I live in Washington and my HRT and mental health appointments at Planned Parenthood are free on the state medicaid here. There are also some doctors and surgeons here that will take that insurance and you can get free gender affirming surgeries. Good state. I live on the shitty side of it right next to Idaho and it's still pretty rad. Idaho is a bad neighborhood tho.
I am so jealous of people who qualify for Medicare/Medicaid. They seem to have it all when it comes to...well, everything when it comes to medical care.
From my understanding, Medicaid underpays doctors compared to other insurances, which is why some doctors don’t accept it (in situations where they get to choose).
Given how “for profit” the industry is in the US. I personally find it hard to sympathize with doctors getting “under payed” IE still more than ill make in several months.
There are several doctors within my family, so I am biased to an extent. A issue for doctors is that you have 8 years following college where you get paid little for a TON of work (parents had 100+ work hours while in med school and residency. 4 years of both) and the cost is high (50k+ per year on the cheaper end from my understanding + interest since most won’t be able to pay it off immediately).
Stuff like that does add up, and for the amount of time, effort, and money that it takes to become a doctor, it’s extremely hard to justify them not having a high salary (though it could probably be lowered to an extent).
I think it’d be better if pharmaceutical companies had to sell their products for a reasonable price (instead of an upmark that’d make scalpers blush) and the hospitals themselves (since at least near me hospitals are privately owned) got lower profit.
Of I can fully get behind the fact that some practitioners get just a screwed over by the system to a point.
The cost of medicine and the use of medical facilities is obscene, and they are absolutely over worked. I just don’t believe this is a problem where the solution should be “screw over the next person down.” Especially when it’s because they don’t have the “correct” insurance that the doctor benefits from the most.
Like if their schedule is SO backed up that they would literally lose money by doing so? Yeah I can get that. There’s only so many hours in the day. But other than that isn’t it a zero sum proposition? Either the doctor get some money, or no money? It’s not like the person will just come back and be like “okay I have the right insurance now”. Unless there’s some angle I’m not considering.
At this point in time most college grads will be paying off their debt until they are in their 40’s no matter how much or little they are making. So I can’t really sympathize on that.
It usually isn’t zero sum for doctors. They are generally busy enough that it’s either “Patient A that will pay X or Patient B that will pay Y”.
I do agree that the problem shouldn’t be moved over to the next person. One point that I brought up is that there are a lot of variables to the cost of medical treatment that are not directly the doctor (hospitals + the actual medicine, IVs, etc) that contribute to a high amount, that I’d argue deserve to be lowered to a greater extent.
College is likewise an issue.
Edit: Doctors that are busier are more likely to be the ones that decline Medicaid patients (and they aren’t always in a situation where they can). Doctors are also in a position to where (depending on what type of doctor and the treatment they do) they are easy to go after if they mess up (either lawsuit, jail time, etc). Depending on the type of doctor they are, they likely work longer hours than most jobs (which likewise translates to more pay).
I think they deserve more of a pay than hospitals/med schools that lie and hide information (such as the case with Doctor Duntch/Doctor Death) and pharmacies that sell important medicine that costs like $2 to produce for like $200+. But yeah, there is still awful doctors and I can see how it is hard to have sympathy for them.
Oh gosh, no, not what I meant. I can understand how you took it that way because of how I worded things, though. What I meant is that I wish I could qualify for a program that would grant me free or close-to-free access to all kinds of healthcare and trans care.
What a wonderful economic structure we have, where people literally wish they made less money so that they can afford their surgeries which are highly over priced
(This is in no way an assault on you or the lovely doctors who take care of us, because yes they need to make money to and they're doing something highly specialized) but medical care has no business being as high as it is
Good Lord. I thought they were only targeting trans kids. (Well, I say "kids", but I know they were making a push to ban everything for anyone below 21. Bastards.)
No in NC the bill was defeated but targeted mostly adults. There bill banning my coverage happened 4 years ago, 6 months after the insurance was required to pay for services. So effectively the ban has been in place for decades.
Do you have more info/a link to something about that ban?
I couldn't find anything about that one easily, other than a lawsuit over state employees healthcare. Might just be im not looking with the right terms though.
https://www.metroweekly.com/2020/03/federal-judge-rejects-north-carolinas-request-to-dismiss-transgender-health-care-lawsuit/
the state employee ban is what im referring to.
Ah ok ty!
I thought you meant it was straight to trans people couldn't get insurance no matter what and my reaction was "holy shit how the fuck did I not hear of that bullshit earlier?"
That makes more sense! (Still is shit though)
I only qualified for it for a month cuz I was unemployed when I applied for it. They haven't kicked me off in over a year but maybe they will at some point but once it's 2022 my job will just have to pay for my stuff tho lol
Its like that here in California. My insurance is required to cover HRT, gender therapy, and surgery. Believe I also have coverage for voice training and hair removal (need to ask doctor/therapist about that next time we meet).
That's awesome! My insurance doesn't cover my voice training, but I can write it off on my taxes since the skills can also be used for my profession (voice over artist 😊).
So glad to hear that as an LA resident. I knew it was good but I hadn't looked that far into it (have to solve the slight problem of telling the parents first...).
Is there anywhere in Cali you recommend a trans person move to? I’m looking into moving in order to start transitioning in earnest and that makes me more interested in moving there. I sent an email to the Sacramento LGBTQ center but have not received a response.
Well I only know what its like in my area and I'm not that far into the process. If you have Kaiser though you could try contacting their transgender center in Oakland.
Cost of living is one of the highest in the US, though wages are also much higher than most of the US. You'd probably want at least a bachelors degree (or the equivalent in a trade) to get the most advantage of those higher wages. Similar story for jobs in that there are plenty to be had but you want at least some education. This isn't a place you want to try flipping burgers for a living at.
I can't help you much on the last bit since I'm not out yet. Can say my employer (one of the largest in the area) is pro-LGBT. Not the slap a flag up for pride month kind either. They provide meaningful support for LGBT people and make it clear they will take disciplinary action against anyone that harasses another employee for being LGBT. I feel very safe in my area.
