Navigating the health care system isn’t easy. With complicated insurance terms, overworked doctors and year-long wait times to get appointments, seeing your doctor can be challenging. This difficulty increases tenfold for specific marginalized communities — such as the LGBTQIA+ community.
LGBTQIA+ patients face blatant discrimination in health care, including access to fewer providers and uninformed doctors. To reach a place of equitable health care for LGBTQIA+ individuals, much work still needs to be done. Proper training for doctors and medical staff and putting laws in place that protect the rights of LGBTQIA+ privacy are some ways health care can be improved.
In this guide, we’ll look at some LGBTQIA+ patients' struggles, review equitable health care improvements and solutions and provide various resources for finding care.
Discrimination Faced by LGBTQIA+ People in Health Care
Although a few positive strides have been taken recently, LGBTQIA+ individuals often encounter prejudice and bias when seeking medical care. This takes the form of outright refusal of care to more subtle forms of discrimination, such as inappropriate questioning or a complete lack of understanding regarding LGBTQIA+-related health questions. These discriminatory practices severely compromise the LGBTQIA+ community’s right to access necessary — and often lifesaving — health care services.
Refusal of Care
As an LGBTQIA+ person, turning on the nightly news can be a depressing experience. State governments limit access to necessary primary health care daily, creating headlines such as “Missouri lawmakers pass gender-affirming care ban for minors and anti-trans sports bill.” These bills encourage a blatant refusal of care or impose serious penalties for doctors and parents who do provide or seek out care.
LGBTQIA+ individuals may encounter refusal of care when seeking services such as hormone replacement therapy, gender-affirming surgeries or even routine primary care. In fact, in a study by American Progress, 7% of respondents reported that their provider wouldn’t give them the necessary health care because of their perceived sexual orientation.
This discrimination violates health care professionals’ ethical duty and creates significant barriers to accessing necessary care. This lack of care can have devastating health consequences.
Lack of Professional Knowledge
LGBTQIA+ health care has recently gained traction. Not long ago, doctors received next to no training (or at least accurate training) on LGBTQIA+ health needs. Unfortunately, this reflects in the medical community, where many health care professionals lack the correct language and understanding of medications. This leaves care in the hands of patients rather than doctors.
The absence of LGBTQIA+-inclusive care can contribute to mistrust and discomfort, ultimately deterring individuals from seeking health care services altogether.
Unequal Access to Care
There are places with strong medical support for the LGBTQIA+ community, but there are just as many, if not more, that don’t have the necessary care available. Communities with higher rates of discrimination against LGBTQIA+ people often have few doctors willing to administer crucial medications such as hormone therapy, mainly because those places are rural areas where health care may already be limited anyway.
According to a study by American Progress, 23% of LGBTQIA+ adults didn’t seek the medical care they needed due to this fear of discrimination. Within this group, 27% were LGBTQIA+ people of color, 32% were LGBTQIA+ people with disabilities, 37% were trans and 50% were intersex.
Fewer Reproductive Care Options
The LGBTQIA+ community (transgender individuals specifically) often face limited reproductive health options within the current health care system. According to the same American Progress study, more than 1 in 5 trans respondents were denied the reproductive care they sought.
Additionally, traditional reproductive health care services are typically designed with cisgender, heterosexual individuals in mind, contributing to the same lack of education on trans issues mentioned above. For instance, lesbian couples or transgender individuals may encounter challenges when seeking fertility treatments or access to assisted reproductive technologies.
Inaccurate Coverage by Insurance Companies
Insurance is complicated and only grows more complex for many members of the LGBTQIA+ community. Many insurance policies have exclusions or limitations targeting LGBTQIA+ individuals, denying coverage for essential health care needs such as gender-affirming surgeries or hormone therapy.
Transgender, nonbinary and intersex individuals deal with these issues most often. The outdated and discriminatory exclusions fail to recognize the medical necessity and well-established standards of care for transgender individuals. As a result, LGBTQIA+ patients have to take on that financial burden themselves.
Navigating Forms of Health Care Discrimination as an LGBTQIA+ Patient
LGBTQIA+ patients encounter various obstacles when getting the care they deserve. Trans patients often have to deal with incorrect pronouns and names on health insurance and patient forms or a lack of coverage for gender-affirming care. Lesbians and gay men don’t always have ready access to the LGBTQIA+-friendly reproductive options they need. And the list goes on.
