Yes, if you claim your child on your federal taxes, you can include them on your Marketplace application - including your application for financial assistance - regardless of your legal or biological relationship with the child. Before you enroll, it is important to make sure the plan you pick covers you and your child together. This will depend on how the plan defines a “family.” You can usually find this information by looking at the “Evidence of Coverage” or the “Certificate of Coverage,” which is the full explanation of what is covered or excluded under each plan. If this information is not available, you may need to call the insurers in your state to see what type of coverage is available. If you cannot find a plan that covers both you and your child, you may be able to enroll yourself and your child individually or check if your child is eligible for your state’s Medicaid program or Children’s Health Insurance Program. After you fill out your application, you’ll be told whether your child qualifies and notified by your state. We encourage you to take advantage of free help (either in-person or by phone) from a trained, LGBTQ-affirming assister to help you consider your options.

The three marketplace application questions regarding sex assigned at birth, sexual orientation, and gender identity are demographic questions for research purposes only. These questions help LGBTQ communities by giving policy makers more information about how access to health insurance affects health disparities in our community. We want you to know that: Your answers do not affect plan eligibility or pricing. Your answers will not be shared with insurers, state agencies, or third parties. At any time, you can return to your HealthCare.gov application and update or remove your answers to these questions. Each question has free text boxes if none of the provided multiple choice answers fit your identity. Finally, if you do not feel comfortable answering, the questions are optional. You can skip or answer "Prefer not to answer."

You might – most people do. The amount of financial help depends on your income. You may qualify for financial help if your annual income is between about $20,000* and $60,000 (or more based on the number of people in your family). In fact, nearly 9 out of 10 people who enroll through HealthCare.gov qualify for financial help, and 4 of 5 people are able to find a plan with a monthly premium of $10 or less. Learn if your income level qualifies you for savings here. If you qualify, you will receive an Advanced Premium Tax Credit (APTC) 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. *If your income is less than this, you may qualify for Medicaid and should fill out a marketplace application to determine your eligibility. If you are living with HIV/AIDS: 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.

To make sure you have health insurance for 2025, you have to enroll between November 1st, 2024 and December 31st, 2024. Many states have longer enrollment periods lasting until January 15th or 31st, but in order to have coverage starting January 1, 2025, you need to enroll by December 15th. If you miss the deadline, you could be locked out of health insurance until 2026 AND forced to pay 100% of your medical bills. It’s not worth the risk, especially when financial help is available: last year, 4 out of 5 HealthCare.gov customers could find a plan with a monthly premium of $10 or less thanks to the American Rescue Plan Act.

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 healthcare. Learn more about your rights and what you can do to fight discrimination here.

Yes. The Affordable Care Act is the first federal law to prohibit discrimination based on sex, including against LGBTQ people, in the health system. The law protects LGBQ and transgender, gender nonconforming, non-binary, and intersex individuals. This includes most types of health insurance coverage and most types of health care providers. If you face discrimination at any point during the enrollment process, please let us know at info@out2enroll.org. If your coverage is denied, appeal with your health insurer – learn how here. If you face discrimination by an insurer or health provider, contact a legal organization here.

Every plan sold in the Marketplace must provide a link to its directory of health providers. If you already have an LGBTQ-affirming provider that you know and trust, you can use your insurer's directory to find out if your provider is included before you sign up for coverage. To find an LGBTQ-affirming provider, check out the LGBTQ Healthcare Directory where providers who sign up affirm their commitment to equality for LGBTQ+ patients.

Every plan sold in the Marketplace must provide a link to its drug formulary (the list of drugs that are covered). If you need a certain drug, you can use this formulary to find out if your drug is covered before you sign up for coverage. If you have a specific health need, 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. If your doctor prescribes a drug for you but your insurer doesn’t cover the drug, you may be able to appeal for an exception to get the drug covered. To do so, contact your insurer. If you want help with your appeal, contact your state’s consumer assistance program or insurance department.

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 gender-affirming care or discriminated against at any point in this process, contact a legal organization here.

The coverage of HIV-related care continues to vary by state. However, plans sold through the Marketplace have to cover a minimum set of essential health benefits. These benefits include prescription drugs, mental health care, and chronic disease management. The Affordable Care Act also prohibits insurers from placing lifetime and annual dollar limits on essential health benefits. This means you can no longer “max out” of care that you need. Because benefits vary by plan, 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.

Insurers cannot refuse to sell you a plan or charge you more just because you have a preexisting condition such as HIV, cancer, or even asthma. This is true even if you have been refused coverage in the past. If you face discrimination at any point during the enrollment process, please let us know at info@out2enroll.org.

Most plans will cover PrEP (HIV pre-exposure prophylaxis) 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 LGBTQ people. And check out this PrEP locator 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.

It depends on your plan. Every plan sold in the Marketplace must provide a link to its drug formulary (the list of drugs that are covered). If you need a certain drug, you can check this formulary to find out if it is covered before you sign up for coverage. It is also very important to see what “tier” level your drugs are on – those at the higher or specialty tiers may require you to pay higher out-of-pocket costs. Because prescription drug coverage vary by plan, 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 and contact your local Ryan White program.

