How insurers are covering the LGBTQ+ community

Insurers are looking to expand coverage of sexual health services and gender affirming care in the wake of lawsuits over allegedly discriminatory policies.

In May, Aetna settled a class action lawsuit that alleged the insurer’s policy for coverage of artificial insemination and in vitro fertilization services discriminated against beneficiaries in same-sex relationships. Blue Cross Blue Shield Illinois has appealed a federal district court’s January finding that, while a third-party administrator of employer-sponsored plans, the insurer discriminated against transgender members and violated the Affordable Care Act's nondiscrimination requirements.

Related: Mounting state lawsuits oppose gender nondiscrimination rule

Such lawsuits have forced insurers and employers to reconsider the benefits offered to members and demonstrate inclusiveness in their plan design, said Randa Deaton, vice president of purchaser engagement at the Purchaser Business Group on Health. However, insurers say that state laws and employer restrictions may limit their ability to cover certain services.

Here are tactics insurers are using to respond to consumers' demand for broader LGBTQ+ care coverage.

Partnerships with LGBTQ+ providers

Many larger insurers like Aetna, Cigna, and Humana, as well as Blue Cross Blue Shield plans in Texas, Maryland, North Carolina and Illinois are working with virtual providers, including Plume Health, to offer healthcare benefits tailored to LGBTQ+ members.

Plume Health, a virtual gender-affirming care provider, expanded from direct-to-consumer services to working with insurers and entered into 20 contracts with health plans in the past year, said Dr. Jerrica Kirkley, co-founder and chief medical officer.

Since the company launched in 2019, it has provided care for 32,000 people in 45 states.

Blue Cross Blue Shield of Massachusetts earlier this month announced a partnership with Folx Health, a provider of gender affirming care, primary care, fertility care, therapy and coverage navigation services to LGBTQ+ patients.

“This experience for our members is extremely important to us,” said Dr. Ashley Yeats, vice president of medical operations at Blue Cross Blue Shield of Massachusetts. “We will help guide them to what's available [so they] have confidence that they're getting access to the very best care that's available anywhere.”

Targeted services for seniors

Some health plans are developing offerings targeted to specific demographics, including LGBTQ+ individuals aged 65 years and older.

SCAN Health Plan, a nonprofit health maintenance organization that serves Medicare Advantage beneficiaries, launched its SCAN Affirm coverage in 2023, aimed at the senior LGBTQ+ population. Members have access to care coordinators and free services including virtual behavioral healthcare, HIV testing and PrEP treatment, as well as hormone therapy, and community resources and education. SCAN is also building a directory of affirming providers to make it easier for LGBTQ+ beneficiaries to access nondiscriminatory care, said Karen Schulte, president of SCAN Health Plan.

Schulte said LGBTQ+ seniors are a growing demographic with disproportionate barriers to accessing care. The number of LGBTQ+ seniors is expected to grow from 3 million to 7 million people by 2030, according to 2021 data from SAGE, a national advocacy and services organization for LGBTQ+ elders.

This population, in comparison to their heterosexual peers, is also less likely to reach out to providers, senior centers and meal programs due to a fear of either harassment or discrimination, SAGE found.

SCAN Affirm has nearly 1,000 members in five California counties, and the health plan intends to expand to other markets.

Standards for coverage

Insurers are also turning to beneficiaries, employers and medical associations for feedback on the LGBTQ+ community's coverage needs.

Highmark, the health insurance arm of integrated healthcare delivery system Highmark Health, conducted its first focus group this year to better understand how the health plan’s policies and coverage processes affect LGBTQ+ members, said Dr. Matt Fickie, senior medical director.

Feedback led the company to update language in coverage policies that could be considered offensive. Also, Highmark Health's Allegheny Health Network purchased electrolysis equipment so transgender members can receive in-network hair removal treatment.

The health plan’s gender affirmation surgery policy is based on conversations with local providers, guidance from organizations including the Endocrine Society and standards of care set by the World Professional Association for Transgender Health, Fickie said.

Highmark also has taken steps to lessen administrative hurdles for LGBTQ+ enrollees, Fickie said. For example, the health plan avoids putting services including PrEP treatment on a prior authorization list to keep insurance processes to a minimum. It also has algorithms in place to ensure that members receive health screenings based on biological risk, regardless of gender identity.