Health insurance can be super confusing (we know!), so we want to help you understand how you can use your insurance with FOLX. In this article, we’ll explain which insurance is in-network with FOLX, what you can use your insurance for at FOLX, and the many ways you can use your insurance (even if it’s not in-network with us). To learn about health insurance in general, read this article.
As a FOLX member, you may be able to use insurance for visits, lab work, and medications, depending on your plan and coverage. Some insurances also cover the monthly membership fee!
You can get help covering costs for:
- Appointments with your clinician
- Prescription medications
- Preventive care visits and wellness checkups
- Lab blood work and screenings
- Mental health care, including talk therapy (available in select states)
- Specialist care visits
- Membership*
* Select insurance plans cover the membership fee. See our FAQ here.
Membership
Membership costs $25/month when paid for the year or $39.99/month when paid monthly. This gives you access to all member benefits, including:
- the ability to book and see an LGBTQIA+ expert clinician within a few days
- messaging with your clinical team (including nurses and medical assistants)
- access to our Member Navigation team for questions or referrals
- prescriptions sent to our partner pharmacy for delivery right to your door (or we can send to your local pharmacy)
- access to our FOLX Community Platform to connect with others and explore resources, support groups, and more
To learn more about membership, check out this article.
Visits
We are in-network with select insurance plans, which means you can use your health insurance to help cover the cost of your care, paying your typical copays, coinsurance, or deductible (if you haven’t met it).
A copay for a virtual primary care visit or a gender-affirming hormone therapy visit often ranges from $30-$50. If you're ever looking for a cost estimate for certain care, it's best to contact your insurance company directly by calling the number on the back of your card.
Your health insurance may cover visits for gender-affirming hormone therapy (GAHT, also known as HRT); sexual and reproductive health needs; primary and preventive care (wellness screenings and chronic condition management); mental health support for anxiety, depression, or insomnia (and counseling/therapy in some states), and much more.
You can also often use your insurance if we order tests or make referrals to specialists or in-person care you might need after your virtual care visit. For more information about our services, including labs and referrals, check out our Library article about virtual primary care at FOLX.
To see a list of insurance plans we accept, visit our FAQs. We are working to accept more insurance plans all the time, and you can find out when we launch new plans by signing up for our newsletter.
If FOLX does not accept your insurance, then you will have to pay our “cash pay” prices. Check out our pricing page for more details.
If you have insurance that is not in-network with FOLX, you may be able to use it to help cover prescription costs or use it for care if we refer you to an in-person provider. Check with your insurance for exact coverage.
Labs
For lab work, we order labs to Quest (except in select states). We offer transparent pricing for all of our health care services, including labs.
If you are in-network with FOLX, we will order your labs through your insurance. Lab work and service fees may be covered by in-network insurance plans. We highly recommend reaching out to your insurance provider prior to getting your labs done to confirm any out-of-pocket cost.
You can check our FAQ for more specific information on using health insurance for labs. The full process for lab work is outlined in this article.
Medications
Health insurance can also help with costs for some prescription medications (whether or not your health insurance is in-network with FOLX). There are multiple options for how to get your prescription medications, and you may be able to use your insurance to help cover the costs. You can use your insurance to pay for your medications if you get your meds at an external pharmacy (not shipped by the FOLX pharmacy).
Make sure to fill out your pharmacy preference in your FOLX member account or when signing up for an appointment. If you would like to use your insurance to pay for your medication, we can send your prescription to an online pharmacy, like Amazon or Capsule, or to your local pharmacy, like CVS or Walgreens.
Using online or local pharmacies
When using online or local brick-and-mortar pharmacies, you’ll want to give your insurance information to the pharmacist. Some insurance plans also have a separate prescription drug coverage benefit, so be sure you have that information or insurance card handy. The pharmacist will be able to check your prescription medication benefits when you give them your insurance information.
Know that, depending on the pharmacy, there may be differences in medication refills, medication names (e.g., name brands versus generic), prices of medication, and stock (amount of medication available at a pharmacy).
Some insurance plans may limit prescriptions to a 30-day supply per refill, while others allow a 90-day quantity per refill. The medication refill timing and the amount you can receive at one time can vary by insurance plan.
For more information about what medications and pharmacy benefits you have, see your Summary of Benefits and Coverage, which you can get directly from your insurance company or your employer. You can also call the number on the back of your insurance card, or visit your insurance provider’s website, to get more information about what coverage they provide.
What happens if your prescription isn’t covered by insurance? First, be sure to check whether the generic version of the prescription is covered. If your prescription medication isn’t covered by insurance, you can use GoodRx to get discounts on certain medications.
FOLX partner pharmacy
You have the option of getting certain medications sent directly to your home when you choose to use the FOLX partner pharmacy. A FOLX-affiliated pharmacy can deliver your gender-affirming hormone medication (e.g., testosterone or estrogen) directly to your door. We provide safe, discreet shipping that includes all the supplies you need. Insurance is not accepted with this option, so payment would be cash pay (out-of-pocket).
In summary
Insurance can be used to cover visits, labs, and medications, depending on your insurance plan and coverage, and the FOLX membership fee is covered by some insurance as well. Check out what insurance plans are in-network with FOLX here, and keep an eye out because we’ll be rolling out more soon. To learn about how pricing works at FOLX and see estimated costs laid out, check out this article. We can’t wait to take care of you!
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FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!
