Health Insurance FAQ

Frequently Asked Questions (FAQs) About Health Insurance

Contact your insurance directly to ask what your Transgender Health Benefits are and what your out-of-pocket costs will be.

What if I do not have health insurance?

• New potential UCLA Gender Health Program (GHP) patients without active health insurance are strongly encouraged to seek coverage either through Covered California or through MediCal. Options vary by income level; please see these services’ websites for more information.
• Covered California and MediCal have multiple plan options. Before making your selection, contact the insurance plan and ask whether UCLA Health Gender Health Program providers are in-network.
• MediCal will often assign you to an in-network primary care physician based on where you live. You can work with this doctor to get referrals to our medical and surgical services.
• If you select an HMO option through Covered California, you may choose a UCLA Gender Health Program provider to be your plan-assigned primary care physician. Once your insurance is active and your UCLA Gender Health Program primary care provider is confirmed, please submit an “Appointment Request” form.
• Some Planned Parenthood locations also provide low cost primary care and hormone replacement therapy services for folks who do not have health insurance.

Does my health insurance cover gender affirming surgeries?

• Most health insurances that are based in California cover gender affirming surgeries as part of their Transgender Health Benefits. 
• Each insurance plan’s coverage varies, so contact your health insurance directly to see what surgeries are covered as well as requirements for surgery.
• Remember that your plan may include a co-payment which you must pay out-of-pocket first. This might be a flat fee or a percentage of the cost of your procedure.
• Gender affirming surgery coverage and gender affirming care in general varies greatly on where you live and what insurance plan you have. 

Does my health insurance cover the case management services the UCLA Gender Health Program provides?

• The case management services provided by the UCLA Gender Health Program are not billed to your insurance and are a free service. 

Does my health insurance cover hormone replacement therapy?

• Most insurances that are based in California provide insurance coverage for hormone replacement therapy as part of their Transgender Health Benefits. 
• Hormone replacement therapy coverage and gender affirming care in general varies greatly on where you live and what insurance plan you have. 
• Each insurance plan’s coverage varies, so contact your health insurance directly to see what gender affirming care services are a covered benefit. 

Does my health insurance cover the gender affirming care of my child/legal dependent?

• Most insurances that are based in California provide gender affirming care insurance coverage for clients who are younger than 18. 
• Each insurance plan’s coverage varies, so contact your health insurance directly to see what gender affirming care services are a covered benefit. 
• No gender affirming medical interventions can be made for children under the age of 18 without consent from parents/legal guardians.

Do you accept out-of-state health insurance?

• We can work with most out-of-state insurances. Contact your insurance directly to ask if you have “out-of-state coverage.” When seeking gender affirming care with out-of-state insurance, your insurance can work with our health system to create a “one time agreement” for services. For more information, please contact UCLA Health Billing. 

Do you accept MediCal and/or MediCare health insurance?

• Yes, UCLA Health is contracted with MediCal and MediCare insurance plans. Work with your current care team for referrals for care and contact our billing department for more information.

Does my health insurance cover behavioral health/mental health care?

• Most health insurance plans provide mental health coverage without a referral. Contact your insurance to get information on your mental health benefits. Some insurances have a mental health line on the back of the insurance card. 
• In the event of an emergency or mental health crisis, you should call 9-1-1 or go to the nearest emergency room if you can safely get there. 24-hour hotlines are also available for support and information: The US Trans Lifeline 1-877-565-8860, the National Suicide Prevention Lifeline at 1-800-273-8255, and the Los Angeles County Department of Mental Health Hotline at 1-800-854-7771.

I work in healthcare and I am referring a patient to the UCLA Gender Health Program for care. What information do I need? 

• Please visit our Refer a Patient page.

Do you accept college student health plans? Do you accept the University of California Student Health Insurance Plan (UCSHIP)?

• If you are seeking gender affirming services for the first time through your UCSHIP, please start with establishing care at your on-campus student health center.
• Review your UCSHIP Transgender Health Policy (the same policy is used by folks who identify as Gender Non-Binary). 
• If you are seeking Gender Affirming Surgery, please obtain the letter(s) of surgical support from your mental health/primary care team, identify the surgeon you’d like to see and get a referral from your student health center primary care provider. 
• Once you’ve obtained authorization, please contact the UCLA Gender Health Program by submitting an appointment request form.
• UCLA Gender Health Program staff will contact you and discuss the next steps.   
• For college students outside of the University of California system, please contact the UCLA Health Billing and Contract team.

Gender Affirming Care Tips

LA Care – MediCal Patients

• LA Care through MediCal has a Transgender Health Program administration team that can walk you through next steps for surgery referral and insurance authorizations. 
• Contact Phone Number: 1-888-839-9909
• LA Care Website

Parents, Caregivers or Guardians of Pediatric Patients

• First of all, thank you so much for seeking out care for your Trans/Gender Diverse/Questioning kid. We are here to help guide you and your child on their unique care path.
• Each pediatric patient and their caregiver system are treated as their own unique patient system. We take direction from our patients and their caregivers and develop a unique care plan for each pediatric patient.
• Our pediatric Primary Care providers are trained to deliver evidence-based care to Transgender/Gender Diverse/Questioning identified pediatric patients.
• Most insurances in the state of California provide gender affirming care as a covered benefit. This means that you will only be responsible for your co-payment at the time of your visit. Check with your insurance regarding your co-pay for in-network primary care services.
• Gender Health Program videos about youth and gender affirming care
• PFLAG / TFLAG

Pediatric Patients Under 18 Years of Age

• Yes, the UCLA Gender Health Program provides gender affirming care and support for pediatric patients (younger than 18 years of age) and their legal caregivers.
• Care for our pediatric patients starts with our gender affirming Primary Care providers.
• Each pediatric patient and their support systems are treated uniquely. We work together as a team to support each patient and their care goals.
• Due to California state law, our primary care team cannot provide gender affirming medical treatments without parent/legal caregiver consent. If a patient is legally emancipated or turns 18, they can consent to their own care without parent consent.
• Supporting documentation of legal emancipation status is needed before medical treatment can begin.
• Our team can clarify any questions that you might have. We can be reached by email at [email protected] or by phone at (310) 267-4334.