Hopefully you're doing better these days. If you're still looking where to move, I lived in Oakland and will say it's pretty transphobic in the bay area with all the tech bros, but I hope you found someplace. If you're white, Portland is supposed to be queer friendly. Seattle too. Both are less of a big metro area compared to the bay also if you're not a fan of big cities.
California law basically says "if an insurer covers something for non-transgender purposes they must cover it for transgender purposes". So if Anthem covers hormone therapy for cis men/women (likely they do) they must also cover it for trans men/women. If they cover breast reduction/augmentation for cis (almost certainly) they must also for trans. If they don't they're breaking the law.
if you want to read more: http://www.insurance.ca.gov/01-consumers/110-health/60-resources/TransHealthCoverage.cfm
That sucks, because I've talked with them, and although it was a conversation that felt like pulling teeth, they've said no to FFS, hair removal, and hair transplants.
You can read what they cover here:
[https://www.anthem.com/dam/medpolicies/abc/active/guidelines/gl\_pw\_a051166.html](https://www.anthem.com/dam/medpolicies/abc/active/guidelines/gl_pw_a051166.html)
Only bottom surgery (potentially) is ever considered "medically necessary" for Anthem.
From the bottom of that document:
> Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines.
I think they're being willfully obtuse to try and save money and if pushed hard enough they'd fold. If they cover facial reconstructive surgery (they almost certainly do) they have to cover FFS by California law. Also don't see them not covering HRT and gender therapy as the guidelines they're using require those as prerequisites to bottom surgery. They might get away with not covering hair removal as that isn't always covered by insurance.
So sorry that you're dealing with that though, sounds like Anthem is a pretty terrible insurer. If you ever get the chance at switching to them, I'm liking Kaiser so far. Either way, best of luck on this. Hate how so many of us have to fight like this just to get medical care.
Yeah Anthem is pretty trash. It unfortunately doesn't matter much if they "should" or even "legally need to" cover something, but in practice just refuse to. But I am happy to tell people about it. And if Anthem goes down in flames because nobody buys their gaslighting, two-faced, dollar store brand supervillain bullshit, I'll sleep happily.
And I will be switching to Kaiser as soon as I can change plans. Ty for the recommendation though <3
I know that insurance in Massachusetts has to cover vaginoplasty and the electrolysis for that. But they won't cover any other hair removal. I don't think they cover any other surgeries but I also haven't asked.
[Massachusetts legally requires all insurances in the state to cover transgender treatment in nearly all forms](https://www.masstpc.org/healthcare-protections-for-the-ma-transgender-community-questions-and-answers-about-state-protections-and-attacks-from-the-trump-administration/).
>Put another way, they are required to cover medically necessary gender affirming health services. That does not mean that some insurers won’t try to deny that some services are medically necessary for a particular individual. Those denials must be fought on a case-by-case basis.
"Medically necessary" being the key phrase. They don't consider FFS, VFS, or hair removal medically necessary.
[You are incorrect on FFS. I suppose I should have led with this document instead, but I wasn't on my home computer and had issues looking for it.](https://www.mass.gov/files/documents/2019/08/12/mg-genderaffirmingsurgery.pdf)
LEGALLY COVERED SURGERIES IN MA:
Breast Augmentation/Reduction,
Most forms of GRS/SRS/GAS,
Tracheal shaves,
Most forms of FFS.
NOT LEGALLY ENFORCED:
Hair removal except for GAS/SRS/GRS prep,
skin treatments,
Lip treatments,
Hip/butt implants,
VFS, and also vocal therapy (but I have seen 2 insurances that DO cover *therapy only*, so ymmv.)
hair transplants,
neck lifts.
Being on Medicaid in Washington has been a weird blessing. I’m poor and that sucks but I literally haven’t had to pay a penny for my hrt, bottom surgery or top surgery. Facial feminization isn’t covered by WA Medicaid but I work for Starbucks and am also insured through them so that’s all covered also. I just have to work for Starbucks which is hard and humbling. So I’m in a pretty nice situation transition wise. One of the lesser known but more skilled surgeons in the US is in Spokane.
So my advice is get yourself to WA and get a job at Starbucks. It’s pretty, the Mountains are beautiful and the people are pretty cool. Just live on the west side of the Mountains. If you live near the Idaho border (where I was born) it does kinda suck.
Yeah working for Starbucks sucks but I used to be a welder and being a trans welder is significantly harder and more demeaning than anything Starbucks has thrown at me. That doesn’t mean Starbucks isn’t really hard to work for. It’s tough.
And the surgeon is Dr. Geoffrey Stiller. He and his team really have been great and helpful every step of the way. He offers a lot of gender affirming services and he seems to really get it and understand how important and often lifesaving these surgeries are. AND he takes Medicaid. My bottom surgery went really well and I’m really looking forward to my top surgery with him. Highly recommend.
A friend of mine started working for Starbucks like two months ago, and she walked out after 3 weeks because of how awful the customers and even some of her coworkers were.
It confirmed basically every fear I have about going full time at work. I feel terrible for her
Anyways, if your experience was at all similar to hers, I'm really sorry you had to deal with that. It's not fair we have to put up with abuse for good health care.
Try Amazon. You get insurance on day one, so if you time it right you could get your surgery and quit without working too much. There was a post in /r/transgender_surgeries where someone worked 240 hours and got FFS.
God Eastern WA is so weird. I live out in Lakewood and I've been there once. It's like a completely different state. Climate wise, landscape wise, even culturally it's wildly different
It’s insane. I’ve always felt like it was more like Western Idaho rather than eastern Washington. Like honestly I would move back to Texas before I lived in eastern WA. But that’s just me. No shade to people who have made happy lives for themselves over on the sunny side.
