If you feel you’ve been discriminated against within a health care setting, you can file a charge of discrimination with the Colorado Civil Rights Division.
Know Your Health Care Rights
Colorado Regulation 4-2-62 prohibits discrimination in private health insurance plans based on sexual orientation or gender identity. Private insurance plans sold in Colorado* CANNOT:
- Inquire about an applicant’s or a beneficiary’s sexual orientation or gender identity in an application for coverage;
- Deny, cancel, limit, or refuse to issue or renew a policy because of a person’s sexual orientation or gender identity;
- Deny, exclude, or otherwise limit coverage for medically necessary services, in accordance with generally accepted professional standards of care, based upon a person’s sexual orientation or gender identity.
*If your health plan ID card has “CO-DOI” on it, your plan is regulated by the Colorado Division of Insurance and subject to Colorado’s insurance laws and regulations.
Starting in 2023 - Colorado will be is the first state in the country to explicitly include gender-affirming care services in its benchmark health insurance plan for essential health benefits (EHBs). These will be comprehensive services that insurance companies must cover for individual plans (meaning not from an employer) and small group plans (for small employers with 2 - 100 employees) starting in 2023. Find further details about the new benchmark plan on the ACA - Benchmark Health Insurance Plan Selection website and in the Oct. 12, 2021 announcement.
- You cannot be denied or charged more for health insurance because of your sexual orientation or gender identity. You also cannot be discriminated against when you receive health care services, from hospitals or other health care providers, based on your sexual orientation, gender identity, or disability (which includes HIV status).
- If you feel as though you’ve been discriminated against within a health care setting, you can file a complaint with the Colorado Civil Rights Division.
- If you feel as though you’ve been discriminated against with your health insurance, you can contact the Division to ask questions or file a complaint: 303-894-7490 / 800-930-3745 / DORA_Insurance@state.co.us or visit our "Ask a Question / Make a Complaint" page.
Health insurance plans can be divided into two categories: public and private.
Private health insurance
Private health insurance plans are run by commercial insurance companies, and include individual and group health plans. You can purchase an individual health plan directly to provide coverage for yourself and your dependents; group plans are purchased by employers to provide coverage for their employees. Individual health plans and group plans regulated by the Division of Insurance (as indicated by a "CO-DOI" designation on the health plan card) must include the following protections:
- You cannot be charged more for health insurance or services because of your sexual orientation or gender identity.
- You cannot be denied or limited coverage based on “pre-existing conditions,” like sexual orientation, gender identity, or health condition (including HIV status).
- For chronic illnesses, like HIV/AIDS, you are entitled to the care you need with no lifetime dollar limits.
- You have a right to medically necessary services, if those services are provided to other patients without regard to their sexual orientation or gender identity. For example, medically-necessary estrogen must be covered for post-menopausal non-transgender women AND for transgender women.
- Colorado prohibits transgender exclusions and clauses in private plans sold in Colorado.
- All free preventive services offered to non-transgender patients also apply to transgender patients.
Public health insurance - Medicare and Health First Colorado (Medicaid)
The two main types of public health insurance are: (1) Health First Colorado, Colorado's state Medicaid program; and (2) Medicare.
Health First Colorado is administered by the Colorado Department of Health Care Policy and Financing.
- You may qualify for Health First Colorado if your household income is less than 133% Federal Poverty Level, even without being pregnant, married, or under 18 years old.
- Gender-affirming care, like hormone therapy and surgery, are covered by Colorado Medicaid. More information can be found in the fact sheet about Colorado Medicaid from One Colorado.
Medicare is run by the U.S. Department of Health and Human Services, and provides health insurance to millions of older and disabled Americans. Medicare provides for transgender healthcare such as routine medically necessary care, hormone replacement therapy and gender reassignment surgeries.
- You have the right to get gender-affirming services as part of Medicare. More information about Medicare and transition-related and transgender care can be found on the website for the National Center for Transgender Equality, and in the resource “Know Your Rights: Medicare.”
For information on how to enroll in private and public health insurance, see the "Get Covered" section below.
- You can have anyone you like visit you in the hospital or long-term care facility (like a nursing home), regardless of blood or legal relationship.
- You can fill out a Hospital Visitation Directive once admitted so as to leave no room for error or miscommunication.
- Hospitals must apply rules equally to everyone, i.e. different-sex and same-sex partner visitation at certain hours.
- You can appoint anyone to be your Medical Durable Power of Attorney (MDPOA), which is the person who would make medical decisions for you if you are unable to do so (see resources below).
