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New ACA Guidance Addresses Preventive Services Coverage Requirements for Transgender Individuals

The U.S. Departments of Health and Human Services, Labor, and the Treasury issued new guidance on May 11th, clarifying consumers’ rights to coverage of preventive services under the Affordable Care Act, including the rights of transgender individuals who have historically experienced inequities in access to health care services.

The ACA requires that a set of important preventive services, such as screenings, immunizations, contraception, and well-woman visits, be covered without out-of-pocket expenses (such as a co-pay or deductible).  These recommended preventive services are designed to help people stay healthy and to catch illnesses earlier on, when treatments can be more successful and costs are often lower.

The new federal guidance states that non-grandfathered health plans and insurers cannot limit coverage of preventive services to those that are specific to the person’s sex assigned at birth, gender identity, or recorded gender. Insurers should cover the preventive services that an individual’s provider, not an insurance company, determines are medically appropriate. This means, for example, that a transgender man with an intact cervix can get coverage without cost sharing for a pap smear, if recommended by his provider. This guidance helps ensure that transgender individuals get the preventive services they need.

The guidance on sex-specific services was one of several clarifications on preventive services protections the Departments issued. Read more about the clarifications on coverage of contraceptives and other preventive services (see FAQ #5 on page 6 for details on coverage of sex-specific recommended preventive services).

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