Qualifying for Life Insurance When You're Transgender

Can you get life insurance if you're transgender? Yes. Will applying for life insurance as a transgender person be as simple as applying as someone who identifies by the gender assigned at birth? No. Life insurance companies have only a little experience interacting with—and underwriting policies for—trans 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 and not a more inclusive "What is your gender identity?" As a trans person, you will naturally want to select the gender you identify as, not the gender you were assigned at birth.

As part of the underwriting process, the insurance company will want to review your medical records. This is a necessary step if you want to pay the lowest available rates for your age and health and maximize how much coverage you have the option to buy. The underwriting department and your insurance agent or broker, if any, will probably learn about the gender you were assigned at birth during this process.

How Gender Affects Life Insurance Premiums

Life insurance companies decide what your premium will be based on numerous factors, but one of them is gender. That's because there's a historical correlation between being male and having a shorter life expectancy, a correlation that has existed since at least 1880 and holds true in every country. Cardiovascular disease and smoking are two big reasons behind this discrepancy. In the United States, the Social Security Administration’s actuarial life tables show that a man who was 40 in 2017 would be expected to live to age 78.56, while a woman who was 40 in 2017 would be expected to reach age 82.47. And yes, it's legal for life insurance companies to charge different premiums based on gender—except in Montana.

A critical question, of course, is which gender will the insurance company use to base your rates? There is no uniform practice across the insurance industry. Some companies will underwrite you based on the gender you identify as, while others will underwrite you based on the gender you were assigned at birth. 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.

You might decide that you only want to work with a company that offers unisex rates or that will ignore the gender you were assigned at birth, or 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

In reviewing your medical records, an insurance underwriter may learn about any gender-affirming surgeries or hormone treatments you have had. These aspects of your health history may affect your rates, according to Dr. Steven Weisbart, chief economist of the Insurance Information Institute.

However, the reason for this is not discrimination against transgender people. Instead, your rates could be affected based on data life insurance companies have about the impact of these hormone therapies and surgeries on life expectancy. If they are potentially life shortening, you may need to pay a higher rate, or purchase a smaller policy so you can afford it. Our article on life insurance for nonbinary individuals goes into detail about how gender-affirming surgery and hormone therapy can affect life insurance rates.

Life insurance underwriting takes numerous factors into account, so a single 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 use
• Illegal drug use
• Driving record
• Criminal record
• Bankruptcy
• Travel to dangerous countries
• Participation in high-risk recreation

You'll see that 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.

How Certain Health Conditions May Affect Premiums

Medical mistrust, lack of access to gender-affirming care, and discrimination by healthcare providers often prevent trans people from getting the healthcare they need or from following their provider's medical advice. As a result, your health may not be optimal. Unfortunately, the limited data available often indicate that transgender populations experience worse health. Less-than-optimal health can mean you'll pay higher life insurance premiums.

Some conditions that can be more prevalent in transgender community can also affect the insurance you can get and its cost. For example, an HIV diagnosis is more common in the transgender community than in the general population. If that's your situation, it may prevent you from getting approved for medically underwritten life insurance.

Then, there's gender dysphoria. This is characterized by a strong desire to be treated as a different gender than the one you were assigned at birth, a strong desire to have the primary or secondary sex characteristics of the opposite sex, and significant distress or problems functioning for at least six months. Gender dysphoria may be a diagnosis you received from a healthcare provider at some point, possibly as a prerequisite for getting access to treatment you needed.

The limited research currently available 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. Being rated as an increased suicide risk could lead to higher life insurance premiums. And 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

If you don't want insurance companies looking at your medical records and you don't want to answer any health questions, you can purchase a non-medically underwritten policy, such as guaranteed issue life insurance, but you will pay more for the same amount of coverage and you won't be able to 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. Trans people tend to have less stable employment, so relying on work-based life insurance could put your dependents in a precarious situation.

Working with a life insurance broker who is 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 will be able to help you apply with the companies that are 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.

If you'd rather go it alone, here's a guideline that might help you 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 places to work for LGBTQ individuals. One requirement for earning a spot on this list is “Equal health coverage for transgender individuals without exclusion for medically necessary care.” Its 2020 list of "Employers with Ratings of 100 Percent" includes the following life insurance companies:

• AIG
• Allianz
• American Family Insurance
• Assurant
• Asurion
• AXA
• Cigna
• Chubb
• Farmers
• Guardian
• The Hartford
• Liberty Mutual
• Lincoln National
• MassMutual
• New York Life
• Northwestern Mutual
• Prudential
• The Standard
• State Farm
• Sun Life
• TIAA
• Transamerica
• Unum
• USAA
• Voya

Note: You may only be able to get a group (employer-based) policy through some of these insurers.

The Bottom Line

If and when life insurance companies gain more experience interacting with and underwriting policies for trans applicants, it may one day be equally streamlined to apply for life insurance as a transgender or a cisgender person. But that's not the case right now. So, if it helps, you can try framing any difficult aspects of the experience as helping to pave the way for others.

Still, it's exhausting to be a trailblazer all the time, to be forever explaining your differences to people who don't understand and may not want to understand. We hope that learning more about how applying for life insurance works—and the specific parts of the process that will be different if you're transgender—will help you approach the process in the way is most comfortable for you.