Health Insurance FAQ

• Government health insurance programs (Medicare and Medi-Cal)
• Various Medicare Advantage, HMO, POS and PPO plans
• Learn more about the health insurance weaccept(Link opens in new window). You can also check which plans our hospitals and doctors accept by calling the UCLA Health referral line at (800) UCLA-MD1(Link opens phone app) (310-825-2631), speak with your benefits coordinator at work (if applicable), or consult your health plan’s provider directory.
• Health Insurance and Patient Billing at UCLA Health
  • See our FAQs(Link opens in new window).

Health insurance offers a number of benefits. It covers crucial services, it’s less expensive than paying on your own for care and it provides financial protection. But it often requires help to successfully understand and navigate.

• The two main types of health insurance are private and public. Private health insurance includes plans you get through an employer or the marketplace. Public health insurance is provided through the government.
  • Private Plans:
    • HMO (health maintenance organization) is a plan where you can only see doctors and use hospitals within a set network. You must choose a primary care physician (PCP) and will need a referral to see a specialist.
    • PPO (preferred provider organizations) is a plan where you can see specialists without a referral from a PCP.
    • POS (point of service) is a plan that combines aspects of HMOs and PPOs, with a network of approved doctors and hospitals. 
  • Public / Government Programs:
    • Medi-Cal is California’s Medicaid program. The state and the federal government jointly fund it. It provides free or low-cost care to children and adults with limited incomes. For more information, call 800-541-5555(Link opens phone app) or visit medi-cal.ca.gov(Link is external) (Link opens in new window).
    • Medicare is a federal program that covers people 65 and older, as well as some people with certain diseases or disabilities. Medicare now authorizes coverage for gender affirming care. For more information, call 800-MEDICARE(Link opens phone app) (800-633-4227) or visit medicare.gov(Link is external) (Link opens in new window).
    • Tricare is an insurance program for dependents of people in the U.S. military. For more information, visit https://www.tricare.mil(Link is external) (Link opens in new window).
• Transgender Health Provisions. If you already have health insurance coverage, most information you need can be obtained from the plan website, your employer's HR department, or the phone number listed on your card. For information about transgender health provisions in the Affordable Care Act, visit the Department of Health and Human Serviceswebsite(Link is external) (Link opens in new window). 

This determines what list of doctors you are able to see for covered services.  This can vary from plan to plan. If you want to see a doctor who is outside of your network, you may have to pay part or all of the cost out of pocket, or in some cases you may be able to get an out-of-network approval.

• For many people, health insurance pays a portion of their health care costs but not all of it. These costs are known as “out-of-pocket” expenses.
  • This is an amount that you are expected to pay out of pocket each year before your insurance begins to pay for covered services. 
  • This is an amount that you are expected to pay with each service (doctor's visit, lab fee, x-ray), regardless of the deductible. 
  • Learn more about health insurance deductibles, copays and co-insurance. Watchvideo(Link is external) (Link opens in new window).

• New potential UCLA Gender Health Program (GHP) patients without active health insurance are strongly encouraged to seek coverage either through CoveredCalifornia(Link is external) (Link opens in new window) or through MediCal(Link is external) (Link opens in new window). Options vary by income level; please see these services’ websites for more information.
• Covered California and MediCal have multiple plan options. Before making your selection, contact the insurance plan and ask whether UCLA Health Gender Health Program providers are in-network.
• MediCal will often assign you to an in-network primary care physician based on where you live. You can work with this doctor to get referrals to our medical and surgical services.
• If you select an HMO option through Covered California, you may choose a UCLA Gender Health Programprovider(Link opens in new window) to be your plan-assigned primary care physician. Once your insurance is active and your UCLA Gender Health Program primary care provider is confirmed, please submit an “AppointmentRequest”(Link is external) (Link opens in new window) form.
• Some PlannedParenthood(Link is external) (Link opens in new window) locations also provide low cost primary care and hormone replacement therapy services for folks who do not have health insurance.

