Our Hormones

My insurance covers hormones, if you have private insurance here in Connecticut your hormones are covered but in many other states they are not and if you have ERISA* though your employer you might not get your hormones covered.

Here in the U.S. most of us either get our insurance through our employers or through Medicaid. You lose your job and you lose your insurance however, you covered for eighteen months by COBRA**.

So where does that leave you if you do not have health insurance or Medicaid? Where do you get your hormones if you are paying out of pocket.

Transgender Adults Often Forced to Seek Unlicensed Hormone Therapy
— Many are uninsured, others have claims denied, study shows
MedPage Today
By Jeff Minerd
November 9, 2020


Transgender adults are commonly denied insurance coverage for gender-affirming hormone therapy, and substantial numbers thus turn to unlicensed, nonprescription options that carry potential health risks, researchers reported.

A cross-sectional analysis of 27,715 transgender adults from a national survey found that approximately 21% reported having their insurance claims denied, said Daphna Stroumsa, MD, of the University of Michigan in Ann Arbor, and colleagues.

As shown in their study online in Annals of Family Medicine, use of nonprescription hormones was more common among those whose claims were denied (OR 2.53, 95% CI 1.61-3.97, P<0.001) as well as among the uninsured (OR 2.64, 95% CI 1.88-3.71, P<0.0001).

Overall, 9.17% of transgender adults who said they were taking hormone therapy indicated they were using non-prescription sources, such as getting the medication from friends or online, a percentage that translates to approximately 75,000 individuals.

I have to disclose that when I first started out on hormones my health insurance would not cover my hormones. My monthly out-of-pocket expense was about $300 while I could order my hormones from a New Zealand based pharmacy for $100 which I did. I was nervous about ordering from there but I figured that since my endo was monitoring my hormones levels ever six months I went New Zealand pharmacy.

I had excellent health insurance at the time but it was through the company’s ERISA policy so I wasn’t covered by Connecticut law and the company was based out of state so it was not bound by Connecticut law. But when I went on Medicare all that changed because the Centers for Medicare & Medicaid Services (CMS) had a ruling that we were covered under Medicare and Medicaid so I now get my hormones covered.

If you live in Connecticut there are a couple of policies that require coverage for us.

First is the oldest ruling, in 2013 the Connecticut Insurance commissioner issued a statement,
BULLETIN IC- 37: GENDER IDENTITY NONDISCRIMINATION REQUIREMENTS
December 19, 2013

Then in 2014 U.S. Department of Health and Human Services ruled that Medicare cannot categorically exclude treatment for gender dysphoria, including transition-related care.

Then on April 15 of this year the Commission on Human Rights and Opportunities (CHRO) issued a ruling that in part said,

Insurance policies that categorically refuse to consider certain procedures for certain people on the basis of their race, sex, or sexual orientation are facially discriminatory. So too are such exclusions for transgender people on the basis of gender identity, a condition unique to them.
[…]
Transgender people are uniquely reliant on medical services to help them treat gender dysphoria – to avoid both personal distress as well as future violence and discrimination. The State cannot permit itself, its agents, and its municipalities to discriminate against this vulnerable group of people.

Even though it was aimed at health insurance policies offered by the State of Connecticut and municipalities it was a warning to the insurance companies that they must cover health insurance for us.

*The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans.

**The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102% of the cost to the plan.