Under all Marketplace plans and most private plans, you have access to free preventive services to help you get the treatment you need. Services include:
- Screenings for depression, tobacco-use, alcohol use, sexually transmitted infection (STI), blood pressure, cholesterol, domestic violence, and more
- Annual Well Visits
- Women’s preventive services (e.g. Pap smear, mammography). This applies regardless of your gender identity or transgender status.
Coverage of Pre-Exposure Prophylaxis Prescription Drugs and Baseline and Monitoring Services
Under the Affordable Care Act (ACA), health insurance companies offering individual and group health insurance plans must provide coverage for specified preventive services, including preventive services that receive a rating of “A” or “B” by the United States Preventive Services Task Force (USPSTF). In June 2019, the USPSTF released a recommendation that pre-exposure prophylaxis (PrEP) be offered to those at higher risk of contracting human immunodeficiency virus (HIV) and/or acquired immunodeficiency syndrome (AIDS). PrEP is a medication which, if taken as prescribed, reduces the risk of getting HIV via sexual contact or among persons who inject drugs. The US Food and Drug Administration (FDA) has currently approved two daily pills, Truvada® and Descovy®, and the injective medication Apretude, for PrEP.
Based on the June 2019 USPSTF recommendation, all insurance companies offering individual and group health insurance plans offering after June 30, 2020, must cover PrEP with no cost sharing - IE, no copayment or coinsurance - to plan members. In July 2021, the United States Departments of Health and Human Services, Labor, and the Treasury issued additional guidance, clarifying that individual and group health insurance plans must also cover services related to PrEP, including office visits associated with baseline and ongoing monitoring; HIV, Hepatitis B and C, and kidney function testing; pregnancy testing; sexually transmistted infection screening and counseling; and adherence counseling.
The Division’s guidance on PrEP coverage is contained in the Division's Regulation 4-2-73 Concerning Human Immunodeficiency Virus Pre-Exposure Prophylaxis Prescription Drugs and Bulletin B-4.112 Policy Directives for Coverage of HIV Prevention Ancillary Services. NOTE: The Division recently updated Regulation 4-2-73 to include coverage or baseline and monitoring services associated with PrEP. The amended regulation, which will be effective on March 2, 2022, is available on the Division's Regulations Adopted But Not Yet Effective webpage.
For additional information about PrEP, please see the following resources:
- Preexposure Prophylaxis for the Prevention of HIV Infection in the United States - 2021 Update, A Clinical Practice Guideline - US Center for Disease Control and Prevention
Get Covered by Health Insurance
Why should LGBTQ people get covered?
- You may qualify for financial assistance.
- You can no longer be discriminated against as an LGBTQ person.
- Same-sex spouses have equal access to family coverage.
- Every health care plan covers core "essential health benefits" like routine check-ups and preventive care.
How can Coloradans get coverage, including LGBTQ people?
You can purchase individual or family health insurance coverage through Connect for Health Colorado (the state's marketplace), an insurance broker, or by contacting an insurance company directly. Open enrollment for individual and family health plans in Colorado begins on November 1 and ends on January 15 each year. You must sign up by December 15th for coverage that starts in January of the following year.
If you need insurance outside of the standard enrollment period, you may qualify for a Special Enrollment Period (SEP), depending on your situation. An SEP is a 60-day period outside the regular open enrollment period when an individual and their family have a right to sign up for health insurance due to “a “life-changing event,” and can be used to newly enroll in the marketplace, or to switch to a different plan. Learn more to see if you qualify.
Connect for Health Colorado
Connect for Health Colorado is the state’s marketplace to purchase health insurance. As the official health insurance marketplace for Coloradans, it provides:
- A place for residents to apply for Premium Tax Credits and Cost-Sharing Reductions to lower the cost of private health insurance.
- Tools that allow customers to easily compare plans and prices from multiple insurance companies and search for preferred providers and medications.
- Qualified health plans which include essential benefits and protections (in accordance with the Affordable Care Act).
- A statewide customer support network of Customer Service Center Representatives, Assisters and licensed Brokers to help Coloradans find the best health plan for their needs and budget.
Health care navigators are available to help you find plans that contain the coverage you need. In addition, One Colorado provides a variety of resources to help find the insurance carrier that’s right for you, including the following guides.
