People aged 65 and older qualify for health insurance coverage under Medicare, the nation’s second-largest health insurance program after Medicaid. At least 2.4 million people of these individuals identify as lesbian, gay, bisexual, transgender, queer, or other forms of sexual identification (LGBTQ+). Select states now have a plan designed specifically for this population: SCAN Affirm.
SCAN Affirm is a Medicare Advantage plan designed by the Senior Care Action Network exclusively for LGBTQ+ seniors.
Transgender people should apply for Marketplace coverage using their full name printed on their Social Security card, but they don’t have to share their gender identity or sexual orientation.
All SCAN plans cover preventive services, hormone therapy drugs, and HIV/AIDS medications.
All SCAN plans cover urgent care visits for times when you need non-emergency care before or after your doctor’s office hours.
What Is SCAN Affirm?
SCAN Affirm is a Medicare Advantage plan designed by the Senior Care Action Network exclusively for LGBTQ+ seniors. Enrollment for the year 2023 began on October 15, 2022. To date, SCAN will offer these benefits to Medicare Advantage members in Arizona, California, Nevada, and Texas in select counties.
This article answers important questions about SCAN’s benefits and addresses the most common concerns about Medicare coverage for older LGBTQ+ people.
Should I share my gender identity or sexual orientation?
You won’t lose any SCAN benefits if you withhold your gender identity and sexual orientation but doing so might limit the programs and services available to you. Disclosing this information to your physician will help give them a clearer picture of your life and issues that can affect your physical and mental health. Openness with these professionals can also make calls and visits more comfortable for all involved.
Federal HIPAA rules require that your doctor and staff keep your personal information confidential unless you permit them to share it. However, your gender marker in Medicare’s system should not affect your access to medical services.
Does SCAN cover HIV treatment medications?
All Medicare plans, including SCAN, cover all medications for HIV treatment with applicable coinsurance and copayments. They are also required to provide PrEP (pre-exposure prophylaxis) HIV prevention medication at no cost. Doctors prescribe this treatment for HIV-negative individuals at substantial risk of contracting HIV.
Some PrEP medications include tablets such as Descovy and the generic alternative to emtricitabine, tenofovir disoproxil fumarate (TDF), and Truvada. The injectable Apretude (cabotegravir) is also an option.
Does SCAN cover hormone therapy drugs?
SCAN covers medically necessary hormone therapy for transgenders. Leuprolide, testosterone therapy, and certain other medications may require prior authorization.
How does a transgender person apply for coverage?
Transgender people should apply for Marketplace coverage using their full name printed on their Social Security card. The website recommends choosing the sex selected on your driver's license and other legal documents. Bear in mind that your health insurance company will refer to the information on your Marketplace application.
If your name or sex changes after enrollment in a plan, you can update your information when you log in. Contact the Marketplace Call Center if you encounter problems.
Will Medicare cover preventive services?
SCAN plans, like other Marketplace health plans, cover certain preventive services at no cost from a health care provider within your plan’s network. You do not have to meet your annual deductible in these cases.
Does SCAN cover sex-specific preventive care?
Medicare plans like SCAN will cover sex-specific preventive care if your healthcare provider deems it medically necessary. Your plan can’t limit preventive services to those based on your sex assigned at birth or your recorded gender. For instance, a transgender has access to screenings for cervical, vaginal, or prostate cancer and mammograms.
Additionally, Medicare plans cover a wide range of screenings for blood pressure, cholesterol, type 2 diabetes, and much more. Screenings and counseling are also available for depression, obesity, and alcohol misuse. Adults at high risk may receive screenings for sexually transmitted infections such as hepatitis C and HIV.
How do I find an LGBTQ+-friendly doctor?
Securing the services of a doctor who understands and respects the needs and preferences of the LGBTQ+ community is becoming easier. SCAN has vetted providers who are committed to serving this population. Plan members need to choose a primary care physician who is in the network before scheduling an appointment.
Some hospitals and medical offices can connect you with doctors who are specially trained to support LGBTQ+ patients and their caregivers. You may also consider these sources for finding a healthcare professional you can feel comfortable with:
- Relatives and friends
- Local LGBTQ+ community centers
- PFLAG local chapters
- National LGBT Chamber of Commerce
- SAGE National Resource Center on LGBT Aging
- World Professional Association for Transgender Health (WPATH)
What if I need urgent care?
All SCAN plans cover urgent care visits for times when you need non-emergency care before or after your doctor’s office hours. Most SCAN plans come with a telehealth benefit for “virtual house calls” at any time with a board-certified physician. Telehealth calls are not meant to replace regular doctor’s visits, though.
What if I can’t afford the medications my doctor prescribes?
If your doctor prescribes a medication that’s too expensive for you, talk with them first. They may be able to find an alternative that works with your budget and treatment plan. Your doctor may also know how to help you get some medications for a lower copayment.
SCAN Member Services can help you explore more economical options as well.
How can I obtain HIV/AIDS medications with no health insurance?
The AIDS Drug Assistance Program (ADAP) under the Ryan White HIV/AIDS Program Part B provides health care assistance for people with limited or no health insurance. Medically and financially eligible recipients can use these grant funds to buy health insurance and get access to drug treatments and monitoring. All 50 states participate in this program.
A voice for those aging in silence
Older LGBTQ+ people face the health concerns that come with aging, but they also deal with unique challenges as a group. They have been described as “aging in silence” because of social, institutional, and economic obstacles to health care. SCAN Affirm is here to listen to and meet the concerns of these seniors.
Where can I find up-to-date information on Medicare benefits for LGBTQ+ people?
Medicare benefits and legal rights for the LGBTQ+ community are constantly changing. The following resources can help you stay on top of developments and maintain access to high-quality, inclusive medical services for LGBTQ+ people:
- U.S. Department of Health & Human Services – LGBTQI+ Health & Well-being
- Human Rights Campaign – Health & Aging
- ACLU – Transgender People and Healthcare