Lesbian, gay, and bisexual respondents are less likely to report discrimination by their health insurer than other sexual minorities.
HealthCare.com’s LGBTQ+ Health Insurance Survey 2022 shows that 1 in 8 LGBTQ+ Americans say they experienced discrimination by their health insurance provider.
But 1 in 3 think health insurance coverage is improving for LGBTQ+ Americans.
6 in 10 are unsure if their health insurance covers gender-affirming medication, gender-affirming procedures, PrEP or fertility treatments.
4 in 10 LGBTQ+ Americans carry medical debt.
Scroll down for the full results of HealthCare.com’s LGBTQ+ Health Insurance Survey 2022.
HealthCare.com LGBTQ+ Health Insurance Survey 2022
Key Findings
1 in 8 LGBTQ+ Americans say they experienced discrimination by their health insurance provider
1 in 3 think health insurance coverage is improving for LGBTQ+ Americans
6 in 10 are unsure if their health insurance covers gender-affirming medication, gender-affirming procedures, PrEP, or fertility treatments
3 in 10 carry more than $1,000 in medical debt
Detailed Findings
1 in 8 LGBTQ+ Americans say they have experienced discrimination from their health insurance provider.
Lesbian (8%) and gay (4%) individuals are much less likely to report discrimination than the 12% of LGBTQ+ Americans who report discrimination as a whole.
The proportions of bisexual (14%), transgender (18%), queer (60%), pansexual (17%), asexual (26%), and questioning (36%) individuals saying they experienced discrimination from their health insurance company are notably higher, although the sub-samples are often too small to compare differences statistically. This also suggests that research with larger samples is needed to validate these trends.
By generation, 22% of Millennial (born 1981-1996) and 20% Gen Z (born 1997-2012) LGBTQ+ individuals have experienced discrimination from their health insurance providers. That compares to 3% of Baby Boomers (born 1946-1964) and 11% of Gen X (1965-1980), indicating that younger groups may experience increased health insurance-related discrimination.
HealthCare.com surveyed 520 lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) Americans to assess their health insurance coverage, personal finances, and experiences with a range of insurance carriers, including government and private programs.
Among the 520 respondents, 209 (40%) identified themselves as bisexual, 156 (30%) as gay, 63 (12%) as lesbian, 24 (5%) as pansexual, 23 (4%) as asexual, 23 (4%) as other, 11 (2%) as not sure/questioning, 10 (2%) as queer, and 1 (0.19%) as straight.
The sample includes 7 (1.35%) individuals who identify as transgender men, and 4 (0.77%) as transgender women.
Percent of sexual minorities reporting discrimination from their health insurance provider based on gender and/or sexual orientation
| Group | Yes | No | Unsure |
|---|---|---|---|
| Queer | 60% | 40% | 0% |
| Not Sure/Questioning | 36% | 36% | 27% |
| Asexual | 26% | 65% | 9% |
| Pansexual | 17% | 71% | 13% |
| Bisexual | 14% | 73% | 13% |
| Lesbian | 8% | 81% | 11% |
| Gay | 4% | 88% | 7% |
Perceptions of Discrimination Accompanied by Views of Improved Coverage
Despite some experiencing discrimination by their health insurer, 32% of surveyed LGBTQ+ individuals think health insurance coverage is improving greatly or improving for LGBTQ+ Americans.
The greatest proportion of respondents, 44%, say health insurance coverage is neither improving nor worsening, while a smaller 13% say health insurance coverage for LGBTQ+ Americans is worsening or worsening greatly.
Encouragingly, the positive views extend across all groups.
Lesbian (33%), gay (39%), and bisexual (45%) Americans are all more likely to say that health insurance coverage is improving greatly or improving. That compares to 19% of lesbian-, 12% of gay-, 12% of bisexual-, and 18% of transgender-identified respondents who think insurance coverage is worsening or worsening greatly.
Queer (60%), pansexual (48%), asexual (48%), and questioning (55%) groups are also far more likely to think that health insurance coverage is improving greatly or improving rather than worsening or worsening greatly.
