Media Contact:
Division of Insurance - Vincent Plymell
vincent.plymell@state.co.us
Guides from Division of Insurance offer details on the services and prescriptions Colorado insurance plans must cover.
DENVER - As we are in the midst of the annual open enrollment for individual coverage (for people who don’t get insurance from an employer), the Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has again prepared a guide on insurance coverage of gender-affirming care (GAC) medical services for individual and small group health insurance plans, and a guide on insurance coverage of prescription medications to prevent and treat HIV.
The DOI updated these guides to reflect the insurance companies and plans that will be available in 2025. These coverage guides can help Coloradans in choosing a health insurance plan for the coming year.
2025 Colorado Division of Insurance Gender-Affirming Care Coverage Guide
2025 Colorado Division of Insurance HIV Prevention and Treatment Coverage Guide
"Access to comprehensive, inclusive, and affirming healthcare is a cornerstone of well-being for the LGBTQ+ community,” said Nadine Bridges, Executive Director of One Colorado. “These updated guides from the Colorado Division of Insurance allow Coloradans to navigate their health insurance options with clarity and confidence, ensuring that essential services like gender-affirming care and HIV prevention remain accessible to those who need them most. At One Colorado, we applaud these efforts to advance health equity and support our communities."
Gender-Affirming Care Guide for 2025
In 2023, Colorado became the first state in the country to explicitly include gender-affirming care services in its benchmark health insurance plan for essential health benefits (EHBs). A benchmark plan establishes the EHBs within Colorado for commercial plans, meaning that individual health insurance plans (plans not from an employer) and small group plans (for employers with less than 100 employees) must cover these services.
Understanding the details of how each health insurance plan covers various services can be challenging for transgender and non-binary people seeking medically-necessary services or hormone therapies as part of their individual treatment plans. This GAC coverage guide provides a simple way to find answers about coverage as people explore their health insurance options for 2025.
Note that the information in this guide is not an exhaustive list of all gender-affirming care procedures, but rather a list of many common services to treat gender dysphoria. Additionally, the guide does not include the different processes, like prior authorization or letters from a provider, that may be required by an insurance company in order to show that it is medically necessary to receive a service or medication.
2025 Colorado Division of Insurance Gender-Affirming Care Coverage Guide
Gender-affirming health care is an important part of the health care services that every transgender person deserves to achieve their own well-being, and it is not a one-size-fits-all health solution. There are many protections in place in Colorado to ensure access to medically necessary gender-affirming care and non-discrimination in health care based on one’s gender identity.
HIV Guide for 2025
HIV is a virus that attacks the body's immune system that can lead to AIDS if left untreated. For 2025, the DOI updated its guide on insurance coverage of prescription medications to prevent and treat HIV. The guide also includes information about Colorado coverage requirements, including cost, access to medication by a provider or pharmacist, and other non-discrimination protections.
The tables in the guide summarize medication coverage for each health insurance company offering individual plans (meaning coverage not through an employer) and small group plans (for small employers with less than 100 employees) for 2025. The guide lists medications individually by treatment category, as well as by the most commonly prescribed medications by providers for consumers, as specified by the Food and Drug Administration (FDA).
While this guide can be used to review the coverage and drug lists of HIV prevention and treatment medications by each insurance company, it is important to note that these tables do not review each plan from the insurance companies, nor all formularies offered by each company, so it is important for consumers to review plans to confirm coverage.
Additionally, Pre-Exposure Prophylaxis (PrEP), medication taken to prevent the contraction of HIV, must be covered without copayment or other cost-sharing. Health insurance companies must also cover the required PrEP baseline and monitoring services, which may include testing, screenings, and counseling, without copayment or other cost-sharing.
2025 Colorado Division of Insurance HIV Prevention and Treatment Coverage Guide
LGBTQ Health Insurance Coverage Rights in Colorado
Colorado Insurance Regulation 4-2-62 prohibits discrimination in private health insurance plans based on sexual orientation or gender identity. Private insurance plans sold in Colorado and regulated by the Colorado Division of Insurance* cannot do the following.
- 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.
Find more information at our website LGBTQ Health Care Rights and Resources.
People with questions about their health insurance coverage can contact the Division of Insurance Consumer Services Team: 303-894-7490 / DORA_Insurance@state.co.us / doi.colorado.gov (click on “File a Complaint”).
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About the Division of Insurance:
The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), regulates the insurance industry and assists consumers and other stakeholders with insurance issues. Visit doi.colorado.gov for more information or call 303-894-7499 / toll free 800-930-3745.
About DORA:
DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado. Consumer protection is our mission. Visit dora.colorado.gov for more information or call 303-894-7855 / toll free 800-886-7675.