It’s not always easy, but some solutions can help propel the community toward a more inclusive future.
Since almost a quarter of all LGBTQIA+ adults face discrimination as medical patients, this is a serious issue preventing individuals from seeking care. This can lead to poorer health outcomes, lack of transgender hormone therapy and gender-affirming care and increased risks of suicide if patients are unable to get the care they need.
Navigating the challenges of discrimination and rejection as an LGBTQIA+ individual can be daunting, but practical strategies and resources are available to help overcome these obstacles.
Know your rights
Understanding your legal rights as an LGBTQIA+ individual can help you advocate for yourself in situations of discrimination or rejection. Research your local and state laws. As for federal laws, the Affordable Care Act (ACA) protects your rights to access health care from federally-funded facilities (more on that down below).
Build a supportive personal network
Surrounding yourself with a loving network of friends, family or LGBTQIA+ support groups can provide emotional support and validation when things get complicated. Seek out safe spaces, online or offline, to connect with others who have faced similar challenges.
Expensive Medical Bills
With health insurance coverage being a complex topic for many members of the LGBTQIA+, medical bills often become a personal responsibility rather than being covered by insurance. This can put a lot of pressure on a person, especially considering LGBTQIA+ individuals already face a wage gap that puts them at an income disadvantage.
Managing expensive medical bills can seem like a never-ending endeavor. You can do things to decrease debt or erase it.
Understand your insurance coverage
Familiarize yourself with the details of your insurance plan, including deductibles, copayments and out-of-pocket maximums. Knowing the scope of your coverage enables you to make informed decisions about what’s covered and what’s not. If you have questions, call a representative and ask whether gender-affirming care, mental health services and other LGBTQIA+-specific health care needs are covered.
Research financial assistance options
Many health care facilities offer financial assistance programs for individuals facing financial hardship. Call your medical provider (before the bills go to collections) to discuss programs, grants or sliding-scale fee structures that can help reduce medical expenses. Nonprofit organizations like the Patient Advocate Foundation and NeedyMeds provide resources and guidance in finding financial assistance programs.
Negotiate medical bills when possible
There’s no harm in reaching out to your medical provider’s billing departments if faced with high medical bills. Explain your situation and ask about reduced or flexible payment options.
Medical Transition Struggles
Medical transition, encompassing hormone therapy, gender-affirming surgeries and various other procedures can present unique obstacles when seeking reliable health care. Thankfully, support networks and resources can assist you in your journey towards gender-affirming care.
When you need help affording medical transition, make sure to:
Advocate for yourself
Participate actively in your health care journey by asking questions, expressing your needs and preferences and advocating for your rights.
Educate yourself on your care
Sometimes, when doctors can’t provide you with the full amount of care you need, you should spend time researching the process and effects of a medical transition. Additionally, you can attend support groups to help you find the help you need.
Explore financial assistance options
Medical transition procedures can be costly, but many providers have financial assistance programs. Remember to check with the billing department and your health insurance company to see what you can work out.
Seek LGBTQIA+-affirming health care providers
Find providers knowledgeable about transgender health care and have experience working with the LGBTQIA+ community. Organizations like Planned Parenthood provide trans care nationwide, often with a sliding-scale financing option.
When your health care provider can’t answer basic medical questions, the whole experience can be a little disheartening. This knowledge gap can lead to inadequate care and misdiagnosis.
While undertrained doctors aren’t your fault, there are still steps you can take to help them understand your needs.
Educate your physician
While this may not always feel comfortable, advocating for yourself can help you get the care you need. Openly discuss your needs and concerns with your health care provider and share any reliable resources or informational materials you know of to help educate them.
Research LGBTQIA+-competent health care providers
Look for providers with specialized training or experience in LGBTQIA+ health care.
Seek LGBTQIA+-specific health centers or clinics
Consider accessing health care services from specialized health centers or clinics that prioritize inclusivity. You can find these centers through the CDC’s directory.
If you encounter a provider who demonstrates a lack of knowledge or sensitivity, there’s likely a place on their website where you can provide feedback to the medical center or leave an online review.