64% of transgender individuals say that health insurance coverage is improving greatly or improving, compared to 18% who think it is worsening or worsening greatly.
Percent of sexual minorities who think that health insurance coverage for LGBTQ+ Americans is improving or worsening
| Group | Improving greatly | Improving | Neither improving nor worsening | Worsening | Worsening greatly |
|---|---|---|---|---|---|
| Queer | 30% | 30% | 20% | 20% | 0% |
| Not Sure/Questioning | 27% | 27% | 36% | 9% | 0% |
| Bisexual | 15% | 30% | 42% | 10% | 3% |
| Asexual | 13% | 35% | 39% | 13% | 0% |
| Gay | 10% | 29% | 49% | 12% | 0% |
| Lesbian | 6% | 27% | 48% | 14% | 5% |
| Pansexual | 4% | 46% | 29% | 17% | 4% |
Many Get Health Insurance from Government Programs
Among respondents, the largest number have Medicare (33%), followed by employer insurance (23%), Medicaid (18%), and private insurance from a federal or state exchange (10%). Only 7% of respondents reported being uninsured.
The greatest number of lesbian (35%), gay (51%), and bisexual respondents (26%) are on Medicare.
Among transgender individuals, 27% are on Medicaid, while a similar 27% have COBRA, a continuation of employer-based coverage that one can keep for at least 18 months after losing or leaving one’s job.
Other groups, including queer (40%), pansexual (42%), asexual (26%), and not sure/questioning Americans (36%), report having higher proportions of employer-based insurance compared to other types of insurance.
However, LGBTQ+ Americans are, to a large degree, unsure of their insurers’ coverage for treatments often sought by their communities.
Asked if their health insurance covers gender-affirming medication (hormones), gender-affirming procedures (surgery), Pre-Exposure Prophylaxis (PrEP) to prevent HIV infection, or fertility treatments, 60% of respondents were unsure.
20% of respondents said that their insurance does not cover any of the above, while 10% said their policies cover gender-affirming hormones, and 10% said their policies cover PrEP. 8% said their policies cover fertility treatments, and 7% gender-affirming procedures.
Among participants who did not take PrEP, 25% said it was because they were concerned about side-effects. 22% said they were not sexually active, 20% said it’s too expensive and their insurance doesn’t cover it, 16% said they don’t know where to get it, and 14% said taking a pill each day is too difficult.
“It’s been 10 years since the FDA approval of PrEP,” notes Rutgers associate professor and LGBTQ+ health equity expert Corina Lelutiu-Weinberger, PhD. “The fact that so many people are still unsure about access and concerned about side effects, despite all the efforts that have been made for PrEP-promotion, is alarming.
“There are multiple and by now well-documented barriers to PrEP uptake. Some of the most prominent ones are stigma around PrEP use and discrimination within healthcare, which leads to missed prevention opportunities or increased patient distrust. PrEP messaging that is tailored to all groups of interest, especially sexual and gender minorities of color, remains inadequate, as is clear and universal PrEP acces for candidates and education for providers. It is more economical to prevent than treat HIV and its co-morbidities, so it’s in insurers’ interest to better promote PrEP. Healthcare providers remain an important target for intervention to reduce stigmatizing beliefs around PrEP and its candidates, and even to educate them on this incredibly powerful biomedical prevention tool, to which many providers remain resistant to integrate in their practice.”
Percent of sexual minority by primary health insurance provider
| Group | Employer | Marketplace | Direct from insurance company | Medicaid | Medicare | COBRA | Uninsured |
|---|---|---|---|---|---|---|---|
| Lesbian | 24% | 6% | 3% | 24% | 35% | 3% | 5% |
| Gay | 22% | 8% | 4% | 8% | 51% | 1% | 2% |
| Bisexual | 19% | 9% | 7% | 23% | 26% | 1% | 11% |
| Queer | 40% | 20% | 10% | 20% | 0% | 0% | 10% |
| Pansexual | 42% | 17% | 0% | 21% | 8% | 0% | 13% |
| Asexual | 26% | 17% | 9% | 17% | 22% | 0% | 4% |
| Not Sure/Questioning | 36% | 9% | 0% | 18% | 27% | 0% | 9% |
Low Awareness of Coverage Features
Hamstrung by Medical Debt
Similar to many Americans, LGBTQ+ adults are heavily impacted by medical debt.
