Image: Ted Eytan / Flickr
While it’s reasonable for a seemingly healthy person to opt out of health insurance, those who are members of the LGBTQ community face higher risks for certain health issues. And, most times, the costs of treating these ailments depend on some kind of insurance.
When most people think about LGBT health issues, they immediately think about HIV/AIDS. While HIV/AIDS continues to disproportionately affect the LGBTQ community, gay health disparities go way beyond one sexually transmitted disease (STD). LGBTQ people suffer more from other STDs such as syphilis, HPV and hepatitis; mental health issues like depression and anxiety; and substance abuse. They’re are all at a higher risk for physical diseases like heart disease and cancer. And, they’re more likely to suffer from violence than their straight counterparts.
The LGBTQ community is a diverse community. Therefore each of the following LGBT health issues affect each sub-community differently; before seeking out a healthcare provider or seeking out a particular treatment option, it’s important to clarify the unique effects each health issue has on each LGBTQ sub-community. While there are many organizations and gay healthcare startups that help to tackle the various health issues affecting the LGBTQ community, there are some issues that can require expensive care and treatment – things that can be alleviated with the right healthcare coverage. We take a look at each of these major LGBT health issues, describe the effects on each sub-community, and point out whether such health issues are or aren’t covered by health insurance companies.
Depression, or major depression disorder (MDD), is a mood disorder that causes a persistent feeling of sadness and loss of interest in nearly all activities over a 2-week period. Other symptoms include: “changes in appetite or weight, sleep, and psychomotor activity; decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating, or making decisions; or recurrent thoughts of death or suicidal ideation or suicide plans or attempts”.
Depression’s Effects on the LGBTQ Community
Overall, depression is one of the more major LGBT health issues affecting the community. LGBT individuals are two to three times as likely to develop major depressive disorder as their peers.
- Gay Men: Depression affects gay men significantly more than it does straight men. According to a 2001 study in the American Journal of Public Health, the prevalence of major depressive disorder in gay men is 10.3 percent compared to 7.2 percent for straight men. A 2015 study in the Journal of Adolescent Health found similar increased prevalence of depression in gay male adolescents compared to their straight male peers. Another study, conducted by the Medius Institute for Gay Men’s Health, found that one-in-five gay men have symptoms of depression compared to one-in-twelve straight men.
- Lesbians: Depression rates are even worse in lesbians than they are in gay men. Part of that reason is that women are affected by depression more significantly than men. The same 2001 study reported that the prevalence of depression in lesbians is 34.5 percent compared to 12.9 percent in straight women.
- Bisexuals: Bisexual men and women suffer from depression more than both gay men and lesbians. Around 40 percent of bisexual men and women suffer from depression. Part of the reason, it’s been hypothesized, is that bisexual individuals often feel rejected by both the straight and the gay community.
- Trans: Although research for depression in the trans community is scant compared to the rest of the LGBTQ population, some studies have shown that trans men and women suffer from depression at an alarming rate of around 50 percent compared to around 7 percent for their cisgender counterparts.
Health Insurance Coverage for Depression
Chances are: yes. Mental health services is one of the ten essential benefits that insurers must provide per the Affordable Care Act (Obamacare). According to a Society for Human Resource Management survey, 87 percent of private plans cover mental health services. Additionally, the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act means that insurance companies can’t charge you more for mental health treatment as they would for equivalent treatment. So, if you pay a $40 co-pay for a regular doctor’s appointment, then your therapy session can’t cost more.
For many of those suffering with depression, though, therapy isn’t enough and anti-depressants are necessary. Insurers plans generally cover most anti-depressants; however, some insurance companies may restrict access to 10 to 15 anti-depressants, place quantity limits, or require prior authorization. This may make it much more difficult to get the right anti-depressant for you. On a more positive note, the Obamacare forbids any insurance company from denying you coverage based on sexual orientation. Additionally, there are many different affordable LGBT-friendly mental health resources that can lead you to a strategy for dealing with depression.
Some Hopeful News
Recent studies have shown that coming out can be significantly beneficial to your mental health. One study showed that openly gay and bisexual men were happier than their heterosexual peers.
Anxiety is a general term for several disorders that cause nervousness, fear, apprehension, and worrying. Examples of anxiety disorders include general anxiety disorder(GAD), panic disorder, social anxiety disorder, agoraphobia, or any type of specific phobia.
Anxiety’s Effects on the LGBTQ Community
Like with depression, studies show that LGBT individuals are about two to three times as likely to develop an anxiety disorder as their heterosexual peers.