From hate crimes to harassment and bullying, the LGBTQIA+ community continues to face disproportionate levels of violence. By exploring preventive measures, support networks and advocacy efforts, we can all work toward a future where all individuals are free to express their identities without fear of violence or harm.
We can all take steps to promote the safety of the LGBTQIA+ community by doing the following:
Advocate for legal protections
Contact your local representatives, attend town hall meetings or join advocacy organizations to advocate for stronger legal protections.
Practice bystander intervention
Learn about bystander intervention techniques and actively intervene if you witness harassment or violence. You can safely intervene by using distraction techniques, calling for help or directly addressing the situation to de-escalate and protect the targeted individual.
Speak out against LGBTQIA+ violence
Share stories and experiences among your social circles and communities. Use social media platforms, participate in community events or join advocacy campaigns to help educate others.
Support LGBTQIA+ organizations
Donate, volunteer or advocate for organizations that work towards ending LGBTQIA+ violence. Organizations like the Human Rights Campaign.
Finding Inclusive Health Care Providers
Caring, helpful providers exist for the LGBTQIA+ community — it’s just a matter of finding them. Various strategies and resources can help you identify and connect with providers who prioritize inclusivity and understand the specific health concerns faced by the LGBTQIA+ community.
LGBTQIA+ Health Services by State
To find LGBTQIA+-friendly health care services in your area, find your state below to see the closest options.
Resources for Connecting With Supportive Health Care Providers
Several organizations are dedicated to providing health services to LGBTQIA+ patients. These resources can help LGBTQIA+ individuals connect with supportive health care providers:
- GLMA (Health Professionals Advancing LGBTQ Equality): GLMA promotes LGBTQIA+-inclusive health care by providing a directory of LGBTQIA+-friendly health care providers. They also offer education for health care professionals looking to improve their understanding of LGBTQIA+ health issues.
- LGBTQ+ Health Care Directory: A comprehensive online directory that allows you to search for LGBTQIA+-friendly health care providers in your area.
- Out2Enroll: An organization that focuses on helping LGBTQIA+ individuals navigate health insurance enrollment, providing information and assistance finding inclusive coverage.
- The Human Rights Campaign (HRC), "My Body, My Health:" In the absence of reliable care, HRC created the “My Body, My Health” initiative, which helps the LGBTQIA+ community (and other marginalized communities) have a better understanding of their bodies, HIV and sexual health.
- The Trevor Project: A well-known organization, the Trevor Project provides emergency mental health counseling for LGBTQIA+ youth. This also includes a directory of mental health professionals specializing in LGBTQIA+ care.
Progress Towards More Inclusive and Accessible Health Care
Despite significant advancements in LGBTQIA+ rights, health care disparities still exist. That doesn’t mean we shouldn’t celebrate our victories, though, and there have been numerous victories, including:
LGBTQIA+ cultural competency training
To address the disparities in health care access and quality of care experienced by LGBTQIA+ individuals, many health care providers and organizations have taken part in cultural competency training, designed to teach them how to be sympathetic and understanding of their LGBTQIA+ patients. They educate health care providers on terminology and challenges faced by LGBTQIA+ patients. By increasing providers' understanding and knowledge of LGBTQIA+ health issues, these programs have gone a long way in establishing a small, supportive community of medical professionals.
Many state governments have recently created laws that protect and enhance access to care for LGBTQIA+ individuals. For example, some states have enacted laws that explicitly protect transgender individuals' access to gender-affirming care. These protections provide a legal framework to safeguard the rights of LGBTQIA+ individuals across the board.
Section 1557 of the ACA
Section 1557 of the ACA is a specific provision worth mentioning. It explicitly prohibits discrimination based on sex, including sexual orientation and gender identity, in health care programs and activities. This provision ensures that LGBTQIA+ individuals are protected from discrimination by health care providers, hospitals and other entities that receive federal funding.
The Affordable Care Act
The Affordable Care Act (ACA) has helped improve health care access for the LGBTQIA+ community. The ACA expanded access to health insurance coverage by establishing the Health Insurance Marketplace and expanding Medicaid eligibility. The ACA also includes expressed access to preventive services and mental health coverage, both of which the LGBTQIA+ community has traditionally had a hard time coming by.
