Young man peers out from behind rainbow-colored blinds at his parents
Illustration by Bailey Mariner

If you are under 26 years old and have a parent or legal guardian with health insurance that covers dependents, you could be added to their plan. This can help you manage healthcare costs.

Privacy and confidentiality can be raised by it for members of the LGBTQIA+ communities.

“In the United States, many young adults are on their parent’s insurance until they’re 26 years old, so they’re not the people receiving the insurance bill or records,” says Lindsey Schafer, a licensed social worker and mental health therapist specializing in sex and sexuality at Wise Therapy Associates in New York City.

“The insurance health records are sent to the home where the parents are living or to the email inboxes of their guardian after the doctor’s appointment.”

She says that it has pushed some of the people she works with to come out to their parents and families before they are ready.

“Many young people who are in this situation don’t know what to do. You can learn more about your rights as an insurance dependent and strategies for maintaining privacy while seeking affirming health services.”

The Health Insurance Portability and Accountability Act came into effect in the United States in 1996. The confidentiality of health information was established by the federal law.

Under the HIPAA Privacy Rule, there are only certain situations where a healthcare professional or insurer can share a patient’s health information without their consent. Seeking payment is one of these situations.

Your doctor can give your insurance provider information about your health history. Each time you use a health service, the insurance provider can give you records of the person who holds the insurance.

If you are dependent on a health insurance plan, this is the person who will pay.

“As a healthcare worker, HIPAA protects my patients by legally prohibiting me from discussing patient issues with friends or family unless the patient explicitly gives consent,” says Bethany Malone, MD, a surgeon in Forth Worth, Texas.

The main person on the insurance might find out about sensitive healthcare topics if they were to look into it. The insurance company sends out an explanation of benefits, a document that lists what healthcare has been distributed and billed to insurance.

If you are a dependent on a parent or guardian, your insurer may give you a copy of the EOB. Your doctor or other healthcare professional may send you bills.

“If you haven’t talked about your gender or sexuality with your parent or guardian, you might be hesitant to seek certain health services.”

For example, in a 2019 study, researchers found that young adults were less willing to take preexposure prophylaxis (PrEP) when they didn’t want their parents to know they were taking it. This medication lowers your risk of contracting HIV.

Although HIV can affect people of any gender or sexuality, it affects people who have sex with men at higher rates than average.

It raises a big question if young adults are not having conversations with their parents about these things. Is it possible to get sexuality- or gender-affirming treatment that will help me live my best life as the person that I identify as, or is it possible to hold back on these things because I am not ready to come out?

The sharing of sensitive health information is regulated by other regulations.

Several states have put in place provisions to protect the confidentiality of health insurance dependents. Some states.

  • Insurance dependents can submit a request for confidential communications from their insurance provider.
  • Allow insurance providers to mail an EOB to patients instead of issuing them when payment is due.
  • The confidentiality of dependents who are seeking treatment for sexually transmitted infections is protected.

Some of the protections apply to adult dependents. They apply to all children. The health services that are covered by these protections vary by state.

If your state has established confidentiality protections for insurance dependents, take a look at this table. This information might change over time.

State Can a dependent request confidential communications? Are there EOB protections? Is there confidentiality for STI treatment? Other protections?
CA yes no no no
CO yes no no no
CT no no yes no
DE no no yes no
FL no no yes no
HI no no no yes
IL Medicaid only no no no
ME no no no yes
MD yes no no no
MA yes yes no no
NY no yes no no
OR yes no no no
WA yes yes yes yes
WI no yes no no

Speak with your doctor or insurance provider to learn more about current laws and practices in your state. You can also explore the Guttmacher Institute’s website for more information on sexual and reproductive rights policy decisions.

How can you manage privacy concerns? Considering taking some steps.

Get informed before your appointments

It is important to know what information your healthcare team and insurer will share with whom to make informed decisions about your health service use and privacy.

It is important to have a conversation with your doctors before you go to see them so that you know what to expect.

She says to ask them if there are other ways to report the billing information. Sometimes doctors can send a bill that is less specific or more discreet.

You can also speak with your doctor and other care team members about confidentiality policies and practices of your insurance company.

Prepare for challenging conversations

If a parent or guardian will receive information about the health services, you might decide to access them.

People should prepare for questions at home.

She suggests that if you are going to go ahead with it, you should be aware that you will have to have a conversation with your family or people who are receiving the bills.

A lot of people in the community live in environments that are anti-gay. If you are in this situation, make sure that you have a safe space and people and resources to lean on if you have to come out, explain a bill, or deal with a situation like this.

Consider enrolling in your own insurance

“If you can afford it, you might consider dropping out of your guardian’s insurance policy and enroll in your own. All of your insurance records will be delivered to you directly.”

Before you sign up for a plan, you should know what services it covers. Every health service is not covered by a single plan. You may need to follow certain steps to get reimbursement for a service that is covered.

If you are interested in hormone therapy or sex-affirming surgery, you should look for a plan that covers those treatments. Contact the insurance provider if you want to know more about the coverage exclusions in the insurance policy contract.

If you decide to drop out of your insurance and enroll in your own plan, you should be prepared for questions from your parents or guardian.

Look for free or low cost health services

“If you don’t have health insurance or can’t claim certain services on your insurance, you may need to pay for the full cost of services out of pocket. You might be eligible for free or low cost health services. Examples include:”

  • Therapy and counseling. Some mental health counselors provide therapy on a sliding pay scale, which means they charge different fees based on a person’s income or ability to pay. You can also consider a therapist who’s in training at a university. They’re a good option for free or low cost support and work under the close supervision of licensed professionals.
  • Crisis support and community access. You can access free and confidential support from a crisis counselor through The Trevor Project, a nonprofit organization that provides mental health support to LGBTQIA+ community members.
  • Gender-affirming care. The National Center for Transgender Equality offers information and tips to help transgender community members understand their health rights, get insurance, and find transition-related financial support.
  • General care and prescriptions. To find clinics and pharmacies that provide free or low cost care to uninsured and underinsured people, visit the National Association of Free & Charitable Clinics.

Sexual health services

“Sex can be difficult to discuss with a parent or guardian if you don’t feel supported or out of your depth. Some organizations offer free or low cost services.”

  • Search GetTested, a database from the Centers for Disease Control and Prevention (CDC), to find free, low cost, and confidential STI testing near you.
  • Contact your nearest Planned Parenthood to learn if they offer free or low cost sexual health services, including PrEP, STI testing, and pregnancy testing and services.
  • Visit the Health Resources & Services Administration Ryan White HIV/AIDS Program to search for HIV care and support services or apply for financial assistance for HIV medications.
  • Check out the Ready, Set, PrEP website to learn if you’re eligible for free PrEP medication. The National Alliance of State & Territorial AIDS Directors (NASTAD) also provides information about state-based PrEP assistance programs.
  • Search the Greater Than AIDS online database to find PrEP providers, HIV testing and treatment services, and information about health insurance options in your state.

If you have an insurance dependent, it is important that you know that your parent or guardian can receive information about the health services that you use.

Some states have passed provisions to protect the confidentiality of insurance dependents, but these protections vary from state to state and from one situation to another.

Speak with your doctor to learn what protections you have and what information your parent or guardian might have. If you decide to access sensitive health services, be prepared for the conversations that might arise.

Sometimes it is a good idea to enroll in your own insurance plan or look for affordable health services that you can access without insurance.