Qualifying for Life Insurance When You’re Transgender

If you’re wondering if you can get life insurance if you’re transgender, the answer is yes. Applying for life insurance as a transgender person may or may not be challenging, depending on several factors. Many life insurance companies have little experience interacting with—and underwriting policies for—transgender applicants. Here’s what we’ve learned about how applying for an individual life insurance policy works when you’re transgender.

Choosing a Gender on Your Life Insurance Application

The first question on many life insurance applications is whether you’re male or female. As a transgender person, you will naturally want to select the gender you identify as, not the gender you were assigned at birth.

Life insurance companies decide what your premium will be based on numerous factors, but one of them is life expectancy. There’s a historical correlation between sex assigned at birth and life expectancy. In the United States, the Social Security Administration’s actuarial life tables show that a man who was 40 in 2020 would be expected to live to age around age 77, while a woman who was 40 in 2020 would be expected to reach age 81.

Life insurers take a variety of approaches in collecting sex and gender information, according to a 2021 survey from the Society of Actuaries (SOA). Insurers may or may not differentiate between sex and gender. Insurers may ask for sex, gender, or sex at birth on an application.

As of the 2021 survey, 73% of respondents didn’t change underwriting classification based on sex at birth versus current gender.

With some insurers, whether you have had gender-affirming surgery and how much time has passed since the surgery can determine which gender category they will use for you.

Jake Tamarkin’s firm, Everyday Life Insurance, uses the term « sex at birth. » He does so after asking life insurers to find out what was expected. “We approached all of our underwriting partners on their expectations about this, and all told us they expect applicants to provide their biological sex on their birth certificate. For that reason, I was surprised to see in the SOA survey that half of the US companies surveyed considered current gender, » said the co-founder and CEO. « None of my underwriting partners do, and they are all well-established, reasonably large companies.” 

So, if you decide that you only want to work with a company that ignores the gender you were assigned at birth, it may take some hunting around for the right insurer. Alternatively, you might prefer to work with whichever company offers you the best insurance coverage at the best price, regardless of how they categorize your gender.

Gender-Affirming Healthcare and Life Insurance Underwriting

Life insurance underwriting takes numerous factors into account, so a single historical factor—whether it’s gender, hormone therapy, or surgical history—may not end up playing a starring role in your premiums. That’s because so many factors are at play when life insurers consider what your premiums should be:

• Age
• Occupation
• Blood pressure
• Build (height and weight)
• Cholesterol
• Physical health history
• Mental health history
• Surgical history
• Family health history
• Prescription history
• Chronic health conditions
• Tobacco, marijuana, and opioid use
• Driving record
• Criminal record
• Bankruptcy
• Travel to dangerous countries
• Participation in high-risk recreation

Each of these factors can affect how long someone might live.

That said, the gender category a life insurer assigns you can matter when it comes to at least three factors: blood pressure, cholesterol, and build. The numbers that are considered ideal for these factors are different for men and women with some life insurers.

Surgical History

In reviewing your medical records, an insurance underwriter may learn about any gender-affirming surgeries or hormone treatments you have had. However, the reason for this is not discrimination against transgender people. Instead, your rates could be affected based on life insurance companies’ data about the impact of these hormone therapies and surgeries on life expectancy.

Insurer Munich Re recommends that insurers not accept a life insurance application until a year after breast augmentation surgery on any person because about 15% of patients require additional surgery within 12 months. The insurer also notes that not much is known about the long-term risks of many procedures historically classified as cosmetic, but that breast augmentation does not seem to increase mortality.

Karsten Filzmaier, a life insurance industry veteran and cardiologist in Munich, notes that transgender interest groups have been challenging Europe’s life insurance industry to disclose how it assesses the medical risks of insuring transgender individuals. He co-authored a paper that found that four in five transgender individuals who had gender reassignment and were monitored medically afterward had “a distinct improvement of their psychological symptoms and a gain in their quality of living.”