- Gay Men: The Canadian Journal of Psychiatry found that gay men are twice as likely as straight men to develop anxiety disorder. A 2001 study found that prevalence of any anxiety disorder among gay men is 15 percent compared to 11.6 percent for straight men.
- Lesbians: Since women are more likely to develop anxiety disorders than men, predictably, lesbians are more likely to develop anxiety disorders than gay men. The same 2001 study found that prevalence of any anxiety disorder in lesbians is around 40 percent compared to 22 percent for straight women.
- Bisexuals: Studies have shown that bisexual men and women are more likely than straight men and women, gay men, and lesbians to be anxious. A British study released last month said that one third of bisexual individuals experience anxiety disorder compared to one third for gay men and women and one fifth for straight individuals.
- Trans: While not enough research has been done as to specific rates of anxiety disorder in trans populations, what research that does exist shows that anxiety disorder is higher for trans and non-conforming individuals.
Health Insurance Coverage for Anxiety
Treatment for anxiety disorders often requires therapy sessions known as cognitive-behavioral therapy (CBT). CBT sessions can be expensive, sometimes costing $100 or more per session. Some insurance plans do cover CBT but some might not cover this specific type of therapy. In addition, not all therapists accept health insurance. Therefore, make sure to find out if your therapist does accept insurance beforehand and get in touch with your insurance company to find out if they will cover you.
Treatment for anxiety disorders can sometimes include prescription medications. These too can be rather expensive. Insurance companies often cover these medications but may place quantity limits or require prior authorization.
Some Hopeful News
Anxiety disorders in the gay community have been correlated in the past with anti-gay sentiment and legal activity in the United States. One study conducted in 2005 found that those LGBT individuals living in states outlawing gay marriage had a 248 percent increased rate of general anxiety disorder compared to those living in states with legal marriage. The Supreme Court legalizing gay marriage in 2015 has started to change the tide. A recent study from the University of Washington has shown that same-sex marriages reported better mental health than singles.
3. Substance Abuse
Substance abuse is a maladaptive pattern of substance use leading to clinically significant impairment or distress. Examples of substances that are often abused include alcohol, tobacco, cannabis, hallucinogens, stimulants and opioids.
Substance Abuse’s Effects on the LGBTQ Community
Substance abuse can often be an unhealthy coping mechanism for some of the aforementioned mental health issues and is, as a result, much more prevalent in LGBT populations. 20 to 30 percent of LGBT individuals abuse substances compared to 9 percent of the general population.
- Gay Men: Gay men use illegal drugs and alcohol at higher rates than the rest of the population. Tobacco use disorder can be 50 percent more in gay men than in straight men. Gay men are also 10 times more likely to use heroin than straight men.
- Lesbians: Lesbians are between 1.5 and 2 times more likely to smoke than straight women. They are also more likely to drink than straight women.
- Bisexual: Bisexual men and women have much higher rates of substance abuse than both homosexual and heterosexual populations. As much as 40 percent of bisexual men and women reportedly smoking heavily. Binge drinking rates are also much higher in bisexual men and women than in heterosexual populations.
- Trans: There are significantly higher rates of substance abuse in trans individuals than in cisgender populations; studies have found high use rates of crystal meth, heroin and tobacco. Tobacco use rates are between 45 percent and 74 percent, which can be particularly problematic for trans women transitioning and taking estrogen as it increases likelihood of blood clots.
Health Insurance Coverage for Substance Abuse
Treatment for substance abuse often requires a visit to a rehabilitation center. Under the Affordable Care Act, your health insurance must cover substance use disorders and cannot increase your rates because you abuse substances. However, not all rehabilitation centers are the same and some may not be covered. Therefore, it’s important to check and make sure the center you choose is covered by insurance. There are LGBT-specific rehabs that may also take insurance.
Some Hopeful News
While LGBT individuals are more likely to suffer from a substance use disorder, they are also more likely to seek out help. A recent study showed higher rates of getting help among LGBT populations than their heterosexual counterparts.
4. Cardiovascular (Heart) Disease
According to the Mayo Clinic, cardiovascular disease (or heart disease) generally refers to conditions that involve narrowed or blocked blood vessels. These blocked vessels can lead to bigger issues like heart attack, chest pain (angina), or stroke.
Heart Disease’s Effects on the LGBTQ Community
Studies show that LGBT people are more likely to be overweight, exercise less, eat poorly, and smoke more. These factors predispose them to cardiovascular disease, making it one of the leading LGBT health issues.
- Gay Men: Due to high rates of tobacco use disorder and alcohol use disorder, gay men are more likely to suffer from cardiovascular disease.
