Alexander Smith knows something that many members of BU’s transgender community may not: the University provides gender-affirming healthcare, which helps align a person’s body with their gender identity. And BU’s Student Health Insurance Plan (SHIP) covers many aspects of that care.
“It’s made it so much easier and so much more convenient,” Smith (CAS’23) says of being able to access much of his care on campus. “There are places around Boston where you can do the same thing, but it can take months to even get an appointment. But I was able to get in within the week to start my process” at BU. As for the insurance, he says, “for me personally, it was a good deal. When I picked up the prescriptions, some of the things were covered and some were not. The needles were covered for the most part. The testosterone was mostly covered as well; it still amounted to about $10” out-of-pocket.
But after attending the University’s Trans Listening Circle meetings, Smith doubts many community members know that BU offers the care. “Nobody has ever really talked about it. They mostly talk about outside sources.”
BU’s Student Health Services (SHS) means to change that. It has launched public service announcements (PSAs)—on the BU Shuttle, at Warren Towers, and on Facebook and Instagram—to alert students about the care and coverage, which are not new. SHS has been providing gender-affirming care for about a year, says Nathan Brewer, cochair of the SHS Gender-Affirming Healthcare Committee. BU’s SHIP has covered such care and transition surgery (which SHS can’t provide but can refer students to) for a decade.
“SHIP coverage includes hormone replacement therapy as well as many gender-affirming surgeries. For instance, chest masculinization and feminization, as well as genital reconstruction are covered,” says Brewer, who also directs the Sexual Assault Response & Prevention Center. “There are some surgeries that SHIP will not cover, including face-lifts and jaw contouring.”
Those interested in more information on coverage can find it here or on the SHS website here. There is also info for students with other types of insurance, including a script for asking their carrier about what types of care it covers and the documentation needed to obtain that care.
“There are places around Boston where you can do the same thing, but it can take months to even get an appointment.”
“We strongly encourage any student who is seeking care to work with SHS providers to understand the financial implications of their decisions and ensure they are covered properly by an insurance plan inclusive of these services,” Brewer says.
In the United States, 89 other colleges and universities have insurance that provides ”minimum or better transgender-inclusive coverage, including at least some transition-related surgeries,” according to the Human Rights Campaign. In greater Boston, that list includes Harvard, Lesley, Babson, Emerson, Northeastern, and Tufts.
Another 23, among them Brandeis, MIT, and Suffolk locally, have student insurance that covers just hormones, the Human Rights Campaign says.
Brewer says the PSAs cap more than a year of information-gathering from students and improvements to the care. “This included a survey to over 100 trans students at BU about their experiences with SHS, as well as qualitative interviews with a small number of folks for more in-depth information,” he says. “Changes [we made] included the parts of the medical record system we use and increasing the options students can choose regarding self-identification—gender ID, pronouns, name.”
SHS has offered gender-affirming training to all staff and specialized training to appropriate provider groups, such as mental health clinicians, doctors, and nurses, Brewer says. “Many providers have also done external training by experts in their respective field. We also now have an interdisciplinary team, which includes representatives from all divisions and disciplines within SHS, to provide comprehensive care to trans students.”
Offering medical and insurance coverage can be a literal life-or-death issue, he says, as there is a “high rate of psychological distress for trans students, up to and including extremely high rates of suicidal ideation and attempts—particularly for those who cannot access gender-affirming care. Multiple research studies have shown that one way of reducing this distress and subsequent suicidality is to provide easily accessible gender-affirming medical and mental health care.”
A handful of trans students receive this care through BU, but the number doesn’t reflect the full need. The University doesn’t have a reliable count of students identifying as transgender, and many seek care outside of BU. “For instance,” says Brewer, “Fenway Health is a world-class health center that specializes in trans-related care. Boston Medical Center also has a clinic.”
Out-of-pocket costs to students vary based on their insurance, the specific care sought, and the provider, Brewer says. “This is why we strongly encourage folks to work with SHS and their insurance provider to understand what is covered versus not and incidental expenses they might not at first consider”—for example, a hotel stay if their surgery center is outside Boston.
