LGBTQ Health Care Rights and Resources
The Division of Insurance (DOI) regulates the health insurance industry in Colorado and ensures companies follow state and federal laws. The following resources help explain the rights and protections of Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Coloradans when accessing health care and benefits, and provide additional information when working with a medical or behavioral health provider, as well as various community resources.
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LGBTQ Health Care Rights and Resources

If you feel you have been discriminated against by a health insurance plan, you can contact the Division to ask a question or file a complaint at 303-894-7490 / 800-930-3745 / DORA_Insurance@state.co.us or visit

File a Complaint

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.

File a Charge of Discrimination with Colorado Civil Rights Division

File a federal civil rights complaint with the U.S. Department of Health and Human Services

 


File a Civil Rights Complaint with Federal Government

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. 
 

Patient Non-Discrimination

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 Coverage

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 Medicaid)


The two main types of public health insurance are Medicaid and Medicare. Colorado's state Medicaid program, called Health First Colorado, is administered by the Colorado Department of Health Care Policy and Financing.

  • You may qualify for Medicaid 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.

For information on how to enroll in private and public health insurance, see the "Get Covered" section below.

Hospital Visitation & Representation

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).

Preventive Health Services for Adults

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:

  • Immunizations
  • Screenings for depression, tobacco-use, alcohol use, sexually transmitted infection (STI), blood pressure, cholesterol, domestic violence, and more
  • Annual Well Visits
  • Contraception
  • Women’s preventive services (e.g. Pap smear, mammography). This applies regardless of your gender identity or transgender status.

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?
 

Individual Health Insurance (not from an employer)

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.

(Note: the guides listed above were prepared for the 2020 open enrollment period, which closed on Jan 15, 2020. New materials for this year's open enrollment period, which begins on November 1, 2020, will be available later this fall.)

 Employer-Sponsored Insurance (group health insurance)

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 (Colorado's Medicaid Program)

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

Medicare

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. 

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.

Federal Rights and Protections

Federal Rights and Protections


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. The federal rule implementing Section 1557, released in 2016, includes explicit protections for LGBTQ individuals on the basis of sex stereotypes and gender identity. The federal rule implementing Section 1557, released in 2016, includes explicit protections for LGBTQ individuals on the basis of sex stereotypes and gender identity. On June 12, 2020, the Trump administration finalized a new federal rule that dramatically alters the protections provided through Section 1557. The new rule eliminates protections for transgender individuals, ends the previous rule’s prohibition against discrimination based on stereotyping. Additional information about the new rule and its implications for LGTBQ individuals is available here


It is very important to note that while this federal rule was eliminated, transgender Coloradans are still protected from discrimination in health care because of Colorado's Anti-Discrimination Act, as well as other health-specific, state-based protections. Governor Polis issued a statement condemning the federal rule's rollback of civil rights protections in health care, and reiterated Colorado's commitment "to remain vigilant to safeguard the rights and protections we have fought so hard to gain. While the Trump administration wants to take our country backward and discriminate against transgender individuals for health care, Colorado law continues to protect Coloradans from such discrimination."


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.

Colorado Rights and Protections

Colorado Rights and Protections


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 "Ask a Question / Make a Complaint" page

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 - cara.cheevers@state.co.us.