- Lesbians: A 2003 study found that lesbians are more likely than straight women to have cardiovascular disease due in large part, the study argued, to higher body mass indexes (BMIs) and wider waist sizes.
- Bisexuals: Research has shown that bisexual women are more likely than heterosexual women to have heart disease but less likely than lesbians. There is less research as to the rates of heart disease and bisexual men.
- Trans: Studies show that transgender people are more likely than cisgender people to obtain cardiovascular disease due to higher use rates of tobacco and potentially due to use of hormones.
Health Insurance Coverage for Heart Disease
If you suffer from cardiovascular disease you will likely need to see a cardiologist, take heart medications, and potentially undergo surgery. Health insurance plans will cover your treatment for these treatment options and because of the Affordable Care Act, they have limits on how much they can charge you out-of-pocket. In addition, certain insurance companies, such as Cigna, offer lump sum heart attack and stroke coverage. These plans will provide a benefit of up to $10,000 to use however you choose in the case of a major cardiac event.
Some Hopeful News
The American Medical Association announced this month that it will be launching a fellowship for physicians to focus on LGBT issues with the aims of reducing the health disparities for disease such as heart disease.
Per the National Cancer Institute: “A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems.”
Cancer’s Effects on the LGBTQ Community
According to the National LGBT Cancer Network, LGBT individuals are more likely to have lung, breast, cervical, anal, and liver cancers than non-LGBT individuals.
- Gay Men: A 2011 study found that gay men are twice as likely as straight men to have cancer. This is especially true for prostate, testicular, and colon cancer. In addition gay men are more likely to develop anal cancer due to an increased risk of becoming infected with human papillomavirus (HPV).
- Lesbians: Lesbians are more likely to develop breast cancer than single women. This is partly because lesbian women are less likely to become pregnant than straight women. This means fewer pregnancy tests and fewer mammograms. It also means they do not benefit from the hormones released during breastfeeding and pregnancy which may help protect women from certain cancers.
- Bisexuals: Bisexual men and women are at a higher risk for all types of cancer than heterosexual men and women. Bisexual women are especially more likely to develop breast cancer than heterosexual women and bisexual men who are sexually active with men are at an especially higher risk for anal cancer.
- Trans: Transgender individuals are at a higher risk of obtaining and dying from certain cancers than cisgender individuals. This may be a result of fewer medical visits due to higher rates of discrimination. For instance, a 2015 World Health Organization (WHO) study found that ovarian cancer kills more transgender men than it does women largely because it goes undetected. Similarly, trans women may be more likely to die from testicular cancer than men because it goes undetected.
Health Insurance Coverage for Cancer
Treatment for cancer can be extremely expensive. Since the passage of the Affordable Care Act, health insurance companies can’t charge you more because of a pre-existing condition, including cancer. However, health insurance won’t always cover all of your cancer treatment, especially expensive chemotherapy. Which facility you choose and whether or not it’s LGBTQ-culturally competent AND is covered by insurance can be a difficult issue for many LGBT individuals suffering from cancer.
Some Hopeful News
A new research study from the Queen Mary University of London has discovered a new genetic test to help find and treat those with high risks of anal cancer. The test might lead to a fewer painful procedures and lessen the unnecessarily excessive of people at low risk. As those who suffer from anal cancer are disproportionately gay men, this is welcome news for the LGBTQ community.
“Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). HIV is a sexually transmitted infection. It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS.” – Mayo Clinic
HIV/AIDS’s Effects on the LGBTQ Community
The connection between the LGBTQ community and HIV/AIDS is well documented and has, for many years, been considered the most significant of all LGBT health issues. However, many people do not understand the severity to which the illness continues to plague the LGBT community.
- Gay Men: Gay men account for around 50 percent of all HIV diagnoses in the United States each year. Gay men are 44 times more likely than straight men to develop HIV or AIDS.
- Lesbians: Although lesbians are at a much lower risk for HIV than gay and bisexual men, there are a significant number of cases where lesbian women suffer from HIV. Since most people assume that lesbian women do not have HIV, they are often ignored from treatment and service programs.
- Bisexuals: The research for rates of bisexual men obtaining HIV is usually together with the rates of gay men as a collective group of men who have sex with other men. Thus, the rates of HIV for bisexual men are similarly around 44 times more than straight men. Since bisexual women are more likely to have sex with bisexual or gay men than straight women are, they report slightly higher rates of HIV than straight women.
- Trans: Transgender men and women are three times as likely to develop HIV as the rest of the population.
