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Same-Sex Couples

When is this year’s open enrollment period?

To make sure you have health insurance for 2019, you have to enroll between November 1st, 2018 and December 15, 2018. If you miss the December 15th deadline, you could be locked out of health insurance until 2020 AND forced to pay 100% of your medical bills. It’s not worth the risk, especially when financial help is available (so most people can find a plan for $50 to $100).

In past years, the enrollment period was much longer. But the Trump administration is taking every effort to sabotage the Affordable Care Act and has cut this time in half. That means it’s more important than ever for you, your family, and your friends to know about the new deadline and your rights when it comes to health insurance and health care.

Can I enroll in health insurance with my spouse?

Yes, you and your spouse can enroll together through the Marketplace. If you file your federal taxes jointly with your spouse, you can also apply jointly for financial help to help make your insurance more affordable. And you can enroll in any “family” or “spousal” plan offered through the Marketplace. Health insurers that offer these plans must allow legally married same-sex spouses to enroll as a family.

This doesn’t apply, however, for couples in a domestic partnership or civil union. Rules about family coverage for these types of relationships vary by state and insurer, so explore your options to ensure that the coverage you buy is appropriate for your family’s needs.

We encourage you to take advantage of free help (either in-person or by phone) from a trained assister to help you consider your options.

Can I apply for financial help with my spouse or partner?

Yes, if you are legally married and file your federal taxes jointly with your spouse, you can apply jointly for financial help to make your coverage more affordable. The amount of financial help depends on your income. You may qualify for financial help if you and your spouse’s annual income is between about $16,000 and $66,000. In fact, over 8 out of 10 people who enroll through healthcare.gov qualify for financial help, and most people find plans available for $75 or less per month. Learn if your income level qualifies you and your spouse for savings here.

If you qualify, you will receive a tax credit that lowers the amount that you pay for insurance each month. Depending on your income, you may also qualify for cost-sharing reductions that lower the amount you pay in co-pays, deductibles, and other out-of-pocket costs. Learn whether you might qualify for financial help using this quick calculator.

How can we find an LGBTQ-friendly doctor who takes our insurance?

Every plan sold in the Marketplace must provide a link to its directory of health providers. If you already have an LGBTQ-friendly provider that you know and trust, you can use this directory to find out if your provider is included before you sign up for coverage.

To find an LGBTQ-friendly provider, check out this list of providers by GLMA: Health Professionals Advancing LGBT Equality. A search for “Community Partners” on this list will also identify LGBT community health centers across the country. (GLMA does not screen each provider and therefore cannot make any guarantees about their services, but all providers on the list have affirmed their commitment to LGBT health as a condition of being listed in the directory.) You can also check out RAD Remedy, a directory that helps connect transgender, gender nonconforming, intersex, and queer people to accurate, safe, respectful, and comprehensive care.

If you are living with HIV/AIDS, we also recommend that you contact your local Ryan White program to see if you qualify for additional financial help or benefits. Depending on your state, the Ryan White program may help lower your monthly premiums or your out-of-pocket costs for prescription drugs. Contact your local Ryan White program to learn more about your options and the benefits you might qualify for.

I recently got married – what does this mean for my health insurance?

Congratulations! You and your spouse have 60 days to consider your options: you can enroll through the Marketplace as a family, join your spouse’s Marketplace plan, or enroll in separate Marketplace plans. You may also be eligible (as a couple or as individuals) for financial help to afford a plan. Once you are enrolled, your coverage will start on the first day of the next month and you’ll be off to a happy, healthy future.

What should I do if I experience discrimination when using my coverage?

If you experience any form of discrimination, you should contact a legal organization here and let us know at info@out2enroll.org. You should never face discrimination when it comes to health insurance or health care. Learn more about your rights and what you can do to fight discrimination at the National Center for Transgender Equality’s Health Care Action Center.

Can I visit my partner or spouse in the hospital or nursing home?

Yes, you have the right to visit your partner in the hospital, nursing home, and most other types of health care facilities. If you face discrimination, you have new rights. If you experience any form of discrimination, you should contact a legal organization here and let us know at info@out2enroll.org.

Will my plan cover PrEP (a prescription drug that can lower the risk of HIV)?

Most plans will cover PrEP (also known as Truvada) but your monthly costs may vary, depending on which plan you choose. Before you enroll, make sure to check your plan’s prescription drug list (or “formulary”) to see where PrEP is listed and how much you might have to pay each month. If you need help, make a free appointment with an assister who has been trained to answer questions about what services are covered for LGBT people. And check out this easy tool to find a doctor or other provider in your area who prescribes PrEP.

If you don’t have health insurance but still want to take PrEP, or if it is too expensive for you even with health insurance, you may qualify for financial assistance directly from Gilead, the company that makes Truvada. Learn more here or contact your local HIV/AIDS service organization or Ryan White center.

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