check with social security or my identification, and if I put male, it will come back denied as applied as 'wrong gender'.  However, if I place female, which I am more leaning towards doing anyways, I am afraid that HRT will have complications getting processed because they think I should be under female to male hormones... not other way around.  That, and spiro is a male drug.  So I am stuck between a rock and a hard place.  Any ideas/thoughts?

Spiro isn't just a male drug it is used for several different things including heart disease (diuretic) , blood pressure, and to help raise potassium levels to name just a few uses for it. I wouldn't think you should have any problems. I have a few female friend who is on HRT due to having things removed due to health problems related to them and she is on both estrogen and testosterone so I wouldn't think you should have any problem. HRT combination is different for everyone depending on the reasons they need it. Insurances are well aware of this. So as long as all your ducks in a row you shouldn't have a problem. My insurance isn't through the marketplace, but I have had any issues. Between my estradiol, syringes, and needles I only pay 11.2 for a 3 month suppy. The sprio is costing nothing since the insurance pays 100 percent since it can be used as a blood pressure med.
Mariah

Spiro is used for high blood pressure and for hirsutism (excessive hair growth) and both of these applications can be given to women.

But let me state, I am now legally female and changed my gender marker with my insurer yet my doctor just prescribed proscar (high dose of finasteride) and insurance covered it without a blink of an eye. Proscar is normally only used for male prostate treatment.

If I were you, I'd apply female. If any issues arose, I'd appeal to the insurer and provide legal documentation of my transition.

Also there are lots of females who need estrogen and/or progesterone for various reasons. Don't sweat those either.

It also heavily depends on the insurer, too. I'd be really surprised if anything you got through the marketplace will give you any problems, though. They're pretty good with that. It's the private insurers, and the ones that are pawned out through your company that you have to worry about, and even then they probably won't bother with you unless something weird comes up.

Thank you everyone for the replies.  I will apply as female.  I did have one prescription get denied through marketplace, it was finasteride.  It is used for other conditions that I do not have and the insurance don't think it is for hormone replacement therapy, but my doctor prescribed it to assist spiro in blocking T as one of the side effects is blocking T.  I didn't give insurance too much problem about it, as I found I can buy it for $10 directly from the drug store. 

I doubt the insurance will deny the pharmacy claim if you check off female. As far as the outside worlds official paperwork goes, you are. The pharmacy claims in my experience are handled by a third party processor. The only time they balk about something is if it is an expensive proprietary drug. They may make the doc go through a few hoops to justify it, as with my wife's BP med, the only thing that works to date. Or suggest an alternative.

My current insurance explicitly states that it does not cover transgender anything. Yet not a word about my injectable E or spiro. Pretty obvious when you add 2 + 2.

BTW - IMHO your pre-existing condition argument might not fly. I am not aware of any federal ruling that states TG care is covered. It varies by state. Most insurances exclude TG care, even therapy.

These only issue you might get if you are ftm is when you are ready for hysto, and they deny you, or a mammogram, etc. I'm playing it as "female" until after the hysto, then next insurance sign up I'll say male, and finally get my t covered. Right now it's not worth fighting to get them to pay for the t when the surgery is so much more expensive. This whole system is stupid, to be honest. Grs is allowed in Medicare, in quite a few progressive states, and even in the federal employees insurance. As far as Medicare, like anyone wants to wait their entire life to feel normal....

Quote from: JoanneB on November 23, 2014, 03:02:11 PM
I doubt the insurance will deny the pharmacy claim if you check off female. As far as the outside worlds official paperwork goes, you are. The pharmacy claims in my experience are handled by a third party processor. The only time they balk about something is if it is an expensive proprietary drug. They may make the doc go through a few hoops to justify it, as with my wife's BP med, the only thing that works to date. Or suggest an alternative.

My current insurance explicitly states that it does not cover transgender anything. Yet not a word about my injectable E or spiro. Pretty obvious when you add 2 + 2.

BTW - IMHO your pre-existing condition argument might not fly. I am not aware of any federal ruling that states TG care is covered. It varies by state. Most insurances exclude TG care, even therapy.

The affordable healthcare act in the United States bars insurance from discriminating coverage such as hormone replacement therapy.  Prior to this being enacted, it was nearly unheard of to have insurance pay for HRT.  The question still remains is forcing insurance to cover SRS as insurance companies think it isn't necessary.  They will lose this battle in time

Quote from: Alexis2107 on November 23, 2014, 03:27:31 PM
The affordable healthcare act in the United States bars insurance from discriminating coverage such as hormone replacement therapy.  Prior to this being enacted, it was nearly unheard of to have insurance pay for HRT.  The question still remains is forcing insurance to cover SRS as insurance companies think it isn't necessary.  They will lose this battle in time

The policy I got through the marketplace -specifically- states it covers NOTHING towards or related to transgendered care. Before this health care act, I would get turned down for insurance simply because I was TG so this is an improvement. They probably will pay for meds if it doesn't state they are for TG issues. My meds are so cheap, it's not worth bothing with.

Quote from: Stephe on November 23, 2014, 04:13:08 PM
The policy I got through the marketplace -specifically- states it covers NOTHING towards or related to transgendered care. Before this health care act, I would get turned down for insurance simply because I was TG so this is an improvement. They probably will pay for meds if it doesn't state they are for TG issues. My meds are so cheap, it's not worth bothing with.

I am not sure, but I will research and find the article where I read back in August of this year, they were forced to cover certain trans gender care.  I could be wrong.  My insurance knows I am TG and on HRT, but that is the extent of it.  They pay for nearly everything.. even prescriptions are 100% paid for except the one for $10 that I was told wasn't necessary for HRT.  My current insurance will pay for SRS but I am not staying in this state   I am moving in with my fiance', which by the way, we're getting married next summer   Anyways, I am moving in with him and that's out of state.  From there, we may move to Washington DC so I can obtain SRS coverage.  Neither of us want to live in the midwest so coming back to my state really isn't an option.  I have plan B already in place if I have a terrible time in a couple years to get SRS paid for, and that is just to spend my own money that I have been saving for a long time for adopting children and/or purchasing a house.  My husband and I will have to figure out what is most important... I can do without the surgery, as long as I am legally female, full time female, and everyone knows I am female.  I don't need a vagina to be female.  But, I don't think it's fair on either of us to go through life without our own little pleasures (sex).  So, doing SRS is really for his peace of mind that, although I will legally be a woman, that he has a woman.. If we both decide that family and/or house are more important, we may put the SRS on the back burner... or pay a lesser fee and have the testes removed so I don't produce T anymore, at the very least. 

Sorry for babbling on, I know I went off topic.  but it's an issue I been battling for a while to figure out and amazingly, there's very little resource.  I nearly am considering making some sort of resource database of what has worked in past... ie.. users post what insurance they purchased that covered SRS, want plans they have, what insurance doctors will accept, etc..... it is really needed as the TG movement ... moves forward.  I feel we are on the bottom of the totem pole... GLBT or whatever the acronym is... we are appended on the back of it all... and sometimes, it is frustrating to feel we are at the end of the line. 

That article you saw may be when California announced it would be covering TG care under the ACA. Big chunks of insurance is regulated by each state. Everything is still in a state of flux with new announcements always being made

If you begin to look to relocate out of DC itself, I believe Maryland covers parts of TG care. Not sure about SRS. Check with Equality Maryland. The folks there are fairly politically active. Whitman-Walker in DC is also a very good TG resource with plenty of helpful people there. Maryland passed a TG Rights law this past year. Parts of MD, like Baltimore and Montgomery County had laws in place many years ago. A few of my group members are from the Rockville area.