Survey: 12% US LGBTQ+ adults claim health insurance discrimination

By Doug Bailey

More than 12% of U.S. adults self-identifying as LGBTQ+ say they have been discriminated by their health insurance provider, according to a new survey by HealthCare.com.

With a record 7.1% of U.S. adults self-identifying as LGBTQ+, the health insurance comparison site launched the survey to better understand these communities’ experiences with providers ranging from Medicare to employer plans. It surveyed 520 LGBTQ+ U.S. adults aged 18 and over.

“This survey uncovered reported discrimination by LGBTQ+ individuals from health insurers, which is likely yet another contributing factor to the poorer health outcomes documented among LGBTQ+ groups,” says Rutgers associate professor and LGBTQ+ health equity expert Dr. Corina Lelutiu-Weinberger.

Lelutiu-Weinberger said at least two directions can emerge from this finding:
1. Further research needs to be conducted to determine the types and frequency of discrimination experienced by LGBTQ+ people by insurers.
2. This novel line of research can inform interventions and/or policy around targeting this type of discrimination.”

At the same time 1-in-8 respondents said they had experienced discrimination by their health insurer because of their sexual orientation, about 30% (about 1-in-3) said they believed health insurance coverage was improving for LGBTQ+ Americans.

Still, the survey revealed wide gaps in understanding coverage options. A full 60% of those surveyed said they did not know if their insurer covered gender-affirming medication, gender-affirming procedures, pre-exposure prophylaxis (PrEP), or fertility treatments.

“It’s been 10 years since FDA approval of PrEP,” Dr. Lelutiu-Weinberger said of the medicine for people at risk for HIV. “The fact that so many people are still unsure about access and concerned about side effects, despite all the efforts that have been made for PrEP promotion, is alarming.”

About 20% of respondents said that their insurance does not cover any of the gender-affirming medication, while 10% said their policies cover gender-affirming hormones, and 10% said their policies cover PrEP; 8% said their policies cover fertility treatments, and 7% gender-affirming procedures.

The survey also found that 3-in-10 respondents carry more than $1,000 in medical debt, an amount much higher than the general population of Americans (6%). For Millennial LGBTQ+ individuals, the share with medical debt rises to 56%.

HealthCare.com’s survey, however, showed that the LGBTQ+ community is better off in some aspects of health insurance and personal finance than Americans as a whole, and worse off in others.

On the whole, participants have an uninsured rate of under 7%, somewhat less than the nearly 9% uninsured rate of the general population.

“Across the different subgroups, bisexual, queer, pansexual, asexual, and not sure/questioning groups are more likely to be uninsured than lesbian, gay, and transgender-identified respondents,” the survey said. “Although the numbers within each of these subgroups are small, calling for caution in drawing conclusions.”

Among respondents, the largest number have Medicare (33%), followed by employer insurance (23%), Medicaid (18%), and private insurance from a federal or state exchange (10%).

The most notable difference the survey identified between the LGBTQ+ community and the general population involved personal savings for a health emergency. When asked how much they have in savings for medical bills, 24% of LGBTQ+ respondents say they have more than $6,000 in savings, compared to just 14% of the general population.

The full survey results can be found here.

Doug Bailey is a journalist and freelance writer who lives outside of Boston. He can be reached at [email protected].