While these are actions on the federal level, it’s important to note that the landscape of health care access for the LGBTQIA+ community varies across states. Some states have implemented laws that protect LGBTQIA+ individuals from discrimination, while others have set forth some that do the opposite.
Ongoing efforts are still necessary to get equitable care for every LGBTQIA+ American. This includes continued advocacy for comprehensive nondiscrimination policies, expanded provider education and education on the financial barriers that limit health care access for many LGBTQIA+ individuals.
Expert Insight on LGBTQIA+ Health Care Acecss and Inclusivity
To get a deeper insight into what health care looks like for the LGBTQIA+ community, we asked some industry experts and those who have worked with the community to give their opinions.
- How does the health care system discriminate against those within the LGBTQIA+ community?
- How can LGBTQIA+ individuals still get the health care they need?
- How can we forge a path toward inclusion within the health care system?
Associate Professor In-Residence at UC Irvine Public Health
Understanding your options, advocacy, support and legal rights is crucial. The following resources can help you find the information and guidance you may need when navigating the health care system as an LGBTQIA+ individual.
- GLAAD: A nonprofit organization advocating for LGBTQIA+ acceptance through positive media, engagement within the community and education services throughout the country.
- CenterLink: A network of global LGBTQIA+ community centers offering educational resources, support and services to the LGBTQIA+ community.
- National LGBTQ+ Task Force: An advocacy organization helping to advance the rights of the LGBTQIA+ community, specifically in the areas of reproductive justice, government representation and policy.
- National Center for Transgender Equality (NCTE): An organization advocating policy change and social justice for the transgender and gender nonconforming communities.
- Lambda Legal: A nonprofit organization fighting for LGBTQIA+ legal rights — specifically for those living with HIV — and advocating for equal legal treatment.
- Trans Lifeline: A hotline and resource center offering support to transgender individuals in crisis. They also offer microgrants for gender-affirming care and name changes, plus LGBTQIA+ migrants.
- PFLAG: A national organization that provides support, education and advocacy for LGBTQIA+ individuals, their families and community allies.
- National LGBTQIA+ Health Education Center: A resource center offering educational materials and training programs to enhance LGBTQIA+ health care inclusivity.
- SAGE: An organization dedicated to improving the lives of older LGBTQIA+ adults through advocacy, inclusive housing, a hotline and more.
- The National Queer and Trans Therapists of Color Network: A directory of queer and trans therapists of color looking to promote mental health resources for the entire LGBTIA+ community.
- Transgender Legal Defense & Education Fund (TLDEF): A nonprofit organization offering the Trans Health Project, which offers education on legal rights for the LGBTQIA+ community and leads the movement toward equitable care for trans patients.
About Christopher Murray
- American Progress. "Advancing Health Care Nondiscrimination Protections for LGBTQI+ Communities." Accessed June 1, 2023.
- American Progress. "Discrimination and Barriers to Well-Being: The State of the LGBTQI+ Community in 2022." Accessed June 1, 2023.
- American Psychological Association. "Bystander Intervention Tip Sheet." Accessed June 1, 2023.
- Assistant Secretary for Planning and Evaluation. "Health Insurance Coverage and Access to Care for LGBTQIA+ Individuals: Current Trends and Key Challenges." Accessed June 2, 2023.
- CDC. "Health Services." Accessed June 2, 2023.
- Human Rights Campaign. "The Wage Gap Among LGBTQ+ Workers in the United States." Accessed June 2, 2023.
- National LGBT Cancer Network. "Cultural Competency Training." Accessed June 2, 2023.
- NPR. "Minnesota to join at least 4 other states in protecting transgender care this year." Accessed June 2, 2023.
- UCLA School of Law Williams Institute. "LGBT people nearly four times more likely than non-LGBT people to be victims of violent crime." Accessed June 2, 2023.
- UCLA School of Law Williams Institute. "More than 60% of suicide attempts among LGBQ people happen within five years of realizing they are LGBQ." Accessed June 2, 2023.
- U.S. Department of Health and Human Services. "About the Affordable Care Act." Accessed June 1, 2023.
- U.S. Department of Health and Human Services. "Section 1557 of the Patient Protection and Affordable Care Act." Accessed June 2, 2023.