Private insurance and plans purchased on Healthcare.gov in Maine tend to have the same coverages and requirements as MaineCare (Internal Link) when it comes to gender affirming care.
It can sometimes be difficult to tell what is and isn’t covered from the literature provided by your insurer, however, so your best bet is to try to find the specific policy on gender-affirming care. You can usually find this by searching “[insurance name] transgender” or “[insurance name] transgender surgery.” For example, if you have Cigna, you would search “Cigna transgender surgery.”
What is stated on paper is sometimes and often not entirely the actual truth, and we recommend confirming all of your private insurance coverages before seeking care you will need covered. For example, in some cases, procedures categorized as “cosmetic” may actually be covered under certain circumstances, so it helps to at least ask.
If you aren’t able to find your insurance’s policy or if you’re having a hard time understanding it, it may be helpful to contact Aspen Ruhlin, the Client Advocate at Mabel Wadsworth Center (firstname.lastname@example.org) or to call Consumers for Affordable Health Care. These are both free resources that may be able to help you understand your insurance coverage of gender-affirming care. You can also call your insurance company, but keep in mind that agents are not always adequately trained on their policy on gender-affirming care, and may accidentally provide incorrect information. When calling your insurance company, you should always get a reference number for the call.
Your Primary Care Provider is likely not familiar with the intricacies of coverage for your plan, so you yourself will need to triple check with your insurance provider about procedure coverage.
How to sign up for Health Insurance
Healthcare.gov is the central marketplace for health insurance in the United States. If you are seeking health insurance not provided by your employer or university, this is where to start. This is also where you would start if you think you qualify for MaineCare.
If you need assistance signing up for care, or have questions about your plan and rights, try reaching out to our friends at Consumers for Affordable Healthcare.