Health Insurance Coverage for HIV/AIDS
The Affordable Care Act requires that every health insurance company cover at least one drug from every category of drugs. This means your HIV/AIDS medication is likely covered but it may not be the medication your physician wants to prescribe to you. Most insurance companies in the Obamacare markets cover most HIV/AIDS medications. Most commonly not covered are single-tablet-regimen combination therapies. Make sure to check your plan’s formulary to see if your medication is covered.
Some Hopeful News
HIV rates are down 18 percent among LGBT youth between the ages of 13 and 24; however, HIV rates haven’t decreased in the young adult population (ages 25 to 34 years).
Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on your genitals, rectum, or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores.
Syphilis’s Effects on the LGBTQ Community
Syphilis is a common issue for gay and bisexual men who have sex with other men.
- Gay Men: The rate of syphilis is increasing in the United States. It increased 19 percent from 2014 to 2015. 60 percent of reported cases occur in gay and bisexual men.
- Lesbians: Syphilis is rare among lesbians.
- Bisexuals: Syphilis is common among bisexual men but rare among bisexual women.
- Trans: Transgender women are at a higher risk for syphilis than the general population and even more than gay men. Additionally transgender people are less likely to visit a physician to get checked for syphilis, which becomes more dangerous when undetected.
Health Insurance Coverage for Syphilis
Treatment for syphilis usually includes antibiotics such as penicillin. Most insurance companies cover your shots of penicillin but the cost varies. It’s important to catch syphilis early, so STD testing is important. For Syphilis, a blood test will be required. If you show symptoms of syphilis, the test will usually be covered. If you’re getting tested as a preventative measure, then coverage varies. While STD tests can be cost-prohibitive, some clinics do offer low-priced or even free STD tests.
Some Hopeful News
The CDC is taking action. In April, they released a call-to-action about the rising rates of syphilis. The report reminds people that syphilis is treatable and curable and that rates have dwindled down before (in the 1990s) with high testing rates.
8. Human Papillomavirus (HPV)
According to the Mayo Clinic, HPV is an infection that commonly causes skin or mucous membrane growths (warts). Certain types of HPV infection cause cervical cancers. More than 100 varieties of human papillomavirus (HPV) exist.
HPV’s Effects on the LGBTQ Community
HPV is a growing health crisis within the LGBT community.
- Gay Men: Anal HPV prevalence among gay men is around 60 percent. Gay men are 17 times more likely to develop anal cancer than straight men. HPV plays a significant role in causing anal cancer.
- Lesbians: Many people assume that lesbian women can’t contract HPV; however, HPV is transmitted by skin-to-skin contact and can cause cervical cancer. In fact, HPV is related to nearly 100 percent of cervical cancer cases. One study showed that the prevalence of HPV among lesbian women to be as much as 30 percent.
- Bisexuals: Prevalence of HPV rates are at 60 percent for bisexual men and up to 30 percent for bisexual women.
- Trans: Transgender women are at high risk for HPV. More studies are needed to show the prevalence rates.
Health Insurance Coverage for HPV
There are no treatment options for HPV but there is a vaccine. The Affordable Care Act mandates insurance companies cover preventative care without increasing rates. Therefore, if you are in population with high HPV rates, your HPV vaccine should be covered.
Some Hopeful News
A recent study found that lesbian women are now getting the HPV vaccine at the same rates as heterosexual women.
Hepatitis (A,B, C, D & E) are viral infections that cause liver inflammation, sometimes leading to serious liver damage.
Hepatitis’s Effects on the LGBTQ Community
HPV is more common amongst all LGBTQ populations.
- Gay Men: According to the CDC, gay men make up approximately 10 percent of new hepatitis A virus (HAV) infections and approximately 15 percent to 25 percent of all new hepatitis B virus infections. It’s also estimated that around 10 percent of gay men have Hepatitis C.
- Lesbians: There is little research as to lesbian women and hepatitis A, B or C; however, it’s possible for a lesbian woman to contract hepatitis due to blood exposure.
- Bisexuals: Bisexual men, like gay men, are at a higher risk of contracting hepatitis A, B or C. Studies show that bisexual women are more likely than straight women and lesbian women to contract Hepatitis A and B.
- Transgender: While being transgender does predispose you to Hepatitis, certain transgender subpopulations may be at higher risk.
Health Insurance for Hepatitis
There are effective vaccines for hepatitis A and B, and health insurers are required to cover those vaccines even if you haven’t paid your yearly deductible. There is no cure for hepatitis C, D, or E but there are some effective treatments; however, drug prices for hepatitis C can be upwards of $1,000 per pill. In 2016, Hepatitis C medicine was the highest drug cost for both Medicare and Medicaid. Private insurance companies will often require prior authorization, meaning you must be truly sick to qualify for the life-saving hepatitis C medications.
