LGBTQ+ Health Insurance in 2025—What’s Changed and What You Can Do

Health insurance has never been simple—but if you’re LGBTQ+, you’ve probably learned how to ask the right questions, advocate for yourself, and read the fine print more carefully than most.

In 2025, many national policy changes have shifted how care is delivered and covered for the queer community. While these changes have created uncertainty, there are still ways to protect your access to care and make sure your insurance is working for you.

This guide breaks down what’s happening, and what to check—whether you’re newly hired, already enrolled in a plan, or choosing one on your own.

Where We Are Now

Even with progress in recent years, the LGBTQ+ community often has to do more to get the care we need. That might look like:

• Confirming that gender-affirming care is covered
• Making sure our name and gender are reflected correctly in records
• Finding affirming mental health providers within insurance networks
• Navigating partner coverage rules that vary by employer or plan
• Asking for clarity around fertility, family-building, or PrEP access

But know this: you’re not starting from zero. You already know how to move through systems with clarity and self-advocacy. What’s new is just where to focus your attention this year.

What’s Changed at the Federal Level

In early 2025, two executive orders were issued that affect how gender-affirming care is handled—particularly for people under 19 and in federally funded programs.

Providers are navigating the legal landscape, but so should we. If you’re in Texas, here’s what navigating gender-affirming care looks like on the ground.

Executive Order 14187

• Directs federal agencies to stop funding gender-affirming care for people under 19
• Some hospitals, even in states with protections, have temporarily paused or limited these services to review compliance
• A few providers have removed public references to gender-affirming care while legal challenges are ongoing

Executive Order 14168

• Requires federal agencies to define sex as assigned at birth
• Affects how gender identity is recorded in systems like Medicare, Medicaid, and federal employee health plans

These policies are being challenged in court, and many states and advocacy organizations are actively working to uphold access. In the meantime, the most important thing is to stay informed about how these changes might affect your plan and to make adjustments if needed.

What You Can Do Right Now

1. If You’ve Just Been Hired

Before enrolling in your employer’s health plan, take a moment to check a few key details.

Checklist:

• Ask for the full Summary of Benefits and Coverage (SBC)—not just the HR summary
• Confirm whether the plan includes gender-affirming care (hormones, surgeries, therapy)
• Check if your partner or spouse can be added, especially if you’re not legally married
• Review fertility, IUI/IVF, or adoption coverage if you’re planning to grow your family
• Look for PrEP and HIV/STI screening coverage
• Contact the insurance provider to ask if there are LGBTQ+-affirming doctors or therapists in your network
• Ask HR how names other than legal names and gender markers are handled internally and with the insurance company

Helpful resource: Out2Enroll

Need help making sense of it all?

If you’re overwhelmed or just want a second set of eyes on your plan, we’re here for you.

Reach out—we’ll walk through it with you.

2. If You’re Already Covered by Employer Insurance

This is a good time to make sure nothing has changed that affects your care or benefits.

Checklist:

• Download your current plan’s SBC from your insurer portal
• Look for updates or changes related to gender-affirming care, partner eligibility, or mental health services
• Call your insurer to confirm continued coverage for services you’re using—especially surgery, HRT, or counseling. If you’re navigating hormone care right now, check out this guide.
• Double-check that your provider network still includes affirming professionals
• Review past communications to make sure your name and gender are showing up correctly
• Reach out to HR if you notice issues—they may be able to help you escalate

Helpful resource: Transgender Law Center Health Resources

3. If You’re Shopping for Insurance on Your Own

Whether you’re using Healthcare.gov or a state exchange, there are plans that can support your needs—you just want to do a little extra research before choosing one.

Checklist:

• Use Healthcare.gov or your state’s site to browse ACA-compliant plans
• Look for plans that clearly state they cover gender-affirming care
• Call providers and ask:
  • Is HRT or gender-affirming surgery covered?
  • Are LGBTQ+-affirming therapists or doctors in-network?
  • Does the plan cover family-building options for same-sex couples?
• Ask about using your name and gender marker, especially if your legal documents are in progress
• If you live in a state where care is restricted, research “shield law” states where protection is stronger: Shield Law Map – Movement Advancement Project

   

Beyond the Basics: What Else You Should Know

Sometimes what matters most doesn’t show up in the plan brochure. Here’s what to keep in mind:

Coverage doesn’t always mean access
Plans may list services but still require multiple steps (referrals, letters, pre-approvals). Get clear on the process before booking care.

Mental health parity isn’t always enforced
Just because therapy is covered doesn’t mean affirming therapists are in-network. Ask your insurer about reimbursement options for out-of-network care if needed.

You can appeal insurance denials
If your claim is denied, you have the right to appeal—and many people win when they do. Resources like Lambda Legal or TLDEF can help.

Mismatches in name or gender marker can cause issues
Deadnaming in records can result in delayed care or billing errors. You may be able to file a confidential communications request to protect your privacy—especially if you’re under 26 and on a parent’s plan.

Out-of-state care isn’t always covered
If you’re traveling to a more affirming state for surgery or specialty care, make sure your insurance will follow you. Prior authorization may be required.

Local LGBTQ+ health clinics often know more than your insurer
They’re not just for care—they can help you enroll in insurance, file claims, appeal denials, and find affirming providers. Start with places like:

• Kind Clinic – Offers help with ACA enrollment through PrideLife, plus guidance for uninsured patients.
• CommUnityCare – Accepts Medicaid, Medicare, and offers sliding scale fees; can help navigate insurance and MAP (Medical Access Program).
• People’s Community Clinic – Provides financial counseling and supports patients using Medicaid, CHIP, and other programs.
• Lone Star Circle of Care – Offers insurance guidance and discounts for uninsured patients, with inclusive primary care.
• Vivent Health – Provides HIV care and insurance navigation for those living with or at risk for HIV.

These clinics don’t just treat—they advocate and know how to help you get the proper coverage and care.

Your employer can advocate for better benefits—if you ask
Not all HR teams realize their current plan may include exclusions or gaps. A conversation can sometimes open the door to real change, especially when backed by resources like Out & Equal or the HRC Corporate Equality Index.

You Still Have Options

Yes, policies are shifting. Yes, some providers are adjusting their offerings. But this doesn’t mean care is out of reach. It just means it’s time to get organized, ask a few more questions, and make sure you’re enrolled in a plan that aligns with your needs.

Many of the best strategies haven’t changed: talk to affirming providers. Lean on LGBTQ+ orgs. Use your community knowledge. Take the time to ask a few extra questions during open enrollment, and don’t hesitate to push for clarity from HR or your insurance company.

You’re not alone in this. We’re here to help you get covered—and stay cared for.

This stuff is complicated on purpose. You don’t have to untangle it alone.

Talk to us. We’ll help you get clear on your options.