• Most health insurances that are based in California cover gender affirming surgeries as part of their Transgender Health Benefits. 
• Each insurance plan’s coverage varies, so contact your health insurance directly to see what surgeries are covered as well as requirements for surgery.
• Remember that your plan may include a co-payment which you must pay out-of-pocket first. This might be a flat fee or a percentage of the cost of your procedure.
• Gender affirming surgery coverage and gender affirming care in general varies greatly on where you live and what insurance plan you have. 

• The case management services provided by the UCLA Gender Health Program are not billed to your insurance and are a free service. 

• Most insurances that are based in California provide insurance coverage for hormone replacement therapy as part of their Transgender Health Benefits. 
• Hormone replacement therapy coverage and gender affirming care in general varies greatly on where you live and what insurance plan you have. 
• Each insurance plan’s coverage varies, so contact your health insurance directly to see what gender affirming care services are a covered benefit. 

• Most insurances that are based in California provide gender affirming care insurance coverage for clients who are younger than 18. 
• Each insurance plan’s coverage varies, so contact your health insurance directly to see what gender affirming care services are a covered benefit. 
• No gender affirming medical interventions can be made for children under the age of 18 without consent from parents/legal guardians.

• We can work with most out-of-state insurances. Contact your insurance directly to ask if you have “out-of-state coverage.” When seeking gender affirming care with out-of-state insurance, your insurance can work with our health system to create a “one time agreement” for services. For more information, please contact UCLA HealthBilling(Link opens in new window). 

• Yes, UCLA Health is contracted with MediCal and MediCare insurance plans. Work with your current care team for referrals for care and contact our billingdepartment(Link opens in new window) for more information.

• Most health insurance plans provide mental health coverage without a referral. Contact your insurance to get information on your mental health benefits. Some insurances have a mental health line on the back of the insurance card. 
• In the event of an emergency or mental health crisis, you should call 9-1-1 or go to the nearest emergency room if you can safely get there. 24-hour hotlines are also available for support and information: The US Trans Lifeline 1-877-565-8860, the National Suicide Prevention Lifeline at 1-800-273-8255, and the Los Angeles County Department of Mental Health Hotline at 1-800-854-7771.

• Please visit our Refer aPatient(Link opens in new window) page.

• LA Care through MediCal has a Transgender Health Program administration team that can walk you through next steps for surgery referral and insurance authorizations. 
• Contact Phone Number: 1-888-839-9909
• LA CareWebsite

• Yes, the UCLA Gender HealthProgram(Link opens in new window) provides gender affirming care and support for pediatric patients (younger than 18 years of age) and their legal caregivers.
• Care for our pediatric patients starts with our gender affirming Primary Careproviders(Link opens in new window).
• Each pediatric patient and their support systems are treated uniquely. We work together as a team to support each patient and their care goals.
• Due to California state law, our primary care team cannot provide gender affirming medical treatments without parent/legal caregiver consent. If a patient is legally emancipated or turns 18, they can consent to their own care without parent consent.
• Supporting documentation of legal emancipation status is needed before medical treatment can begin.
• Our team can clarify any questions that you might have. We can be reached by email at genderhealth@mednet.ucla.edu or by phone at (310) 267-4334.

• First of all, thank you so much for seeking out care for your Trans/Gender Diverse/Questioning kid. We are here to help guide you and your child on their unique care path.
• Each pediatric patient and their caregiver system are treated as their own unique patient system. We take direction from our patients and their caregivers and develop a unique care plan for each pediatric patient.
• Our pediatric Primary Care providers are trained to deliver evidence-based care to Transgender/Gender Diverse/Questioning identified pediatric patients.
• Most insurances in the state of California provide gender affirming care as a covered benefit. This means that you will only be responsible for your co-payment at the time of your visit. Check with your insurance regarding your co-pay for in-network primary care services.
• Gender Health Program videos about youth and gender affirmingcare(Link is external) (Link opens in new window)
• PFLAG /TFLAG