Transgender and gender-diverse Medicare beneficiaries use significantly more emergency department services than cisgender people, particularly for psychological care, and these visits were more likely to be followed by an admission.

It brings up an obvious question; with outsized use of emergency services, why are there delays in seeking timely health care that result in visits to the ER?

The data were a random 20% sample of the Medicare inpatient, carrier, and enrollment files from 2011 to 2020. The number of transgender and gender-diverse people was small (3,693) but senior citizen age beneficiaries were 20.2 percentage than the broader population of beneficiaries.

The authors believe it is more than just cost that leads transgender and gender-diverse people to postpone routine medical care until after they qualify for Medicare, but also substantial societal stigma due to their identities in health care settings - or at least perceived concerns about stigma.

Since the dominant reason for treatment was psychological care, and these visits were more likely to be followed by an admission, the authors advocate for "cultural humility" by medical personnel and to discriminate less. Since those causal claims were not in the data, and the analysis was only descriptive, which means potential misclassification , and that the data pool was only Medicare fee-for-service individuals, it seems unwarranted to argue that health care providers are bigots rather than the more obvious reason that the costs were too high before they got on Medicare.