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Transgender Health

What if I didn’t enroll by the January 31st deadline?

For most people, the last day to enroll in a health plan for 2017 was January 31, 2017. But, in some cases, you may still be able to get coverage this year.

If you have a certain major life change, you may qualify for a special one-time opportunity to enroll after the deadline. These changes include losing your health coverage, getting married, having or adopting a baby, moving, or gaining citizenship. Learn more about all the life changes here and remember that you have to enroll no later than 60 days after the major change happens. We also encourage you to take advantage of free help (either in-person or by phone) from a trained LGBTQ-friendly assister to help you understand your options.

In addition, you may qualify for free or low-cost coverage depending on your income and your state. You can get this type of coverage – through Medicaid or the Children’s Health Insurance Program – at any time during the year. Unlike the Marketplace, there’s no deadline and you can apply at any time. You can get more information here or can get free help from a local expert.

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 the 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 that 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.

Is being transgender still considered a preexisting condition?

No, being transgender is no longer a preexisting condition. Insurers cannot refuse to sell you a plan or charge you more based on your gender identity or medical history. This is true even if you have been refused coverage in the past. Plus, coverage is better than ever for 2017. To help you understand your options, we’ve created new state-specific Transgender Health Insurance Guides and encourage you to make an appointment with an LGBT-friendly expert who can help you enroll for free.

If your coverage is denied, appeal with your health insurer – visit http://bit.ly/2hGFuWn. If you face discrimination by an insurer or health provider, contact a legal organization at http://bit.ly/2hHkLxi 

If you want more information on what your insurance company might cover, check out these medical policies from Transcend Legal – but make sure you look at your own policy too since that’s what will really determine what services are covered.

Do I qualify for financial help to purchase health insurance through the Marketplace?

Yes, you may be eligible for financial help to make your coverage more affordable. The amount of financial help you’ll receive depends on your income. You may qualify for financial help if your annual income is between approximately $12,000 and $47,000. 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.

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.

Do Marketplace plans cover benefits and services related to gender transition?

The coverage of transition-related care continues to vary by insurer and state. However, you have the right to expect that your plan will cover the services you need as long as those services are covered for other people on your plan. These services may include preventive screenings such as mammograms, Pap tests, and prostate exams; hormone therapy; mental health services; and surgical procedures related to gender transition. If your coverage is denied, appeal with your health insurer – visit http://bit.ly/2hGFuWn. If you face discrimination by an insurer or health provider, contact a legal organization at http://bit.ly/2hHkLxi 

However, some plans may still have transgender exclusions. These exclusions are discriminatory and deny coverage to transgender people for medically necessary health care. These exclusions were prohibited in most types of health insurance beginning in 2017, but be aware that some exclusions may still persist in many plans. To help you understand your options, we’ve created new state-specific Transgender Health Insurance Guides and encourage you to make an appointment with an LGBT-friendly expert who can help you enroll for free.

For more information, visit this resource at healthcare.gov.

If you want more information on what your insurance company might cover, check out these medical policies from Transcend Legal – but make sure you look at your own policy too since that’s what will really determine what services are covered.

Will my hormones be covered by my Marketplace plan?

Yes, they should be. You have the right to expect that your plan will cover the services that you need – including hormone therapy – as long as those services are covered for other people on your plan. This is true even if your plan has an exclusion for transition-related care. If you are denied coverage for transition-related care or discriminated against at any point in this process, contact a legal organization at http://bit.ly/2hHkLxi. Read more here.

Will my preventive care be covered by my Marketplace plan?

Yes, it should be. You have the right to expect that your plan will cover the preventive services that you need, regardless of your sex assigned at birth, gender identity, or the gender on your insurance card. Covered services should include services such as mammograms, Pap tests, and prostate exams. This is true even if your plan has an exclusion for transition-related care. If you are denied coverage for preventive care or transition-related care or discriminated against at any point in this process, contact a legal organization at http://bit.ly/2hHkLxi. Read more here. For more information, please see FAQ #5 of this guidance.

Will gender confirmation surgery be covered by my Marketplace plan?

It depends on your plan. Unfortunately, plans in many states still include discriminatory exclusions to deny coverage to transgender people for medically necessary health care. These exclusions often mean that insurers will deny coverage for gender confirmation surgery. These exclusions are discriminatory and deny coverage to transgender people for medically necessary health care. These exclusions were prohibited in most types of health insurance beginning in 2017, but be aware that these exclusions do still persist in many plans.

To help you understand your options, we’ve created new state-specific Transgender Health Insurance Guides and encourage you to make an appointment with an LGBT-friendly expert who can help you enroll for free.

If your coverage is denied, appeal with your health insurer – visit http://bit.ly/2hGFuWn. If you face discrimination by an insurer or health provider, contact a legal organization at http://bit.ly/2hHkLxi 

 

If you want more information on what your insurance company might cover, check out these medical policies from Transcend Legal – but make sure you look at your own policy too since that’s what will really determine what services are covered.

How should I answer the gender marker question on the Marketplace application?

We recommend that you answer this question according to the sex you believe is on file with the Social Security Administration (SSA) to help avoid confusion during the enrollment process. For more information, see this resource at healthcare.gov.

However, we recognize that many transgender people prefer to answer this question according to the gender they identify with, even if it’s different from what’s in the SSA record. You can do this, but be aware that this may result in some confusion if there is gender matching with SSA records or if you seek coverage for sex-specific care.

If you face discrimination at any point during the enrollment process, please let us know at info@out2enroll.org.

Which states prohibit transgender exclusions?

Transgender exclusions were prohibited in most types of health insurance in ALL states beginning in 2017. In addition, 19 states and the District of Columbia explicitly prohibit transgender exclusions, including in plans available through the Marketplace. In addition to DC, these states are California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington.

To help you understand your options, we’ve created new state-specific Transgender Health Insurance Guides and encourage you to make an appointment with an LGBT-friendly expert who can help you enroll for free. If your coverage is denied, appeal with your health insurer – visit http://bit.ly/2hGFuWn. If you face discrimination by an insurer or health provider, contact a legal organization at http://bit.ly/2hHkLxi.

If you want more information on what your insurance company might cover, check out these medical policies from Transcend Legal – but make sure you look at your own policy too since that’s what will really determine what services are covered.

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