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"This is a huge deal for our state and community:" Colorado requires some insurers to cover gender-affirming care

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Posted at 8:40 AM, Oct 15, 2021

COLORADO SPRINGS — Colorado will become the first state in the country to require certain health care plans to cover comprehensive health services for the LGBTQ+ community.

Federal and state officials announced Tuesday that more gender-affirming care and mental and behavioral health care would be covered as essential health benefits on Colorado’s individual (meaning not from an employer) and small-group (for small employers with less than 100 employees) health insurance plans starting in 2023.

The Centers for Medicare and Medicaid Services says the additional care that will be covered include face/forehead and/or neck tightening, facial bone remodeling for facial feminization, mandibular angle augmentation/creation/reduction, orbital recontouring, rhinoplasty (nose reshaping), breast and chest reduction and construction and laser hair removal.

"This is a huge deal for our state and community. Gender-affirming care is very important to those who are transgender. It's hard to get without insurance, and costs between $10,000 to $30,000 depending on which surgery you get," said Lauryn Hogan.

The new plan is expected to make a big difference in the state, but especially for Hogan who came out in 2018.

"I will be able to get my tops surgery, my bottoms surgery, and maybe my facial surgery. I have to check on that one, but I know it's a cosmetic one and a lot of transgenders have gender identity disorder," said Hogan. "I don't have to worry about working so many hours, finding multiple jobs to try to afford these surgeries that are medically necessary for me."

Hogan is among many in the LGBTQ+ community who sees this as a step forward in equality.

"Coverage is difficult to get, care is difficult to get. This is a door opening that allows them to get something that will allow them to get something long-term," said Ylva Victoria Pech.

She's one of the lucky few who didn't have to worry about paying for her care, but it's often not the case.

"I didn't run into the problems many transgenders do, but moving forward it gives a much broader base for providing care," said Pech.

"Every insurance has different loopholes, and different reasons for denying this care so having standardized practices will help ease that confusion and with the cost," said Alissa Smith, Communications Manager for Inside Out Youth Services.

Smith says the new plan will help youth when it's time to get into the workforce.

"Some of them are already excited about this because they already have trouble accessing healthcare whether it's because of parental permission or cost. So having this option for when they turn 18 to be able to chose what they want to do with their bodies and help them feel more comfortable in their own skin, it's going to be so affirming for them," said Smith.

The benefits were added to the state’s benchmark plan” after an extensive review process at the Colorado Division of Insurance that included meetings with insurance companies and other stakeholders. The state's existing plan already provides some benefits that can be used for gender-affirming care, such as mental health benefits for gender dysphoria, but these benefits fill in gaps in care.

"We found that adding gender-affirming care, alternatives to opioids, additional medication-assisted treatment, and annual mental wellness exam would not increase premiums in any meaningful way per member, per month," said Cara Cheevers, Colorado Divison of Insurance.

She says the added coverage would only increase costs by 64 cents per member, per month for people on individual and small-group market plans. Insurers will be required to cover these services when they go into effect in 2023.

"It is a required benefit, no different than primary care visits or emergency room services. We are not concerned with insurance companies leaving the market due to this change, we have done extensive analysis to access the impact on premiums and carriers have been involved throughout the stakeholder process. We have also had carriers who've moved to Colorado in the last couple of years, and really expanded their footprint," said Cheevers.

She says the division has already heard from different states about replicating the state's model and expanding coverage for gender-affirming care.

The LGBTQ+ community wanting to see more changes moving forward.

"Rates of being uninsured are very high in the LGBTQ+ community and the rates of being unemployed are very high so not everyone has access to this comprehensive insurance. So the next step is not only going to be to make sure insurance
covers this but everyone has insurance to cover this," said Smith.

"I think legislation needs to happen to where its nationwide care for transgender folks," said Hogan.