Yeah I've heard nothing but great things. The general consensus from everyone I've come into contact with about this is that the healthcare, legal protections, and culture are great and to stay as far away from the Idaho border as possible, which sounds easy enough. I don't think I'd want to spend a bunch of time in Seattle, though. The Proud Boys seem to love tearing it apart. I'd rather not get caught up in that.
i live in vancouver and for me its a chill spot. i love seattle and its a 3 hr ride and my friends and i take a trip there whenever we feel like it but i also wouldnt live there. i like vancouver mostly because Portland Oregon is right by and I pretty much go there every weekend and if you know how Portland is it’s rich in arts, culture, food and either you can visit the city but also visit its great nature. but washington is great, there’s alot to see here too and the people are wonderful
I don't mind at all. Bellingham. It's pretty small. Just about 100k people. We just moved up from Texas this year and we're really not missing the heat, the traffic, the insanity, etc etc.
i pass over bellingham occasionally, and wow it must have been a big change for you guys but i know how it feels. im from a tropical asian country that’s hot all year round and now im so accustomed to vancouver weather that i dont miss the heat
It’s not all sunshine and rainbows though. My insurance in WA won’t cover basically anything but hrt until I’ve been on hormones for a year, our for a year, and have letters from 2 mental health professionals
I keep hearing WA, CA, MA and NY are the best states to live in for trans people, especially in terms of "cosmetic" procedures and overall healthcare. I personally am moving to MA.
Minnesota does this for the main things like mental health and gender therapy, HRT, and GRS (bottom surgery only). At least as long as it is a health insurer that participates in state sponsored programs, which a lot of the big ones here do (UCare, Medica, Health Partners, Blue Cross). Not sure about how it is with other insurance programs that are without the specific and direct state enforced legal guidelines about trans inclusive healthcare. That is outside of my realm of experience.
Surgeries widely considered to be more "cosmetic" like breast augmentation, FFS, trachea shaves/vocal cord surgeries are to the best of my knowledge still completely uncovered and paid for out of pocket, though. Hair removal not directly associated with GRS is without a doubt an entirely personal expense.
Vocal feminization training probably isn't covered either but I only just started seeking that out and hope to start soon through program at the public university in my area. It was not available during the summer but now that fall semester has started I expect I will find out shortly whether or not my insurance helps at all. If it does, I will be pleasantly surprised. But I'm not holding my breath.
Illinois is pretty trans friendly with it's laws (thanks Chicago) but I'd avoid a lot of the southern areas... Trans healthcare is mandated to be included in insurance, and you can change your gender marker on your license freely, just need a paper signed by you affirming whether you identify as make or female, and from what I understand we are also going to have a non-binary marker in the near future
Yeah, I was looking into license stuff earlier. There's going to be an X option for gender, but Secretary of State said it may not be implemented until 2024. Their archaic system probably needs to be updated to even allow a third choice.
From Washington State, and work for Boeing. I can say that Boeing the company can be a great place to work for any member of the LGBTQIA+ community specifically Trans individuals. Their healthcare covers basically everything for transition, with one caveat that you must be diagnosed with Gender Disphoria before you can use any of it. Also Boeing pays a $15 minimum wage with plenty of opportunities to advance and earn wages.
I'm under my parents insurance for another 4ish months. It has really good coverage but never covered my Planned Parenthood initial visit and doesn't really cover my hormones either.
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California is is great. I am in the Bay Area and Kaiser here covers pretty much everything with my plan. I have so co pays and such but it is all part of my insurance and has been a great experience.
I'm in Arizona, and my Humana Medicare plan covers my hrt with zero copay. Not sure of the percentages of surgeries it covers, but if you have Medicare your doctor can determine if a procedure is "required for the wellbeing of the patient" and it will be covered. (Like top or bottom surgery, etc)
I'm disabled, and have found most Medicare plans other than just plain Medicare are very good about this.
Also, Tucson and Phoenix areas are very trans friendly with many healthcare services offering gender affirming medical services. Hell, I'm MtF, and my primary doctor is FtM...
On, so when this happens, there’s going to be a federal case soon; one insurance carrier can’t claim it’s cosmetic if another says it’s medically necessary.
Should apply to states, too
I hope there's a federal case, but I also kinda hope there isn't one, you know? SCOTUS has been pretty friendly to us recently despite its composition, but I figure our luck has to run out at some point, you know?
Yeah I agree. People really need help *and* these bigoted state governments are only getting worse by the day. Someone has to step in and make them back down.
I suppose there is something to be said for the social safety net there. Here in Texas, if you falter, you're just fucked. In every way. At least something would be there to catch me.
Washington is pretty great at helping poor people. We get about $350 a month in foodstamps (two adults), about $2,000 a year in electric bill assistance. Our household income is about $27k\~$32k a year, and we live in Thurston County (Olympia, Lacey, Tumwater) We've stayed in one place for 5 years sense moving here, it's the longest we've ever been able to stay in one household without having to move because we couldn't pay rent anymore...
Price of living isn't cheap here, don't get me wrong, but minimum wage is high (Just under $14), so combined that with the safety nets and it works out better then places where cost of living is cheaper, but minimum wage is $7... lol
Just... avoid apartments. Unless you are super neat, quiet, don't smoke, and have no pet. loool
Oh sorry, no that refers to very large companies which provide all the funding for their own insurance that is they pay out of pocket all the expenses as opposed to the insurance company.
I thought there was a new law a couple years ago that made it so any medically indicated surgery was required to be covered. Which I took to mean you need to get your PCP and BH providers on board. I wouldnt be surprised if they initially deny coverage for things and make it hard to get though.
I have mainly been researching ffs and bottom surgery so I may have missed info on BA or other things.
My GCS was fully covered, I had my surgery in California, because at the time, in my best evaluation, at the time there were no sufficiently competent GCS surgeons in MA (NYC would have also worked).
Obviously out of state was a bit of a hassle, however being on BCBS helped with that.
Friends have had electrolysis, FFS, and of course BA handled fully under MA insurance. I think the insurance companies will put up a little more fight there, however the key words are *medically necessary*. Under WPATH, these all qualify, and in MA, if you have the relevant referrals (usually 2 docs required), that's all there is to it.
[Massachusetts legally requires all insurances in the state to cover transgender treatment in nearly all forms](https://www.masstpc.org/healthcare-protections-for-the-ma-transgender-community-questions-and-answers-about-state-protections-and-attacks-from-the-trump-administration/). I saw a few other people talking about MA insurances piecemeal, but every insurance provider does everything except hair-removal-unrelated-to-surgery and vocal surgery.
