As Laws Shift, Trans People May Have to Travel for Gender-Affirming Care — At Their Own Cost

Throughout history and across cultures, human beings have challenged the sex binary and played with gender expression. But medical interventions that can help better align patients’ bodies with their gender identities — including hormonal treatments and surgeries — have evolved.

Meanwhile, the rate of young people who identify as transgender has nearly doubled in recent years, leading to a legal battle in the U.S. about who should be able to access which types of gender-affirming care — and when.

The result: An evolving matrix of laws and restrictions that leave some transgender people and their families without access to certain types of medical treatments, at least without traveling far from home.

As restrictions increase, trans people seek care far from home

While some conservative legislators have drafted laws that could restrict gender-affirming medical care even for trans adults, much of the controversy (and consequent legislative battling) has revolved around transgender youth.

Many, including U.S. Assistant Secretary for Health Rachel Levine (herself a transwoman) say gender-affirming care can help prevent suicide in teenagers. At the same time, others — including Laura Edwards-Leeper, the licensed clinical psychologist who founded the first pediatric gender care clinic in the country — worry that some young people receive treatment without proper assessment. While some treatments, like puberty blockers, are reversible, others, like top surgery (double-mastectomy), are not — and research on the long-term outcomes of such procedures in adolescents is limited.

Still, transgender youth and adults alike who live in states where restrictions limit access — or in rural areas that may be devoid of providers specializing in gender-affirming treatments — do wind up traveling to seek care.

Along with the obvious additional hurdle of travel itself, such arrangements can also increase the cost of some procedures. According to one study published in JAMA, patients who received genital gender-affirming surgeries outside of their home states experienced out-of-pocket costs 49% higher, on average, than those who had such surgeries closer to home.

How to find and afford medical care — no matter where you live

Where you live shouldn’t impact your access to medically necessary care, no matter your identity. But unfortunately, as studies and laws continue to evolve, the story may not be that simple for all patients.

For those who want to connect with medical providers who understand the specific needs of transgender patients, the World Professional Association for Transgender Health (WPATH) offers a provider directory search. And while not all health insurance policies cover all forms of gender-affirming care, more than a dozen states prohibit transgender exclusions in health insurance service coverage. These states include California, Oregon, Washington, Colorado, Illinois and New York, among others.

For those who live in states with restrictions, however, health insurance coverage of transgender services may be harder to come by — and policies differ in their coverage of out-of-state procedures of any kind. Some policies cover only emergency or urgent care outside of the state you live in, while others cover routine medical care out-of-state so long as it’s carried out with an in-network provider. Still, the best way to understand your policy’s coverage — especially as related to transgender health care — is to contact your insurer directly, as some insurers may consider the procedures elective.

But no matter where you live, be sure to review your potential health insurance policy in full before enrolling, so you can understand which services are covered and which are excluded. Regardless of gender, Americans pay more for health care than residents of any other developed country — so it’s worth taking the time to understand exactly what you’re paying for.