Some Hopeful News
Hepatitis C drug prices may be coming down soon. States are increasing their Medicaid programs for hepatitis C drugs and an Indian drug company is producing a low-cost generic version of the drugs that will significantly lower the price for those infected.
The American Psychological Association defines suicide as the act of killing yourself, most often as a result of depression or other mental illness. In the United States, suicide accounts for about 2 percent of all deaths.
Suicide’s Effects on the LGBTQ Community
Suicide is a serious issue in the LGBT community, especially among LGBT youth. Studies have shown that LGBT youth are four times as likely to attempt suicide and 4 to 6 times as likely to cause injury or harm to themselves from those attempts.
- Gay Men: 12 percent of urban gay men have reported suicide attempts – a rate that is three times higher than the rest of the population.
- Lesbians: Lesbians are twice as likely as to commit suicide as their heterosexual counterparts.
- Bisexuals: Bisexual teens are three times as likely to make a suicide attempt as heterosexual teens. Unlike gay men and lesbian women, bisexual men and women are more likely to continue making attempts into adulthood.
- Trans: 40 percent of transgender adults have attempted suicide. Nearly all of whom made an attempt before the age of 25.
Health Insurance Coverage for Suicide
Health insurance companies aren’t allowed to increase rates or deny you coverage for prior suicide attempts, but many do. Since insurance companies can deny coverage based on certain activities you take that predispose you to injury (such as skydiving), some companies use that ability to deny coverage based on your history of self-harm. However, per the Health Insurance Portability and Accountability act of 2006 and the Affordable Care Act of 2010, insurers can’t deny coverage based on pre-existing conditions. Over 90 percent of people who die from suicide have depression or another mental health disorder. Therefore, your insurer should not be allowed to deny you coverage.
Some Hopeful News
Studies have shown that legalization of gay marriage have reduced suicide rates among LGBT youth by 14 percent.
11. Violent Hate Crimes
“A criminal act or attempted criminal act against an individual or group of individuals because of their actual or perceived race, color, religion, ancestry, national origin, sexual orientation, gender, or disability.” – LA County DA
Violent Hate Crime’s Effects on the LGBTQ Community
Violent hate crimes against the LGBT community is a serious issue in the United States. According to the Southern Poverty Law Center, LGBT people are twice as likely to be victims of violent hate crimes than other minority groups such as African Americans, Jews and Muslims. The most notable example of this occurred a year ago when a shooter murdered 49 people at a gay nightclub in Orlando, Florida.
- Gay Men: According to a 2013 study, gay men are the largest group of hate violence survivors.
- Lesbians: Although fewer reported violent hate crimes are committed against lesbian women than against gay men, they are still more likely to be victims than heterosexual women.
- Bisexuals: Bisexual men and women are less likely to be victims of a hate crime than gay men or lesbians but still twice as likely as heterosexual men and women.
- Trans: Hate crime violence against transgender people is on the rise and is often deadly. More than 20 transgender individuals were reportedly killed in both 2015 and 2016 in fatal hate crimes.
Health Insurance Coverage for Violent Hate Crime
Health insurance coverage for injuries as a result of hate crimes should be covered the same way any other injury is covered.
Some Hopeful News
The world is starting to act on this. At the end of 2016, the United Nations affirmed that LGBT rights are human rights and appointed Vitit Muntarbhorn, a Thai human rights lawyer, as the first ever UN Independent Expert on violence and discrimination based on sexual orientation and gender identity. He has already released a report calling on dozens of nations to improve their LGBT rights.
- Here’s Why Americans Are Forgoing Health Insurance and Joining Faith-Based Health Plans - August 8, 2017
- What’s Wrong with Prior Authorization for Medication and How to Fix It - July 24, 2017
- Here’s Why Ambulances Are So Expensive - July 12, 2017
- A Guide to Nursing Home Coverage: Medicare, Medicaid, and Other Options - July 7, 2017
- Supporters, Opponents of Association Health Plans Uncertain About Senate Healthcare Bill - June 30, 2017
- 11 Major LGBT Health Issues That Are (Mostly) Covered by Your Health Insurance - June 29, 2017
- 7 Healthcare Options If You Lose Your Obamacare Subsidy - June 26, 2017
- Do You Really Need to Take That Ambulance to the Emergency Room? - June 19, 2017
- Obamacare State Exchanges in Midst of Uncertainty as Insurers Prepare to Exit - June 19, 2017