Tracker Pixel for Entry

Health insurance coverage in North Dakota and Minnesota

by Faye Seidler | .(JavaScript must be enabled to view this email address) | Culture | November 8th, 2017

Nobody is going to look you in the eye and tell you that choosing an insurance plan is easy, but when you’re transgender the choice can be twice as hard. I spend every year talking to our local insurance agencies to find out what is and isn’t covered for the trans healthcare.

While the second half here will be focusing on trans healthcare, I’ll start by going over some basics that can help anyone!

The first thing to talk about is the Healthcare Marketplace. If you’re in North Dakota, open enrollment ends on Dec 15th, and you’ll want to go here to apply before that date:

If you’re in Minnesota, open enrollment ends on Jan 15th, and you’ll want to go here to apply before that date:

The application process can honestly be pretty lengthy, but at every step there are options to get help both in person and over the phone.

The benefit of applying through the Healthcare Marketplace is that individuals can qualify for lower premiums and tax credits to help pay for insurance cost. Individuals can end up saving hundreds of dollars a month by purchasing through the marketplace. Savings are often directly related to income level, where if an individual’s income is low enough, they may qualify for free insurance through Medicare.

Unfortunately, if someone’s workplace offers insurance, they cannot use the marketplace or be eligible for tax credits. This means if a person wants a different insurance plan than what their company offers, or if someone needs to get insurance after the deadline is up, then they have to buy private plans directly through insurance companies -- and private plans tend to be pretty expensive.

The long and short of all of this is that if a person doesn’t have insurance through their job, they should use the websites listed above.

With that out of the way, let’s talk about some standard terms to expect with insurance.

The premium is the amount of money you pay for a plan and doesn’t factor into any of the other costs we’ll be talking about.

Deductible is the amount of money you have to pay towards healthcare, before the major perks of a plan kick in. That means if you have a $5,000 deductible, you won’t get major benefits from the plan until you’ve paid $5,000 in healthcare.

Out-of-pocket maximum refers to the most money you’ll have to spend on healthcare, before your plan covers 100% of everything they normally cover.

Co-insurance refers to the percentage you have to pay after your deductible is met and before your out-of-pocket maximum is hit. So, if a person has a 10% coinsurance, a $5,000 deductible, and a $1,0000 Out-of-Pocket Maximum, after paying the first $5,000 dollars, they’d only have to pay 10% of all services that have a coinsurance. So if they’d paid $5,000 already and had a medical bill for $1000, they’d only have to pay for $100 dollars for it or 10% of $1000.

Finally, co-pay just means a person pays that amount for each visit or service. If a plan says a doctor visit has a $30 copay, a person will always have to pay $30 to see a doctor.

When individuals are trying to determine the best plan for them, they have to consider how much in medical costs they typically accrue. The sad truth is that insurance tends to be a gamble between security and affordability. If a person expects significant medical costs, they will want a plan with a lower deductible, so the benefits kick in right away. If they don’t expect any major medical cost, they can go with a higher deductible plan that typically costs much less.

Now that we have some of the basic terms down, let’s look at benefit summaries.

Every plan will give an individual a summary of benefits which lets them know what is covered and to what extent. If a person routinely sees a specialist, they’ll want a plan that covers specialists. If they have specific conditions or specific risks, it is important to look for plans that cover those. There is always a brief summary of the benefits as well as a comprehensive benefit packet that describes everything.

Even if it appears that something is covered it is always best to confirm with an insurance agency in writing, prior to scheduling a service.

I mentioned earlier that if someone has insurance through their work, they don’t qualify for the marketplace or marketplace savings. However, if their workplace insurance plan isn’t covering their medical issues or needs, it may be less expensive in the long run to purchase a plan at cost through a private insurance company.

So, let’s say a person pays only $1,000 a year for workplace health insurance, but accrues $10,000 in cost from health care services their insurance didn’t cover. It may be beneficial for them to purchase a private plan through an insurance company that could cost $4,000 a year, but cover their needed medical expense and therefore save them money.

These are the important things to think about and explore while choosing the right health insurance. It’s highly advisable that if a person has questions they should contact these websites or also private insurance companies, to ask for quotes and to get help understanding specific insurance plans.

Do not use this article as anything more than a rough set of guidelines, and please speak with a professional healthcare navigator or company representative before making decisions.

With all the basics out of the way, let’s talk insurance for trans people.

I’ve talked with representatives or obtained reliable information from Medica, Medicaid (low income), Medicare (over 65), Bluecross Blueshield (BCBS), and Sanford Health Plan.

Given the caveat that each service I’m about to mention has been deemed medically necessary, all of these insurance agencies in both North Dakota and Minnesota cover hormone therapy, prostate examines, breast examines, and endocrinologist visits, assuming that a plan covers specialists.

