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Transgender Health

I heard the deadline has changed – when is this year’s open enrollment period?

The deadline this year has changed! To make sure you have health insurance for 2018, you have to enroll between November 1st, 2017 and December 15, 2017. If you miss the December 15th deadline, you could be locked out of health insurance until 2019 AND forced to pay a penalty and 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.

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 2018. 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.

What if my plan refuses to cover the services that I need?

If your plan refuses to cover medically necessary services that are recommended by your doctor, you have the right to appeal this decision and have it reviewed by an independent third party.
You have the right to:

  • Ask the insurer to reconsider its decision.
  • Know why an insurer denied your claim or ended your coverage.
  • Know how to challenge the insurer’s decision.

 

Typically, you must first go through a process called the “internal appeals process” where you appeal directly to your insurer. If you are unhappy with the result from the internal appeal, you can then request an “external review” from an independent third party.

We recommend going through this process because many denials are overturned during the appeals process. If you need help filing an internal appeal or external review, contact your state’s consumer assistance program or insurance department.

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.

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