What does your hair mean to you? Is it a bold statement of self-expression, a perfect finishing touch to your look or just something you quickly style and move on with your day? For most, hair is a choice — a reflection of identity, mood or routine. But for those battling autoimmune diseases, that choice is taken away. Instead of a form of self-expression, hair becomes a source of loss, frustration and longing. Imagine waking up each day wondering if today will be the day you see more strands on your pillow than on your head. For these patients, hair isn’t just hair — it’s a daily reminder of a struggle they never chose.

Yet, in Maryland, thousands of residents suffering from conditions like alopecia areata, scarring alopecia and lupus are forced to bear the financial burden of purchasing a cranial prosthesis (a wig or hairpiece) out of pocket because insurance does not recognize it as a necessary medical expense. For them, this isn’t about vanity — it’s about dignity, confidence and feeling like themselves again. No one should have to fight both their own body and a system that refuses to see their pain. It’s time for change.

Maryland has a significant number of individuals experiencing hair loss due to medical conditions. Nationally, 6.8 million people are affected by alopecia areata, including an estimated 147,000 Maryland residents. Hair loss conditions such as central centrifugal cicatricial alopecia (CCCA) disproportionately impact African American women, with studies estimating that up to 16.1% of Black women suffer from CCCA. Additionally, patients of color are less likely to afford costly medical treatments, including cranial prostheses, due to existing health care disparities. A report from the Maryland Health Care Commission found that the average cost of a cranial prosthesis is $1,640, an amount many lower-income individuals cannot afford out-of-pocket. Without insurance coverage, many patients who need these prostheses for both medical and psychological well-being are left without options.

Hair loss is deeply tied to self-esteem, confidence and social perception. Studies show that patients experiencing hair loss due to conditions like alopecia areata or lupus face significantly higher rates of anxiety and depression. The stigma around hair loss leads to 85% of alopecia areata patients experiencing social exclusion or emotional distress. The psychological burden is even greater for African-American women, for whom hair is a key part of cultural identity. Cranial prostheses provide a non-invasive and low-cost intervention to restore confidence and improve mental health outcomes. Research indicates that patients who wear wigs or prostheses report higher self-esteem, social confidence and emotional well-being. Expanding insurance coverage for these prostheses is not just a cosmetic issue — it is a mental health necessity.

Opponents of insurance mandates often cite concerns about rising health care expenses. However, the financial impact of providing coverage for cranial prostheses is minimal when compared with other covered medical expenses. For instance, California’s A.B. 2668 mandates $750 annual coverage for cranial prostheses per patient. To put this into perspective, a single hospital stay in Maryland costs $10,500 on average, significantly more than the cost of covering cranial prostheses for multiple patients. Maryland insurers already cover breast prostheses for mastectomy patients, recognizing their importance for body image and mental health. Cranial prostheses serve a similar purpose and should receive equal consideration. Preventing the psychological distress and social withdrawal caused by untreated hair loss can reduce long-term health care costs, including mental health treatment and lost productivity.

While Maryland currently mandates coverage for cranial prostheses for cancer-related hair loss, it must take the next step by extending coverage to all medical hair loss conditions. Only four states — Delaware, Minnesota, Missouri and New Hampshire — have enacted such legislation. Maryland should join them in ensuring equitable access to cranial prostheses. This legislative change would reduce financial hardship for patients, improve mental health outcomes and acknowledge that medical hair loss is not a cosmetic issue but a serious health concern.

We call on Maryland lawmakers to take action and mandate insurance coverage for cranial prostheses for those experiencing medical hair loss. By doing so, we can support mental well-being, restore dignity and ease the financial burden of thousands of residents who have been overlooked for too long. No one should have to choose between their health and their identity. Other states have already recognized the importance of this coverage — now it’s time for Maryland to join them and ensure every patient gets the care they deserve.

Dr. Aamir Hussain is a board-certified dermatologist practicing in the Washington, D.C., metropolitan area. Magdi Elghannam is a medical student at the University of Maryland School of Medicine. Nathan Kattapuram is a medical student at Georgetown University School of Medicine.