I believe all of them cover blood tests in relation to hormone therapy, but I wasn’t able to get a clear answer as to whether lab work is considered preventative in relation to monitoring hormone levels.

In North Dakota, individuals can purchase BCBS, Sanford Health Plan, Medicaid, and Medicare through the healthcare marketplace. Sanford Health Plan, Medicare, and BCBS of North Dakota all offer gender confirmation surgery.

In Minnesota, individuals can purchase BCBS, Medica, Medicaid, and Medicare through the MNsure healthcare marketplace. Every plan we’ve talked about in this article covers transgender confirmation surgery in Minnesota.

All surgery requires prior approval and must follow the criteria established by the World Professional Association for Transgender Health. Don’t be scared by that, since most surgeons will not operate unless a person meets those standards anyway.

The standard treatments that an individual gets through therapy and endocrinology often set the precedent for medical necessity, and the health care practitioners involved with those treatments are the ones who will advocate for surgery at the behest of their trans patient.

All in all, this year is looking much better than last year and I hope we will continue to improve access to trans healthcare. I also encourage any healthcare service providers to examine themselves and make efforts to improve the services they give to trans patients.

Any organization is welcome to contact me for more information about trans issues or staff training!

[Editor’s Note: Fae Seidler is North Dakota Safe Zone Project Spokeswoman]

Recently in:


​Best of the Best 2018

by Sabrina Hornung

Last Sunday we celebrated our annual Best Bets award ceremony at the Plains Art Museum and we had a packed house. With awards from over 50 categories, members of our community gathered, rallied and supported each other in our…

Professionally people know me as a trans activist, educator, or community organizer. This is often the topic of my Trans Corner column. What they may not know is I’m an incredible geek who spends her time unwinding playing video…

Thursday, May 31, 5-9 p.m.11 8th St S, FargoNine regional artists join forces in Fargo’s newest artist collective gallery. Along with the core group of artists, art enthusiasts can anticipate guest artists and great opportunities…

“If I look like a kid on Christmas morning, it’s because that’s the way I feel right now. How I wish my parents could have heard the words you said about me,” Luci Baines Johnson said. She was preparing her commencement…


Armageddon and Rage

by Ed Raymond

Is Our Democracy Dying From A Koch Assisted-Suicide?The One Percent is going after wealth like Captain Ahab went after The Great White Whale. Rupert Murdoch’s Wall Street Journal recently wrote about “the up-market way to…

FARGO - A collection of memories from High Plains Reader's annual Cocktail Showdown. Participants were judged on creativity, flavor, and presentation; and this year we added a new category. Like years before, each establishment was…

The organization Nature of the North is storming Fargo with their mission to get everyone out and in nature one way or another. This week’s attempt is a workshop featuring Cyrus Bickell of Disgruntled Brewing in Perham, MN. A man…

Nikki Lane is a trailblazer. Her unique voice could be described as a cross between Wanda Jackson’s grit and Neko Case’s hauntingly smoky vocals. It’s classic and it’s fresh. In 2017 she won an Ameripolitan award in the…

Writer-director Alexandra Dean’s “Bombshell” recounts the remarkable life and achievements of Hedy Lamarr, the Golden Age screen goddess whose physical beauty and career as a Hollywood actor long overshadowed her…


​Civility is for the Birds

by HPR Contributor

By Tayler Klimektklimek@cord.eduTucked in the back of Roberts Street Studio, if you follow the “yellow brick road” (a funny story, if you get the chance to ask her), you are likely to find local artist Mackenzie Kouba working…

Theater B is giving away seven tickets to go see “The Moors” by Jen Silverman, from April 26 until May 12. Described as part Brontë, part Twilight Zone, “The Moors” is a dark comedy set on a bleak and unforgiving…

Fargo has its share of people who are passionate about stand-up comedy, even if the success of clubs devoted to it has been mixed. Despite the fact we have seen places like Courtney’s Comedy Club and Level 2 Comedy Club close…

I consider myself an avid wine drinker, but I recently found out there are more than 10,000 varieties of grapes, and about 1,500 of those are used to make commercial wines. I don’t know about you, but I could probably name about…

Best Local CelebrityCarson WentzBest Stylist / BarberJed Felix, Everett’s BarbershopBest Salon / Barber ShopEverett’s BarbershopBest Tattoo Parlor46 & 2 TattooBest Tattoo ArtistMeg Felix, No Coast TattooBest Gift ShopZandbroz…

By Melissa Martinmelissamartincounselor@live.comAnd they lived “happily ever after.” Many people in the U.S. believe in love and matrimony, but marriage takes consistent effort and time to weather the ups and downs.According to…

By Ken Smithkelandsmith@gmail.comWhen the State of North Dakota decided to sell the campus of the Ellendale Branch of the University of North Dakota following the disastrous January 1970 fire that destroyed the two main buildings,…