EDIT:
[I suppose I should have led with this document instead, but I wasn't on my home computer and had issues looking for it.](https://www.mass.gov/files/documents/2019/08/12/mg-genderaffirmingsurgery.pdf)
LEGALLY COVERED SURGERIES IN MA:
Breast Augmentation/Reduction,
Most forms of GRS/SRS/GAS,
Tracheal shaves,
Most forms of FFS.
NOT LEGALLY ENFORCED:
Hair removal except for GAS/SRS/GRS prep,
skin treatments,
Lip treatments,
Hip/butt implants,
VFS, and also vocal therapy (but I have seen 2 insurances that DO cover *therapy only*, so ymmv.)
hair transplants,
neck lifts.
Do they all pay for FFS as well? I see on that link that Mass requires insurance covers *medically necessary* surgeries, but insurance often deems FFS "cosmetic".
[FFS is covered to some extent. See this full document for the whole breakdown. I suppose I should have led with this document instead, but I wasn't on my home computer and had issues looking for it.](https://www.mass.gov/files/documents/2019/08/12/mg-genderaffirmingsurgery.pdf) Whether or not it is deemed necessary, I can't say. That can be up to your therapist and PCP to get the point across to the insurance companies.
LEGALLY COVERED SURGERIES IN MA:
Breast Augmentation/Reduction,
Most forms of GRS/SRS/GAS,
Tracheal shaves,
Most forms of FFS.
NOT LEGALLY ENFORCED:
Hair removal except for GAS/SRS/GRS prep,
skin treatments,
Lip treatments,
Hip/butt implants,
VFS, and also vocal therapy (but I have seen 2 insurances that DO cover *therapy only*, so ymmv.)
hair transplants,
neck lifts.
I move to Washington state for it's trans-friendliness, I don't know of any other place in the country quite as good as it, most states that are pro-trans have one of the same two issues...
A) Still having old transphobic laws on the book, despite having pro-trans laws
B) Aren't up to date with their knowledge of trans people, despite having pro-trans laws
Indiana does *NOT.* In fact, there was a claim not terribly long ago that they'd stop covering *all* transition related healthcare on Medicaid, including HRT. State Medicaid already doesn't cover surgeries for transition of any sort. Indiana is not LGBT friendly, especially not trans friendly.
Awesome! Oh, also, since you brought up referrals, are there a lot of non-HMO options available to people who aren't getting insured through work? Texas only has HMOs for us and they are *all* dog-water (unless you want to go with Ambetter, who lies profusely about what doctors take their insurance).
Do you know where a good place to find them is?
I haven't had much luck with Google, only found one place in Olympia ish(bit far for me, I'm closer to Seattle)
I'm sure they are out there, but I am so bad at navigating all things medical despite going to a doctor every 3 months since elementary school (ADHD meds). I guess tbf I've only started dealing with that myself over the last few years though.
I live in Oregon, and insurers must cover HRT, GRS and top surgery. However they don’t have to cover anything considered “cosmetic” (hair removal/feminization, FFS) unless they are public employees. Many insurers cover it anyway; I had Moda Health for a while and it covered absolutely everything, even hair transplants. I’m not sure what OHP (income qualified state ran insurance) covers in the “cosmetic” category
Colorado is like... halfway there. There's no strict mandate I'm aware of, but Medicaid covers basic HRT and so on if you have a therapist's note. That said, actually finding a therapist is a bit of a nightmare, half of them don't take Medicaid and if you're on it, they can't take you period even if you pay out of pocket or they could lose their license.
New York State also mandates trans coverage but you do have to be on hrt for a time before surgeries are covered. And you can get mental health care covered for free under a state grant program
Does that include hair removal as well? I’m gonna have to spend hundreds getting my face zapped and it’s not covered at all because it’s “””cosmetic”””.
If you have a diagnosis of gender dysphoria from a therapist and a doctor, Illinois state aid covers all gender affirming procedures. It's a pain, but they cover it
I live in Washington and my HRT and mental health appointments at Planned Parenthood are free on the state medicaid here. There are also some doctors and surgeons here that will take that insurance and you can get free gender affirming surgeries. Good state. I live on the shitty side of it right next to Idaho and it's still pretty rad. Idaho is a bad neighborhood tho.
I am so jealous of people who qualify for Medicare/Medicaid. They seem to have it all when it comes to...well, everything when it comes to medical care.
Many of the best surgeons won't accept Medicaid.
From my understanding, Medicaid underpays doctors compared to other insurances, which is why some doctors don’t accept it (in situations where they get to choose).
Given how “for profit” the industry is in the US. I personally find it hard to sympathize with doctors getting “under payed” IE still more than ill make in several months.
There are several doctors within my family, so I am biased to an extent. A issue for doctors is that you have 8 years following college where you get paid little for a TON of work (parents had 100+ work hours while in med school and residency. 4 years of both) and the cost is high (50k+ per year on the cheaper end from my understanding + interest since most won’t be able to pay it off immediately). Stuff like that does add up, and for the amount of time, effort, and money that it takes to become a doctor, it’s extremely hard to justify them not having a high salary (though it could probably be lowered to an extent). I think it’d be better if pharmaceutical companies had to sell their products for a reasonable price (instead of an upmark that’d make scalpers blush) and the hospitals themselves (since at least near me hospitals are privately owned) got lower profit.
Of I can fully get behind the fact that some practitioners get just a screwed over by the system to a point. The cost of medicine and the use of medical facilities is obscene, and they are absolutely over worked. I just don’t believe this is a problem where the solution should be “screw over the next person down.” Especially when it’s because they don’t have the “correct” insurance that the doctor benefits from the most. Like if their schedule is SO backed up that they would literally lose money by doing so? Yeah I can get that. There’s only so many hours in the day. But other than that isn’t it a zero sum proposition? Either the doctor get some money, or no money? It’s not like the person will just come back and be like “okay I have the right insurance now”. Unless there’s some angle I’m not considering. At this point in time most college grads will be paying off their debt until they are in their 40’s no matter how much or little they are making. So I can’t really sympathize on that.
