If you’re under 26 years old and have a parent or legal guardian with health insurance that covers dependents, you might be added to their plan. This can help you manage the costs of healthcare.
However, it can also raise concerns about privacy and confidentiality — especially for members of the LGBTQIA+ communities.
“In the United States, many young adults are on their parent’s insurance until they’re 26 years old, so they’re not the people receiving the insurance bill or records,” says Lindsey Schafer, a licensed social worker and mental health therapist specializing in sex and sexuality at Wise Therapy Associates in New York City.
Those insurance health records go straight to the home where their parents are living or arrive in their guardians’ email inboxes not long after doctor’s appointments.
“It’s pushed some of the people I work with to come out to their parents and families before they’re ready because they don’t have control of those insurance records,” she adds.
Understandably, many young people who find themselves in this situation might not know what to do. Read on to learn more about your rights as an insurance dependent and strategies for maintaining privacy while seeking LGBTQIA+ affirming health services.
In 1996, the Health Insurance Portability and Accountability Act (HIPAA) came into effect in the United States. This federal law established standards to protect the confidentiality of sensitive health information.
This means your doctor can share information about your health history with your insurance provider. In turn, each time you use a health service, that insurance provider can share records with the person who holds the insurance.
If you’re a dependent on a health insurance plan, this policyholder is your parent or guardian.
“As a healthcare worker, HIPAA protects my patients by legally prohibiting me from discussing patient issues with friends or family unless the patient explicitly gives consent,” says Bethany Malone, MD, a surgeon in Forth Worth, Texas.
“While this protects the doctor-patient relationship, there are still other ways that the main person on the insurance might find out about sensitive healthcare topics. This happens in the form of an explanation of benefits (EOB), a document that the insurance company sends out that lists what healthcare has been distributed and billed to insurance,” she adds.
If you’re a dependent on a parent or guardian’s insurance plan, your insurer may share a copy of the EOB with your caregiver by mail or electronically. Your doctor or other healthcare professionals might also send bills for services to them.
If you haven’t talked about your gender or sexuality with your parent or guardian or you don’t want them to know that you’ve accessed certain health services, you might be reluctant to seek those services.
For example, in a
Although HIV can affect people of any gender or sexuality, it affects transgender women and men who have sex with men at higher rates than average.
“If young adults are not already having conversations with their parents or guardians about these things, it raises a big question,” says Schafer. “‘Am I able to get sexuality- or gender-affirming treatment that’s going to help me live my best life as the person that I identify as, or am I going to hold back on these things because I’m not ready to come out?’”
HIPAA is not the only regulation that governs the sharing of sensitive health information.
Several states have established additional provisions to protect the confidentiality of health insurance dependents. For example, some states:
- allow insurance dependents to submit a written request to their insurance provider for confidential communications
- allow insurance providers to mail an EOB directly to patients instead of policyholders or issue EOBs only when payment is due
- protect the confidentiality of dependents who are seeking treatment for sexually transmitted infections (STIs)
In some cases, these protections apply to adult dependents only. In other cases, they also apply to minors. The specific health services covered by these protections vary by state.
Take a look at this table to learn whether your state has established confidentiality protections for insurance dependents. Keep in mind that this information might change over time.
|State||Can a dependent request confidential communications?||Are there EOB protections?||Is there confidentiality for STI treatment?||Other protections?|
Speak with your doctor or insurance provider to learn more about current laws and practices in your state. You can also explore the Guttmacher Institute’s website for more information on sexual and reproductive rights policy decisions.
How can you manage insurance-related privacy concerns? Considering taking these steps.
Get informed before your appointments
To make informed decisions about your health service use and privacy, it’s important to learn what information your healthcare team and insurer will share — and with whom.
“I think it’s really important to know what to expect, so there are no surprises,” says Schafer, “Have this conversation with your doctors before you even go into their office so that you know ahead of time what’s going to be sent to your home or your guardians.”