Prescription History

Not all transgender people take gender-affirming hormones. But for those that do, it’s important to know that hormone use may lead to side effects that can affect life insurance premiums. Feminizing hormones can increase cholesterol, raise levels of potassium in the blood and affect heart function, cause blood clots or anemia, increase body fat, and affect mood. Masculinizing hormones can change cholesterol and increase red blood cells, potentially causing or worsening a cardiovascular problem.

But available studies seem to show that hormone use has a smaller effect on heart problems and cancer rates than previously thought, according to Filzmaier, and that the medical risk from gender reassignment and long-term hormone therapy is minor to insignificant. He encourages insurance underwriters to focus on each individual applicant’s risk profile and says the biggest issues affecting transgender underwriting are likely suicide and risky behavior.

How Certain Health Conditions May Affect Premiums

A 2021 survey found that transgender respondents were more likely to rate their health as « fair/poor, » with more frequent poor physical and mental health days. Transgender people are also more likely to deal with health conditions, including HIV, emphysema, and ulcers, according to the survey. Cost concerns were cited as a top reason for avoiding medical care, even among those with insurance.

Less-than-optimal health can mean you’ll pay higher life insurance premiums or may have difficulty finding coverage. For example, an HIV diagnosis is more common in transgender women than in the general population. If that’s your situation, it may prevent you from getting approved for medically underwritten life insurance.

The limited research finds that suicidal ideation and suicide attempts are much more common in people with gender dysphoria than in the general population. Additional studies have found that suicide attempts are more common in the transgender population than in the general population. Increased suicide risk could lead to higher life insurance premiums—for example, a suicide attempt within the past two years or hospitalization for a mental disorder within the past year can make you uninsurable until enough time has passed without incident.

That being said, when an applicant has a mental health condition such as mild to moderate depression that is well managed, it might not affect their premiums. The effect also depends on the insurance company, as some may be comfortable giving preferred rates to an applicant with depression while others may not.

Alternatives to Medical Underwriting

Suppose you don’t want insurance companies looking at your medical records and don’t want to answer any health questions. In that case, you can purchase a non-medically underwritten policy, such as guaranteed issue life insurance. Still, you will pay more for the same amount of coverage and won’t get nearly as much coverage. You also won’t be covered until a two- or three-year waiting period is up. These policies aren’t as good because they are designed for people in poor health who present a high risk to insurers.

A less drastic, but still inferior, option would be to get a policy that requires you to answer health questions but does not require a medical exam, such as final expense life insurance, a type of whole life coverage. You can also get term coverage without a medical exam.

Tips for Transgender Life Insurance Applicants

If possible, get group life insurance through an employer so you don’t have to answer questions about your medical history or have your medical records scrutinized. But be aware that you might not be able to secure enough coverage this way, and you might lose your coverage if you stop working for that employer.

Working with a life insurance broker sensitive to the unique needs of transgender applicants could make the process easier. A good broker will be familiar with the ins and outs of different insurers’ underwriting guidelines and can help you apply with the companies most likely to give you the best coverage at the best rates and provide the smoothest application process. Another plus: Working with a broker is free.

« You could save yourself a lot of hassle by confirming with your agent before applying whether or not a particular product’s underwriters consider recent or planned medical procedures and prescriptions when reviewing applications, » Tamarkin says.

If you’d rather go it alone, you may be able to find companies whose employees may be more likely to provide you with a positive experience when you apply for life insurance. The Human Rights Campaign Foundation produces a Corporate Equality Index of companies that are top-rated workplaces for LGBTQ individuals.

You can use HRC’s Employer Search to see how an insurer treats its LGBTQ employees, which might signal increased awareness regarding transgender applicants for its life insurance products. Similarly, the Sexuality and Gender Alliance of Actuaries’ (SAGAA) list of sponsors may be another good starting place.

However, just because an employer is listed on HRC’s site or is a sponsor at SAGAA doesn’t mean that the life insurance application or premium will be based on gender identity.

The Bottom Line

When life insurance companies gain more experience interacting with and underwriting policies for trans applicants, and if actuarial tables shift, the life insurance application process may change. In the meantime, navigating the life insurance application process can go more smoothly if you work with a trans-inclusive life insurance agent who can help explain your options.