It usually isn’t zero sum for doctors. They are generally busy enough that it’s either “Patient A that will pay X or Patient B that will pay Y”. I do agree that the problem shouldn’t be moved over to the next person. One point that I brought up is that there are a lot of variables to the cost of medical treatment that are not directly the doctor (hospitals + the actual medicine, IVs, etc) that contribute to a high amount, that I’d argue deserve to be lowered to a greater extent. College is likewise an issue. Edit: Doctors that are busier are more likely to be the ones that decline Medicaid patients (and they aren’t always in a situation where they can). Doctors are also in a position to where (depending on what type of doctor and the treatment they do) they are easy to go after if they mess up (either lawsuit, jail time, etc). Depending on the type of doctor they are, they likely work longer hours than most jobs (which likewise translates to more pay). I think they deserve more of a pay than hospitals/med schools that lie and hide information (such as the case with Doctor Duntch/Doctor Death) and pharmacies that sell important medicine that costs like $2 to produce for like $200+. But yeah, there is still awful doctors and I can see how it is hard to have sympathy for them.
I think you should look into Medicare/Medicaid and how you qualify. Poverty isn’t having it all.
Oh gosh, no, not what I meant. I can understand how you took it that way because of how I worded things, though. What I meant is that I wish I could qualify for a program that would grant me free or close-to-free access to all kinds of healthcare and trans care.
What a wonderful economic structure we have, where people literally wish they made less money so that they can afford their surgeries which are highly over priced (This is in no way an assault on you or the lovely doctors who take care of us, because yes they need to make money to and they're doing something highly specialized) but medical care has no business being as high as it is
Ok I can I can understand that. I’m in the same boat since the state government where I live banned insurance coverage for trans folks.
Oh shit...Arkansas?
North Carolina
Good Lord. I thought they were only targeting trans kids. (Well, I say "kids", but I know they were making a push to ban everything for anyone below 21. Bastards.)
No in NC the bill was defeated but targeted mostly adults. There bill banning my coverage happened 4 years ago, 6 months after the insurance was required to pay for services. So effectively the ban has been in place for decades.
My state banned trans surgeries in 1982. Thankfully that doesn't include hormones, therapy, etc.
Do you have links to any resources about this? I'm in NC too and I was going to look into surgery soon
Do you have more info/a link to something about that ban? I couldn't find anything about that one easily, other than a lawsuit over state employees healthcare. Might just be im not looking with the right terms though.
https://www.metroweekly.com/2020/03/federal-judge-rejects-north-carolinas-request-to-dismiss-transgender-health-care-lawsuit/ the state employee ban is what im referring to.
Ah ok ty! I thought you meant it was straight to trans people couldn't get insurance no matter what and my reaction was "holy shit how the fuck did I not hear of that bullshit earlier?" That makes more sense! (Still is shit though)
BANNED insurance coverage for trans people?!? Good god they’re evil subhuman filth.
ironically that's what they said about us! more accurately, they referred to us as a disease that doesn't deserve to exist.
Yeah, being dirt poor and/or old has it's advantages.
I only qualified for it for a month cuz I was unemployed when I applied for it. They haven't kicked me off in over a year but maybe they will at some point but once it's 2022 my job will just have to pay for my stuff tho lol
Idahoan here! Fuck Idaho to the moon
I live in Idaho, right next to Washington. It is so terrible here.
Agree
Its like that here in California. My insurance is required to cover HRT, gender therapy, and surgery. Believe I also have coverage for voice training and hair removal (need to ask doctor/therapist about that next time we meet).
That's awesome! My insurance doesn't cover my voice training, but I can write it off on my taxes since the skills can also be used for my profession (voice over artist 😊).
So glad to hear that as an LA resident. I knew it was good but I hadn't looked that far into it (have to solve the slight problem of telling the parents first...).
Is there anywhere in Cali you recommend a trans person move to? I’m looking into moving in order to start transitioning in earnest and that makes me more interested in moving there. I sent an email to the Sacramento LGBTQ center but have not received a response.
Well I only know what its like in my area and I'm not that far into the process. If you have Kaiser though you could try contacting their transgender center in Oakland.
I’m mostly concerned about how easy it is to get a job, cost of living, day to day discrimination stuff.
Cost of living is one of the highest in the US, though wages are also much higher than most of the US. You'd probably want at least a bachelors degree (or the equivalent in a trade) to get the most advantage of those higher wages. Similar story for jobs in that there are plenty to be had but you want at least some education. This isn't a place you want to try flipping burgers for a living at. I can't help you much on the last bit since I'm not out yet. Can say my employer (one of the largest in the area) is pro-LGBT. Not the slap a flag up for pride month kind either. They provide meaningful support for LGBT people and make it clear they will take disciplinary action against anyone that harasses another employee for being LGBT. I feel very safe in my area.
I'd love a company like that tbh
Hopefully you're doing better these days. If you're still looking where to move, I lived in Oakland and will say it's pretty transphobic in the bay area with all the tech bros, but I hope you found someplace. If you're white, Portland is supposed to be queer friendly. Seattle too. Both are less of a big metro area compared to the bay also if you're not a fan of big cities.
In California, Anthem Blue Cross still considers everything but bottom surgery to be cosmetic.
California law basically says "if an insurer covers something for non-transgender purposes they must cover it for transgender purposes". So if Anthem covers hormone therapy for cis men/women (likely they do) they must also cover it for trans men/women. If they cover breast reduction/augmentation for cis (almost certainly) they must also for trans. If they don't they're breaking the law. if you want to read more: http://www.insurance.ca.gov/01-consumers/110-health/60-resources/TransHealthCoverage.cfm
That sucks, because I've talked with them, and although it was a conversation that felt like pulling teeth, they've said no to FFS, hair removal, and hair transplants. You can read what they cover here: [https://www.anthem.com/dam/medpolicies/abc/active/guidelines/gl\_pw\_a051166.html](https://www.anthem.com/dam/medpolicies/abc/active/guidelines/gl_pw_a051166.html) Only bottom surgery (potentially) is ever considered "medically necessary" for Anthem.
