Obamacare Guidelines: Insurance Must Cover ‘Mammogram or Pap Smear for a Transgender Man’

The Department of Health and Human Services’ most recent guidelines explaining the “preventive services” mandate under the Patient Protection and Affordable Care Act—or Obamacare—says health insurance plans must provide co-pay-free pap smears and mammograms to “transgender men.”

As defined by the federal Office of Personnel Management: “a person assigned the female sex at birth but who identifies as male is a transgender man.”

The guidelines, written as a FAQ sheet, state:

Q5: Can plans or issuers limit sex-specific recommended preventive services based on an individual’s sex assigned at birth, gender identity or recorded gender?

No. Whether a sex-specific recommended preventive service that is required to be covered without cost sharing under PHS Act section 2713 and its implementing regulations is medically appropriate for a particular individual is determined by the individual’s attending provider. Where an attending provider determines that a recommended preventive service is medically appropriate for the individual – such as, for example, providing a mammogram or pap smear for a transgender man who has residual breast tissue or an intact cervix – and the individual otherwise satisfies the criteria in the relevant recommendation or guideline as well as all other applicable coverage requirements, the plan or issuer must provide coverage for the recommended preventive service, without cost sharing, regardless of sex assigned at birth, gender identity, or gender of the individual otherwise recorded by the plan or issuer.