Q | When I retire, how do I get health insurance?
If you are 65 years old, you can enroll in Medicare when you retire. If you are retiring and are under age 65, you can sign up for a new health insurance plan through the Health Insurance Marketplace→ or enroll in a plan through a private insurance company. Or you may be able to continue employer-sponsored coverage for a limited time (18 to 36 months). Depending on your state of residence and your income and assets, you may be eligible to enroll in Medicaid.
Q | Where do I find information about enrolling in Medicare? When can I enroll?
You can find information about enrolling in Medicare at medicare.gov→. You may also be able to request Medicare counseling through your local area agency on aging or your state department on aging.
You are eligible for Medicare at age 65. People under age 65 may also be eligible for Medicare if they have a disability or ALS (Lou Gehrig’s disease) and are receiving Social Security benefits, or if they have end-stage kidney disease. See this Medicare resource page→ for more information.
Your initial enrollment period for Medicare is a 7-month window that starts 3 months before you turn 65, includes your birthday month, and ends 3 months after. So, if you were born in August, your initial enrollment period would be May – November of the year you turn 65.
Find out more about enrolling in Medicare from the National Council on Aging→.
Note. While it is not mandatory to enroll in Medicare, declining to enroll without other health coverage that is at least as good as Medicare can lead to penalties.
Q | What is Medicaid?
Medicaid is a joint US federal and state program that provides free or low-cost health coverage to eligible adults, children, pregnant people, older adults, and people with disabilities. It is an essential government program that many trans and gender-expansive people with low incomes rely on to access healthcare services.
If you want to enroll in Medicaid or you are currently on Medicaid, contact your state’s Medicaid office, your state’s social services office, or a local area agency on aging (for older adults) to ask for more information specific to your healthcare needs.
If you are 65 and older, you can have both Medicaid and Medicare at the same time as long as you are eligible. In this case, Medicare would be the primary insurance and Medicaid would be the secondary. Healthcare coverage is different under Medicare and Medicaid, so be sure to ask about the differences when you enroll.
Q | What is long-term care insurance? How do I sign up?
Long-term care insurance covers a wide range of services for people needing long-term care including assistance with bathing, dressing, eating, toileting, and transferring, as well as care received in nursing homes, assisted living facilities, or at home. It helps to cover the high costs of care services. You can get a standalone policy or a hybrid policy that either piggybacks onto an existing life insurance policy (called a rider) or combines long-term care and life insurance (called linked-benefit).
If you’re interested in long-term care insurance, you should sign up well before you need it to avoid paying more for the policy. Some factors may disqualify you from signing up for this type of insurance, such as advanced age, preexisting conditions or disabilities (including HIV/AIDS and chronic illnesses), difficulties with mental and physical functioning, having a life-limiting illness, and substance use. This is important for trans people to know because people in the trans community experience higher rates of HIV/AIDS, disability, and substance use, which could affect access to long-term care insurance.
If you are eligible, the sign-up process may include the following steps:
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Interview (phone or in-person)
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Health questionnaire (for basic information about your health)
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Medical records review (for detailed information about your health)
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Cognitive screening (to check for dementia and other challenges with memory and reasoning)
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Physical exam (not required by all insurance companies)
This process may require you to disclose your gender identity, which could put you at higher risk for discrimination or denial of coverage as a trans or gender-expansive person. Consider talking to someone (a friend or family member, a trusted financial advisor, or an options counselor through your local area agency on aging) to weigh the risks and benefits of long-term care insurance.
Note. Consider your financial situation before signing up for long-term care insurance. If you are having trouble paying your bills, this type of insurance is likely not a good fit. The insurance premium should not take more than 7% of your income.
To learn more about long-term care insurance, visit AARP Understanding Long-term Care Insurance→.
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Q | What is life insurance? When do I need it?
Life insurance policies pay money to "named beneficiaries" when you die. The beneficiaries can be one or more people or even an organization. The payout acts as a financial safety net to help your loved ones cover expenses like funeral costs, remaining bills, and daily living expenses.
The best time to get life insurance is (1) when you’re younger, (2) when you have the financial means, and (3) when you have made significant life changes (like getting married, having children) or taken on new financial responsibilities. There are many life insurance options, and some may be available through your employer. If you’re considering a life insurance policy, consulting with a financial advisor can help guide your decisions.
Find more information about life insurance from AARP.
Q | What do I do if my insurance company denies coverage for my care?
If your insurance company denies coverage for a claim, you have the option to appeal. The appeal process can vary for private insurance companies. Medicare and Medicaid have separate rules for appeals. Generally, you can submit an internal appeal which is reviewed within your insurance agency. If the internal appeal is denied, you have the option to submit an external appeal reviewed by a third party. If you believe the denial of coverage was discriminatory, you may consider legal action.
For more information on your rights in insurance coverage for transition-related care, check out this resource from Advocates for Trans Equality→.
For general information about the appeals process and a sample appeals letter, check out this resource from the National Association of Insurance Commissioners→.
Sources
National Council on Aging. What are the three types of long-term care insurance. 2024. Retrieved from https://www.ncoa.org/article/what-are-the-three-types-of-long-term-care-insurance/
National Council on Aging. Six potential roadblocks to getting long-term care insurance. 2024 Retrieved from https://www.ncoa.org/article/6-potential-roadblocks-to-getting-long-term-care-insurance/
Resources
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Information on Insurance Coverage for Transition-Related Care→ from Advocates for Trans Equality
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Insurance Coverage undere Medicare for Gender-Affirming Treatments→ from Advocates for Trans Equality
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Policy Affecting Healthcare Coverage through Medicare and Medicaid for Trans and Gender-Expansive People→ from the Trans Legislation Tracker
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Insurance Apeals Process→ from the National Association of Insurance Commissioners
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Health Insurance Marketplace at healthcare.gov→
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From the National Council on Aging
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