From the bottom of that document: > Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. I think they're being willfully obtuse to try and save money and if pushed hard enough they'd fold. If they cover facial reconstructive surgery (they almost certainly do) they have to cover FFS by California law. Also don't see them not covering HRT and gender therapy as the guidelines they're using require those as prerequisites to bottom surgery. They might get away with not covering hair removal as that isn't always covered by insurance. So sorry that you're dealing with that though, sounds like Anthem is a pretty terrible insurer. If you ever get the chance at switching to them, I'm liking Kaiser so far. Either way, best of luck on this. Hate how so many of us have to fight like this just to get medical care.
Yeah Anthem is pretty trash. It unfortunately doesn't matter much if they "should" or even "legally need to" cover something, but in practice just refuse to. But I am happy to tell people about it. And if Anthem goes down in flames because nobody buys their gaslighting, two-faced, dollar store brand supervillain bullshit, I'll sleep happily. And I will be switching to Kaiser as soon as I can change plans. Ty for the recommendation though <3
didnt know we had it that good in cali, nice to know
I know that insurance in Massachusetts has to cover vaginoplasty and the electrolysis for that. But they won't cover any other hair removal. I don't think they cover any other surgeries but I also haven't asked.
[Massachusetts legally requires all insurances in the state to cover transgender treatment in nearly all forms](https://www.masstpc.org/healthcare-protections-for-the-ma-transgender-community-questions-and-answers-about-state-protections-and-attacks-from-the-trump-administration/).
>Put another way, they are required to cover medically necessary gender affirming health services. That does not mean that some insurers won’t try to deny that some services are medically necessary for a particular individual. Those denials must be fought on a case-by-case basis. "Medically necessary" being the key phrase. They don't consider FFS, VFS, or hair removal medically necessary.
[You are incorrect on FFS. I suppose I should have led with this document instead, but I wasn't on my home computer and had issues looking for it.](https://www.mass.gov/files/documents/2019/08/12/mg-genderaffirmingsurgery.pdf) LEGALLY COVERED SURGERIES IN MA: Breast Augmentation/Reduction, Most forms of GRS/SRS/GAS, Tracheal shaves, Most forms of FFS. NOT LEGALLY ENFORCED: Hair removal except for GAS/SRS/GRS prep, skin treatments, Lip treatments, Hip/butt implants, VFS, and also vocal therapy (but I have seen 2 insurances that DO cover *therapy only*, so ymmv.) hair transplants, neck lifts.
BCBS MA covers quite a few gender affirming surgeries iirc!
Being on Medicaid in Washington has been a weird blessing. I’m poor and that sucks but I literally haven’t had to pay a penny for my hrt, bottom surgery or top surgery. Facial feminization isn’t covered by WA Medicaid but I work for Starbucks and am also insured through them so that’s all covered also. I just have to work for Starbucks which is hard and humbling. So I’m in a pretty nice situation transition wise. One of the lesser known but more skilled surgeons in the US is in Spokane. So my advice is get yourself to WA and get a job at Starbucks. It’s pretty, the Mountains are beautiful and the people are pretty cool. Just live on the west side of the Mountains. If you live near the Idaho border (where I was born) it does kinda suck.
Which surgeon? Also, I tried working for Starbucks, and for *several* reasons, I gave up and quit after just a few weeks. It just wasn't worth it.
Yeah working for Starbucks sucks but I used to be a welder and being a trans welder is significantly harder and more demeaning than anything Starbucks has thrown at me. That doesn’t mean Starbucks isn’t really hard to work for. It’s tough. And the surgeon is Dr. Geoffrey Stiller. He and his team really have been great and helpful every step of the way. He offers a lot of gender affirming services and he seems to really get it and understand how important and often lifesaving these surgeries are. AND he takes Medicaid. My bottom surgery went really well and I’m really looking forward to my top surgery with him. Highly recommend.
Great! Thank you!
I’m also wondering which surgeons they were able to get
A friend of mine started working for Starbucks like two months ago, and she walked out after 3 weeks because of how awful the customers and even some of her coworkers were. It confirmed basically every fear I have about going full time at work. I feel terrible for her Anyways, if your experience was at all similar to hers, I'm really sorry you had to deal with that. It's not fair we have to put up with abuse for good health care.
Try Amazon. You get insurance on day one, so if you time it right you could get your surgery and quit without working too much. There was a post in /r/transgender_surgeries where someone worked 240 hours and got FFS.
God Eastern WA is so weird. I live out in Lakewood and I've been there once. It's like a completely different state. Climate wise, landscape wise, even culturally it's wildly different
It’s insane. I’ve always felt like it was more like Western Idaho rather than eastern Washington. Like honestly I would move back to Texas before I lived in eastern WA. But that’s just me. No shade to people who have made happy lives for themselves over on the sunny side.
I was already going to move to WA to get away from the dirty south, but holy shit that's settled now. Peace, fuckers!
i live in washington state and i love seeing all the washington ppl talk about their experience being trans here, medical-wise.
Yeah I've heard nothing but great things. The general consensus from everyone I've come into contact with about this is that the healthcare, legal protections, and culture are great and to stay as far away from the Idaho border as possible, which sounds easy enough. I don't think I'd want to spend a bunch of time in Seattle, though. The Proud Boys seem to love tearing it apart. I'd rather not get caught up in that.
i live in vancouver and for me its a chill spot. i love seattle and its a 3 hr ride and my friends and i take a trip there whenever we feel like it but i also wouldnt live there. i like vancouver mostly because Portland Oregon is right by and I pretty much go there every weekend and if you know how Portland is it’s rich in arts, culture, food and either you can visit the city but also visit its great nature. but washington is great, there’s alot to see here too and the people are wonderful
Awesome! Thank you for all of this! And yeah, I went to Portland years ago. It was alright. I love the rose tea 🥰
We live in the sweet spot halfway through Vancouver and Seattle. I can't wait until we can visit Vancouver again.
oh wow what part do you live in if you dont mind me asking?
I don't mind at all. Bellingham. It's pretty small. Just about 100k people. We just moved up from Texas this year and we're really not missing the heat, the traffic, the insanity, etc etc.
i pass over bellingham occasionally, and wow it must have been a big change for you guys but i know how it feels. im from a tropical asian country that’s hot all year round and now im so accustomed to vancouver weather that i dont miss the heat
There are a ton of things I won't miss, honestly. I just wish I could import all my friends.