39% of respondents have some amount of medical debt. For 1 in 3, the amount is over $1,000.
For Millennial LGBTQ+ individuals, the share with medical debt rises to 56%.
Among sexual minorities, gay respondents are far more likely to be free of medical debt. As such, three-quarters (75%) of the gay respondents report having zero medical debt.
In aggregate, 53% of the sample are somewhat or very concerned that a major health situation in their household could lead to bankruptcy or debt.
That compares to 29% who are not very or not at all concerned.
The majority of respondents (54%) are somewhat or very concerned that a major health situation in their household could lead to bankruptcy or debt.
Millennial LGBTQ+ respondents are also, compared to other generations, the most likely to report financial concerns: 63% say they are somewhat or very concerned that a major health situation in their household could lead to bankruptcy or debt.
Further, lesbian-(50%) and bisexual-identified participants (55%) are more likely than gay-identified participants (42%) to report concerns around major health situations leading to bankruptcy.
Though small in number in this sample, queer, pansexual, asexual, and not sure/questioning respondents are all more likely to report they are somewhat or very concerned than to say they are not very concerned or not concerned at all.
Percent of sexual minorities reporting zero medical debt
Comparing LGBTQ+ Health Finance Issues to Americans as a Whole
HealthCare.com’s survey revealed that the LGBTQ+ community is better off in some aspects of health insurance and personal finance than Americans as a whole, and worse off in others.
Taken as a whole, participants have an uninsured rate of under 7%, somewhat less than the nearly 9% uninsured rate of the general population reported by the government for the fall of 2021, though within the margin of error.
Across the different subgroups, bisexual, queer, pansexual, asexual, and not sure/questioning groups are more likely to be uninsured than lesbian, gay, and transgender-identified respondents, although the numbers within each of these subgroups are small, calling for caution in drawing conclusions.
In terms of health finances, the 39% of LGBTQ+ respondents reporting medical debt is slightly less than the 45% of the general population we found in HealthCare.com’s fall 2021 survey.
The most notable difference this survey identified between the LGBTQ+ community and the general population involves personal savings for a health emergency. When asked how much they have in savings for medical bills, 24% of LGBTQ+ respondents say they have more than $6,000 in savings, compared to just 14% of the general population.
Further Research into Discrimination Needed
HealthCare.com’s LGBTQ+ health insurance survey represents a first attempt to assess these groups’ experiences with health insurance providers, as well as the state of their health finances.
Experts say that further research is required to substantiate and expand on these initial findings.
“This survey uncovered reported discrimination by LGBTQ+ individuals from health insurers, which is likely yet another contributing factor to the poorer health outcomes documented among LGBTQ+ groups,” says Dr. Lelutiu-Weinberger.
“At least two directions can emerge from this finding: one, further research needs to be conducted to determine the types and frequency of discrimination experienced by LGBTQ+ people by insurers; and two, this novel line of research can inform interventions and/or policy around targeting this type of discrimination.”
Methodology
HealthCare.com conducted this survey on April 13, 2022, utilizing a SurveyMonkey Audience to poll a national sample of 520 LGBTQ+ U.S. adults aged 18 and over. The margin of error for this survey is plus or minus 4 percentage points. While cross-group comparisons were possible for larger groups in this report, in some cases, statistical analyses were not possible due to small group numbers (e.g., n<5) that prevented comparing group proportions. For these groups, the margin of error is plus or minus 14 percentage points. The sample was balanced for age, gender, and U.S. region according to the Census Bureau’s American Community Survey.