- 2021 Transgender Health Insurance Buyer's Guide
- 2021 Hormone Therapy Prescription Coverage Guide
- 2021 PrEP and HIV Prescription Drug Coverage
(Note: the guides listed above were prepared for the 2021 open enrollment period, which closed on Jan 15, 2021. New materials for this year's open enrollment period, which begins on November 1, 2021, will be available later this fall.)
Many Coloradans receive health insurance through their employers. Employers may provide coverage by purchasing a health insurance plan from an insurance company, which is called a "fully insured" plan. All fully-insured group health plans are regulated by the Division (as indicated by a "CO-DOI" designation on the health plan card), and must include the same protections as individual health insurance plans.
In some instances, an employer may create their own health plan, and collect premiums and pay claims directly, instead of purchasing a plan from an insurance company. Such plans, often referred to as "self-funded," are regulated at the Federal level by the U.S. Department of Labor and the Treasury Department, and are still required to comply with certain components of state and federal law. It may be difficult to tell if your employer's plan is self-funded, because many employers will use an insurance company to administer the plan, so you may get information and even your insurance card from that insurance company. Many large private sector employers have taken steps to actively remove exclusions on transgender healthcare from their self-funded plans. The Human Rights Campaign (HRC) Corporate Equality Index surveys employers on this important benefit. HRC also offers a List of Businesses with Transgender-Inclusive Health Insurance Benefits.
Health First Colorado is a public health insurance program for Coloradans who qualify. You may qualify for Health First Colorado if you meet certain income requirements and fall under one of the following categories:
- Children ages 0-18 with household income under 260% Federal Poverty Level (FPL);
- Pregnant women, over the age of 19, whose household income is under 260% FPL;
- Parents and Caretaker Relatives (you must have a dependent child) whose household income does not exceed 133% FPL; or
- Adults without dependent children whose household income does not exceed 133% FPL.
Health First Colorado has ongoing enrollment for lower-income individuals and families (individuals with monthly incomes under $1,305 and families of four under $2,688), To can see if you qualify and to apply for coverage, review the application website for Health First Colorado.
Additional information on gender-affirming care covered by Health First Colorado is available in the following resource:
Medicare provides health insurance to older (65 and over) and certain younger people with disabilities. To find out additional information about eligibility and enrollment, you can visit Medicare.gov or call Medicare Customer Service at 1-800-663-4227.
Federal and State Rights and Protections for LGBTQ People Seeking Health Care
On June 15, 2020, the Supreme Court of the United States (SCOTUS) issued a landmark civil rights decision, ruling that LGBTQ workers are protected under Title VII of the Civil Right Act and cannot be fired solely based on sexual orientation or gender identity. This ruling means that LGBTQ Americans throughout the country cannot be fired from their job, and thus lose access to their employer-based health care, because of who they are. Governor Polis issued a statement in support of the SCOTUS decision, reiterating the administration’s commitment “to lead on anti-discrimination policies… to build a Colorado for All.” LGBTQ Coloradans have been protected from employment-based discrimination since 2008, when the Colorado Anti-Discrimination Act was passed.
The DOI is committed to ensuring LGBTQ Coloradans have equitable access to health insurance coverage and the benefits and services that will allow them to lead healthy and affirmed lives. The Division uses its regulatory authority over health insurance companies to enforce federal and state protections for LGBTQ individuals seeking health care; however, if you feel you have been discriminated against, and/or denied access to benefits, please contact the appropriate state or federal authorities to ask a question or file a complaint.
- The ACA prohibits the denial of health care coverage for individuals and families based on pre-existing conditions, which include HIV status, having received or receiving gender-affirming care, and a history of chronic illness or disease. While the ACA does not mandate insurance plans offer coverage that is inclusive of all LGBTQ needs, it does prohibit insurance companies from categorically denying coverage for services, such as gender-affirming care or from denying a benefit that is covered for other people.
- Section 1557 of the ACA prohibits discrimination against LGBTQ people in health insurance coverage and health care. On May 10, 2021, the Biden Administration announced that it would enforce Section 1557 and Title IX’s prohibitions on discrimination based on sex to include: (1) discrimination on the basis of sexual orientation; and (2) discrimination on the basis of gender identity. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in covered health programs or activities. The update was made in light of the U.S. Supreme Court’s decision in Bostock v. Clayton County and subsequent court decisions. More information can be found here.
- If you have experienced discrimination on the basis of your sexual orientation or gender identity in a health care setting, you can file a complaint with the U,S. Department of Health and Human Services Office for Civil Rights, Additional details on drafting a complaint, as well as an electronic complaint form, are available here.