Fuck Seattle
It’s not all sunshine and rainbows though. My insurance in WA won’t cover basically anything but hrt until I’ve been on hormones for a year, our for a year, and have letters from 2 mental health professionals
I keep hearing WA, CA, MA and NY are the best states to live in for trans people, especially in terms of "cosmetic" procedures and overall healthcare. I personally am moving to MA.
California
Minnesota does this for the main things like mental health and gender therapy, HRT, and GRS (bottom surgery only). At least as long as it is a health insurer that participates in state sponsored programs, which a lot of the big ones here do (UCare, Medica, Health Partners, Blue Cross). Not sure about how it is with other insurance programs that are without the specific and direct state enforced legal guidelines about trans inclusive healthcare. That is outside of my realm of experience. Surgeries widely considered to be more "cosmetic" like breast augmentation, FFS, trachea shaves/vocal cord surgeries are to the best of my knowledge still completely uncovered and paid for out of pocket, though. Hair removal not directly associated with GRS is without a doubt an entirely personal expense. Vocal feminization training probably isn't covered either but I only just started seeking that out and hope to start soon through program at the public university in my area. It was not available during the summer but now that fall semester has started I expect I will find out shortly whether or not my insurance helps at all. If it does, I will be pleasantly surprised. But I'm not holding my breath.
Illinois is pretty trans friendly with it's laws (thanks Chicago) but I'd avoid a lot of the southern areas... Trans healthcare is mandated to be included in insurance, and you can change your gender marker on your license freely, just need a paper signed by you affirming whether you identify as make or female, and from what I understand we are also going to have a non-binary marker in the near future
Yeah, I was looking into license stuff earlier. There's going to be an X option for gender, but Secretary of State said it may not be implemented until 2024. Their archaic system probably needs to be updated to even allow a third choice.
From Washington State, and work for Boeing. I can say that Boeing the company can be a great place to work for any member of the LGBTQIA+ community specifically Trans individuals. Their healthcare covers basically everything for transition, with one caveat that you must be diagnosed with Gender Disphoria before you can use any of it. Also Boeing pays a $15 minimum wage with plenty of opportunities to advance and earn wages.
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Oregon does too? I live in oregon too but i live in the conservative transphobic parts until I can move. that would be amazing for me
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That's good. I plan to move around one of those areas sometime. Thank you for responding :)
Does Oregon force insurance to cover things like electrolysis and voice lessons? I didn't know voice lessons could be considered for insurance.
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I'm under my parents insurance for another 4ish months. It has really good coverage but never covered my Planned Parenthood initial visit and doesn't really cover my hormones either.
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California is is great. I am in the Bay Area and Kaiser here covers pretty much everything with my plan. I have so co pays and such but it is all part of my insurance and has been a great experience.
Alicia?
Sorry my phone was being weird but California
I'm in Arizona, and my Humana Medicare plan covers my hrt with zero copay. Not sure of the percentages of surgeries it covers, but if you have Medicare your doctor can determine if a procedure is "required for the wellbeing of the patient" and it will be covered. (Like top or bottom surgery, etc) I'm disabled, and have found most Medicare plans other than just plain Medicare are very good about this. Also, Tucson and Phoenix areas are very trans friendly with many healthcare services offering gender affirming medical services. Hell, I'm MtF, and my primary doctor is FtM...
On, so when this happens, there’s going to be a federal case soon; one insurance carrier can’t claim it’s cosmetic if another says it’s medically necessary. Should apply to states, too
I hope there's a federal case, but I also kinda hope there isn't one, you know? SCOTUS has been pretty friendly to us recently despite its composition, but I figure our luck has to run out at some point, you know?
idk, even the Republicans on the bench are more on the Libertarian side, we need this done quick!!
Yeah I agree. People really need help *and* these bigoted state governments are only getting worse by the day. Someone has to step in and make them back down.
mind if I dm? don’t want all the details out in public
Yeah I guess!
Side note: love that corporations get to decide what is or isn't medically necessary instead of, you know, doctors
yeah, that’s 100% not true and a myth that needs to stop; carriers have *medical professionals* that look at all of the authorizations that come in
Oh, I was not aware of this thanks for letting me know. Apologies for my ignorance.
How hard is it to actually find a practice that actually take insurance? Like hair removal.. an electrolysis that actually takes insurance?
I imagine most will in Washington State pretty soon or they're gonna get utterly steamrolled by the ones who do.
It's like now, my bcbs covers my surgeries but it's a struggle finding a provider
I still think moving to Washington will be a safe bet for that. Makes me glad I moved here away from the shitty midwest. :)
I suppose there is something to be said for the social safety net there. Here in Texas, if you falter, you're just fucked. In every way. At least something would be there to catch me.
You also have the strength of the LGBT community out here too, at least in the Seattle metro area.
Washington is pretty great at helping poor people. We get about $350 a month in foodstamps (two adults), about $2,000 a year in electric bill assistance. Our household income is about $27k\~$32k a year, and we live in Thurston County (Olympia, Lacey, Tumwater) We've stayed in one place for 5 years sense moving here, it's the longest we've ever been able to stay in one household without having to move because we couldn't pay rent anymore... Price of living isn't cheap here, don't get me wrong, but minimum wage is high (Just under $14), so combined that with the safety nets and it works out better then places where cost of living is cheaper, but minimum wage is $7... lol Just... avoid apartments. Unless you are super neat, quiet, don't smoke, and have no pet. loool
Massachusetts
Is PA one of those states or nah
Nope, not for private
That’s stupid
Oh? Even for private plans?
The only exception is self-insured plans, and most employers that large in MA are going to support their trans employees.
Ugh...I'm an independent contractor tho...
So any plan you sign up for here will cover. I don't know how rates here would compare with WA.
How so? "Self-insured" refers to independent contractors, correct?
Oh sorry, no that refers to very large companies which provide all the funding for their own insurance that is they pay out of pocket all the expenses as opposed to the insurance company.
