There have been some questions arising from the recent announcement by the Social Security Administration about what happens to you spouse if you change your gender marker. The NTCE has tried to answer some of those questions…
Will changing my gender with SSA affect my health benefits?A complete list of questions and a list of resources is here.
Changing your gender marker with Social Security will typically not affect your health insurance at all if you have private insurance. While some insurance plans may automatically refuse coverage of services that appear inconsistent with a gender marker in the plan’s records, insurance plans generally do not base their gender data on, or match it with, Social Security records, but instead use data from enrollment forms.
An exception is that if a person is enrolled in Medicare, or is enrolled in both the Medicaid and Supplemental Security Income (SSI) programs, their insurance record will be based Social Security data. In that case, they may experience automatic refusals for coverage of services that appear inconsistent with a gender marker in Social Security records. These automatic rules were developed as a means to prevent erroneous or fraudulent billing, with the unintended consequence of sometimes affecting trans people. (This can happen with private insurance too, but that will be based on the gender in plan records, not Social Security records.) These types of denials can usually be resolved by having your provider’s office either add a specific billing code, contact the plan, or help you request a formal coverage determination. For more information, see NCTE’s health care and Medicare rights below.
What does “Appropriate Clinical Treatment” mean?
The new policy recognizes that people’s medical needs vary, and that treatment options must be decided by health care professionals on an individual basis. You are entitled to an updated gender marker if you have had the clinical treatment determined by your health care providers to be appropriate, in your individual case, to facilitate gender transition.No specific type of treatment is required, and details of your treatment should not be included in the letter from your physician to SSA.
NCTE encourages you and your doctor to only state in the letter that you have had the clinical treatment determined by your health care providers to be appropriate. Details about surgery, hormone treatment, or other treatments are unnecessary and not help
How does Social Security treat marriages involving transgender people?
Social Security recognizes as valid any marriage that was recognized under state law as being a valid, different-sex marriage when it was entered into. Any marriage that was valid when it was entered continues to be valid regardless of a spouse’s transition.
Social Security looks to state law and government-issued documents (such as birth certificates and court orders) to determine marital status – it is not based on the gender marker in your Social Security record. For this reason, changing your gender marker with Social Security will not affect your or your spouse’s right to Social Security benefits.