For most people, the last day to enroll in a health plan for 2016 was January 31, 2016. 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 to a new place, having a change in your income, 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.
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.
Yes, everyone needs health insurance. Unfortunate accidents and illnesses happen every day, even if you’re young and healthy. Without health insurance, you may have to pay a penalty – and you’re responsible for 100% of your medical bills if you get sick or injured. When simple stitches can cost more than $2,000 or a day in the hospital can cost more than $4,000, you’ll be glad you chose to get covered. Plus, your Marketplace plan will cover free preventive services, which can help keep you healthy in the first place.
We recognize it’s important to find a plan that fits your needs and your budget. You might think that you can’t afford health insurance but over 8 out of 10 people who enroll qualify for financial help, and most people find plans available for $75 or less per month. Learn whether you might qualify for financial help using this quick calculator.
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, you can check this list of providers provided by the Gay and Lesbian Medical Association (GLMA). A search for “Community Partners” on the GLMA 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 to help connect transgender, gender nonconforming, intersex, and queer people to accurate, safe, respectful, and comprehensive care.
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.
Many of us in the LGBTQ community have been left out when it comes to health insurance. It has been too hard to find coverage that treats our families fairly, that covers the care we need, and that doesn’t break the bank. And our health suffers as a result. Our community continues to face significant disparities in tobacco use, obesity, abuse and violence, mental and behavioral health issues, and HIV infection.
That’s where the Affordable Care Act comes in. For the first time, there are new affordable options, protections against discrimination based on sexual orientation and gender identity, and coverage even if you have a preexisting medical condition. The law may not be perfect – but this is an unprecedented opportunity for our community – and we encourage you to consider your new coverage options, even if you only need health insurance for a few months.
Yes, you may be eligible 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 approximately $16,000 and $63,000. In fact, over 8 out of 10 people who enroll through healthcare.gov qualify for financial help, 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.
You may also qualify for even more benefits through your local Ryan White Program, including lower monthly premiums or out-of-pocket costs for prescription drugs. Find a Ryan White program near you to learn more about your options.
If you experience any form of discrimination, you should file a complaint with the Office for Civil Rights and let us know at firstname.lastname@example.org. It can be frustrating to file a complaint, but this is especially important given the lack of clarity about what must be covered. The more complaints, the more likely we are to get more guidance in the future.