“Ask them if there are alternate ways to report that billing information,” she adds. “Sometimes, doctors can send a bill that may be less specific or a little bit more discreet or confidential.”
In addition to speaking with your doctor and other care team members, you can contact your insurance provider to learn more about their confidentiality-related policies and practices.
Prepare for challenging conversations
In some cases, you might decide to access health services even if it means that a parent or guardian will receive information about those services.
Schafer encourages people to prepare for potential questions this might raise at home.
“If you’re going to go ahead with it, be aware that this might be a conversation that you’re going to have to have with your family or the people who are receiving these bills,” she suggests.
“The sad reality is that a lot of people who are part of the LGBTQIA+ community live in homophobic and transphobic environments. If you’re in this type of situation, make sure that you have a safe space and people and resources to lean on if you have to come out, explain a bill, or deal with a situation like this,” she says.
Consider enrolling in your own insurance
If you can afford to do so, you might consider dropping out of your guardian’s insurance policy and enrolling in your own insurance plan. That way, all of your insurance records will be delivered to you directly.
Before you enroll in a plan, learn what types of services it covers. No single plan covers every health service. Even if a service is covered, you may need to meet certain criteria or follow certain steps to receive reimbursement for it.
For example, if you’re interested in transition-related care such as hormone therapy or sex-affirming surgery, look for a plan that covers those treatments. Review the list of coverage exclusions in the insurance policy contract and contact the insurance provider for more information.
Be prepared for questions that your parents or guardians might have about your decision to drop out of their insurance and enroll in your own plan.
Look for free or low cost health services
If you don’t have health insurance or you can’t claim certain services on your insurance, you may need to pay for the full cost of services out of pocket. However, in some cases, you might be eligible for low cost or free health services. Examples include:
- Therapy and counseling. Some mental health counselors provide therapy on a sliding pay scale, which means they charge different fees based on a person’s income or ability to pay. You can also consider a therapist who’s in training at a university. They’re a good option for free or low cost support and work under the close supervision of licensed professionals.
- Crisis support and community access. You can access free and confidential support from a crisis counselor through The Trevor Project, a nonprofit organization that provides mental health support to LGBTQIA+ community members.
- Gender-affirming care. The National Center for Transgender Equality offers information and tips to help transgender community members understand their health rights, get insurance, and find transition-related financial support.
- General care and prescriptions. To find clinics and pharmacies that provide free or low cost care to uninsured and underinsured people, visit the National Association of Free & Charitable Clinics.
Sexual health services
Sex can be difficult to discuss with a parent or guardian in any case, but it may be especially hard if you’re not out to them or don’t feel supported. Some organizations offer free or low cost services and care for sexual health specifically:
- Search GetTested, a database from the Centers for Disease Control and Prevention (CDC), to find free, low cost, and confidential STI testing near you.
- Contact your nearest Planned Parenthood to learn if they offer free or low cost sexual health services, including PrEP, STI testing, and pregnancy testing and services.
- Visit the Health Resources & Services Administration Ryan White HIV/AIDS Program to search for HIV care and support services or apply for financial assistance for HIV medications.
- Check out the Ready, Set, PrEP website to learn if you’re eligible for free PrEP medication. The National Alliance of State & Territorial AIDS Directors (NASTAD) also provides information about state-based PrEP assistance programs.
- Search the Greater Than AIDS online database to find PrEP providers, HIV testing and treatment services, and information about health insurance options in your state.
If you’re an LGBTQIA+ health insurance dependent, it’s important to know that your parent or guardian may receive information about the health services that you access.
Some states have passed provisions to protect the confidentiality of insurance dependents, but these protections vary from state to state and from one situation to another.
Speak with your doctor and contact your insurance provider to learn what protections are available to you and what information your parent or guardian might receive. If you decide to access sensitive health services, be prepared for the conversations it might spark.
Sometimes, it might be right for you to enroll in your own insurance plan or look for affordable health services that you can access without insurance.