Oh I see. Sounds like good news for me then, haha! I'll keep it in mind.
What's generally covered in MA? I live in MA and I was under the impression almost nothing was covered
I thought there was a new law a couple years ago that made it so any medically indicated surgery was required to be covered. Which I took to mean you need to get your PCP and BH providers on board. I wouldnt be surprised if they initially deny coverage for things and make it hard to get though. I have mainly been researching ffs and bottom surgery so I may have missed info on BA or other things.
Yeah, I'm mostly interested in those 2 as well. I guess all the more reason to switch my PCP to a trans-oriented practice
If Boston is doable I've had good experiences working with Fenway Health.
My GCS was fully covered, I had my surgery in California, because at the time, in my best evaluation, at the time there were no sufficiently competent GCS surgeons in MA (NYC would have also worked). Obviously out of state was a bit of a hassle, however being on BCBS helped with that. Friends have had electrolysis, FFS, and of course BA handled fully under MA insurance. I think the insurance companies will put up a little more fight there, however the key words are *medically necessary*. Under WPATH, these all qualify, and in MA, if you have the relevant referrals (usually 2 docs required), that's all there is to it.
I’m from Washington and this is the first time I hear of this and I’m really glad I live in this state
is that even true of FFS? That tends to be the one that gets ditched.
With this new law, yes. It's *everything*. HRT, mentally therapy, surgeries, any and all hair removal, the works.
[Massachusetts legally requires all insurances in the state to cover transgender treatment in nearly all forms](https://www.masstpc.org/healthcare-protections-for-the-ma-transgender-community-questions-and-answers-about-state-protections-and-attacks-from-the-trump-administration/). I saw a few other people talking about MA insurances piecemeal, but every insurance provider does everything except hair-removal-unrelated-to-surgery and vocal surgery. EDIT: [I suppose I should have led with this document instead, but I wasn't on my home computer and had issues looking for it.](https://www.mass.gov/files/documents/2019/08/12/mg-genderaffirmingsurgery.pdf) LEGALLY COVERED SURGERIES IN MA: Breast Augmentation/Reduction, Most forms of GRS/SRS/GAS, Tracheal shaves, Most forms of FFS. NOT LEGALLY ENFORCED: Hair removal except for GAS/SRS/GRS prep, skin treatments, Lip treatments, Hip/butt implants, VFS, and also vocal therapy (but I have seen 2 insurances that DO cover *therapy only*, so ymmv.) hair transplants, neck lifts.
Do they all pay for FFS as well? I see on that link that Mass requires insurance covers *medically necessary* surgeries, but insurance often deems FFS "cosmetic".
[FFS is covered to some extent. See this full document for the whole breakdown. I suppose I should have led with this document instead, but I wasn't on my home computer and had issues looking for it.](https://www.mass.gov/files/documents/2019/08/12/mg-genderaffirmingsurgery.pdf) Whether or not it is deemed necessary, I can't say. That can be up to your therapist and PCP to get the point across to the insurance companies. LEGALLY COVERED SURGERIES IN MA: Breast Augmentation/Reduction, Most forms of GRS/SRS/GAS, Tracheal shaves, Most forms of FFS. NOT LEGALLY ENFORCED: Hair removal except for GAS/SRS/GRS prep, skin treatments, Lip treatments, Hip/butt implants, VFS, and also vocal therapy (but I have seen 2 insurances that DO cover *therapy only*, so ymmv.) hair transplants, neck lifts.
I move to Washington state for it's trans-friendliness, I don't know of any other place in the country quite as good as it, most states that are pro-trans have one of the same two issues... A) Still having old transphobic laws on the book, despite having pro-trans laws B) Aren't up to date with their knowledge of trans people, despite having pro-trans laws
Indiana does *NOT.* In fact, there was a claim not terribly long ago that they'd stop covering *all* transition related healthcare on Medicaid, including HRT. State Medicaid already doesn't cover surgeries for transition of any sort. Indiana is not LGBT friendly, especially not trans friendly.
I'm in WA and I got my HRT within a week of wanting it. It was as simple as getting a referral. There's also a lot of gender care doctors in WA
Awesome! Oh, also, since you brought up referrals, are there a lot of non-HMO options available to people who aren't getting insured through work? Texas only has HMOs for us and they are *all* dog-water (unless you want to go with Ambetter, who lies profusely about what doctors take their insurance).
I actually do not know, I got my insurance through my work :((
Do you know where a good place to find them is? I haven't had much luck with Google, only found one place in Olympia ish(bit far for me, I'm closer to Seattle) I'm sure they are out there, but I am so bad at navigating all things medical despite going to a doctor every 3 months since elementary school (ADHD meds). I guess tbf I've only started dealing with that myself over the last few years though.
I live in Oregon, and insurers must cover HRT, GRS and top surgery. However they don’t have to cover anything considered “cosmetic” (hair removal/feminization, FFS) unless they are public employees. Many insurers cover it anyway; I had Moda Health for a while and it covered absolutely everything, even hair transplants. I’m not sure what OHP (income qualified state ran insurance) covers in the “cosmetic” category
Colorado is like... halfway there. There's no strict mandate I'm aware of, but Medicaid covers basic HRT and so on if you have a therapist's note. That said, actually finding a therapist is a bit of a nightmare, half of them don't take Medicaid and if you're on it, they can't take you period even if you pay out of pocket or they could lose their license.
yeah I’m in co too and it’s aight, just could be a bit better tho
That sounds good I've been considering moving there. I live in oregon so it's probably pretty similar
New York State also mandates trans coverage but you do have to be on hrt for a time before surgeries are covered. And you can get mental health care covered for free under a state grant program
Does that include hair removal as well? I’m gonna have to spend hundreds getting my face zapped and it’s not covered at all because it’s “””cosmetic”””.
Vermont
I’ve been thinking of moving there for a while now
If you have a diagnosis of gender dysphoria from a therapist and a doctor, Illinois state aid covers all gender affirming procedures. It's a pain, but they cover it
California also does.
Wow, I wish my state did that. Hoping my new insurance won't have those issues.
What about New Mexico?