- In 2008, the state of Colorado passed the Colorado Anti-Discrimination Act (CADA) which protects Coloradans from discrimination based on disability, race, creed, color, sex, sexual orientation, marital status, familial status, religion, national origin, or ancestry. These protections apply to education, employment, and in places of public accommodation, such as health care facilities. The state of Colorado defines sexual orientation as “an individual’s orientation toward heterosexuality, homosexuality, bisexuality, or transgender status or another individual’s perception thereof.”
- CADA created the Colorado Civil Rights Division. The Director and the staff of the Division receive, investigate, and make determinations on charges alleging unfair or discriminatory practices in violation of the Act. If you feel like you have been discriminated against within a health care setting or wrongfully denied benefits, you can file a a charge of discrimination with the Colorado Civil Rights Division through their "Filing a Charge of Discrimination" page.
- If you feel you have been discriminated against by a health insurance plan, you can contact the Division to ask questions or file a complaint: 303-894-7490 / 800-930-3745 / DORA_Insurance@state.co.us or visit our "File a Complaint" page.
- AIDS Drug Assistance Program (ADAP): helps ensure that people living with HIV and AIDS who are uninsured and under-insured have access to medication; eligibility criteria and application instructions here.
- Colorado Health Network’s Health Insurance and Medication Access Program: provides financial assistance for medical services, health insurance premiums, and medication costs for Coloradans who are either living with HIV or who are utilizing PrEP as an HIV prevention strategy..
- Denver Health LGBTQ Center of Excellence: offers LGBTQ-friendly and competent care to LGBTQ patients.
- Denver LGBT Healthcare Guild for Gender and Sexual Minorities: offers mental and physical health services, support, and resources for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Inter-sex, Gender-Variant, 2-Spirit, Same-Sex Attracted, Asexual, Allies, and other sexual minorities.
- Gay and Lesbian Medical Association: offers a provider directory for mental and physical health for LGBTQ people across the country and Colorado.
- National Center for Transgender Equality (NCTE): offers resources to explain up-to-date rights and protections for transgender people.
- One Colorado, the state’s largest LGBTQ LGBTQ advocacy organization, offers resources for patients and providers.
- Public Health Intervention Program (PHIP): provides financial assistance for individuals on PrEP (pre-exposure prophylaxis), an FDA-approved, once-a-day pill for HIV prevention; eligibility criteria and application instructions here.
- RAD Remedy — Trans & Queer Referral Aggregator Database (Yelp for Providers): connects trans, gender non-conforming, intersex, and queer folks to accurate, safe, respectful, and comprehensive care in order to improve individual and community health. Please note this is a national database and may not have comprehensive, Colorado-specific providers listed.
- The Center – Advancing LGBT Colorado: provides a host of free services, targeted programs, cultural events, and other resources for the LGBTQ community.
- The Colorado Name Change Project : information and forms on how to update your name and gender marker in the state of Colorado
- The Transformative Freedom Fund: provides financial support for transition-related care to trans* folks in Colorado. The application cycle is open January-April every year and funding decisions are made by mid-June for each funding cycle.
- Transgender Center of the Rockies: offers holistic services to transgender and gender-expansive individuals, including mental, physical, and social services.
- Trans Health Boulder County: offers trans health resources in Boulder County.
- Where to Start, What to Ask: A Guide for LGBTQ People Choosing Health Care Plans: information on how the Affordable Care Act and the insurance marketplaces benefit LGBTQ-headed families.
The DOI is committed to ensuring lesbian, gay, bisexual, transgender, and queer (LGBTQ) Coloradans are able to access health care and live healthy and affirmed lives. Since the passage of the federal Affordable Care Act (ACA) and the state's expansion of Health First Colorado (Medicaid) in 2014, over 600,000 Coloradans have gained insurance, and the rate of uninsured LGBTQ individuals has fallen from 10% to 5% since 2011 (Closing the Gap: The Turning Point for LGBTQ Health, 2019). Yet LGBTQ Coloradans still often face difficulties in achieving a healthy life. In addition to concerns about healthcare affordability, access, and the quality of care, they face several unique challenge that affect their ability to live healthy and affirmed lives. Lack of understanding, discrimination, stigma, violence, and higher rates of health problems are just some of the issues that can compound and result in worse health outcomes.
For more information about the LGBTQ health insurance-related issues, contact Cara Cheevers, Behavioral Health Program Manager for the Division of Insurance - email@example.com.