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, and you can check if your income level qualifies you and your spouse for savings here. You may qualify for financial help if you and your spouse’s annual income is between about $20,000 and $81,000. In fact, nearly 9 out of 10 people who enroll through healthcare.gov qualify for financial help, and most people find plans available for $100 or less per month. If you qualify, you will receive an Advanced Premium Tax Credit (APTC) 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 copays, deductibles, and other out-of-pocket costs. Learn whether you might qualify for financial help using this quick calculator.

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 spouses of any genders 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.

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, please know that you have rights and advocates who can help you. If you experience any form of discrimination, contact a legal organization here and let us know at info@out2enroll.org.

Congratulations! Your marriage counts as a Special Enrollment Period, which means you and your spouse have 60 days to choose a new health insurance plan. Your options are to: enroll through the Marketplace as a family, join your spouse’s Marketplace plan, or enroll in separate Marketplace plans. If you do not make a selection in this time, you will not be able to change your plans until next year's Open Enrollment Period. You may also be eligible (as a couple or as individuals) for financial help to afford a plan. If you need help choosing a plan or accessing financial assistance, connect with an LGBTQ-affirming enrollment assister. 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.

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 communities continue to face significant disparities in tobacco use, obesity, abuse and violence, mental and behavioral health issues, and HIV/AIDS. That’s where the Affordable Care Act comes in. Finally we have 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. You can find plans with coverage for mental health care, preventive screenings, and wellness services. If you need help finding a plan that fits your needs and budget, get free help from an LGBTQ-affirming enrollment assister.

Yes, everyone needs health insurance. Unfortunate accidents and illnesses happen every day, even if you’re young and healthy. Without health insurance, you will be responsible for 100% of your medical bills if you get sick or injured. When getting stitches can cost more than $2,000 or spending 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 and mental health treatments to help keep you healthy in the first place. We know 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 most people qualify for financial help to make coverage more affordable. Learn whether you might qualify for financial help using this quick calculator.

It depends on your plan. Unfortunately, plans in many states still include discriminatory exclusions to deny coverage to transgender people for medically necessary healthcare. These exclusions often mean that insurers will deny coverage for gender confirmation surgery. 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. Moreover, if you are under the age of 18, it can also depend on laws in your state regarding gender-affirming care for minors. To help you understand your options, we’ve created state-specific Transgender Health Insurance Guides and encourage you to make an appointment with an LGBTQ-affirming enrollment assister who can help you enroll for free. If your gender-affirming care is denied, learn how to appeal with your health insurer here. If you face discrimination by an insurer or health provider, contact a legal organization here. If you want more information on what your insurance company might cover, check out these medical policies from Advocates4TransEquality – but make sure you look at your own policy too since that’s what will really determine what services are covered.

You have rights. The coverage of gender-affirming care continues to vary by insurer and state. But 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-affirming care. To help you understand your options, we release state-specific Transgender Health Insurance Guides every year and encourage you to make an appointment with an LGBTQ-affirming enrollment assister who can provide free assistance in the enrollment process. If your gender-affirming care is denied, learn how to appeal with your health insurer here. If you face discrimination by an insurer or health provider, contact a legal organization here. If you want more information on what your insurance company might cover, check out these medical policies from Advocates4TransEquality – but make sure you look at your own policy too since that’s what will really determine what services are covered.

The coverage of gender-affirming 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-affirming care. However, some plans may still have transgender exclusions. These exclusions are discriminatory and deny coverage to transgender people for medically necessary healthcare. 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 release state-specific Transgender Health Insurance Guides every year and encourage you to make an appointment with an LGBTQ-affirming enrollment assister who can provide free assistance in the enrollment process. 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 Advocates4TransEquality – but make sure you look at your own policy too since that’s what will really determine what services are covered. If your gender-affirming care is denied, learn how to appeal with your health insurer here. If you face discrimination by an insurer or health provider, contact a legal organization here.

Every plan sold in the Marketplace must provide a link to its directory of health providers. If you already have a provider for your gender-affirming care that you know and trust, you can use your insurer's directory to find out if your provider is included before you sign up for coverage. To find a provider of gender-affirming care, check out the LGBTQ Healthcare Directory where providers who sign up affirm their commitment to equality for LGBTQ+ patients. You can search for a provider located near you who specializes in gender-affirming hormones, counseling, surgeries, procedures, and more.

Blanket exclusions of gender-affirming care have been prohibited in most types of health insurance in ALL states since 2017. Furthermore, 24 states and the District of Columbia explicitly prohibit exclusions of gender-affirming care, including in plans available through the Marketplace.

We recommend that you answer this question according to the information 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 cause confusion if your application is checked against SSA records or if you seek coverage for “sex-specific” care (such as a hysterectomy or prostate exam). It can also complicate your application for financial assistance through the Advanced Premium Tax Credit. Instead, we recommend you file the marketplace application with information matching what the Social Security Administration has. Then, after the application has been approved and your financial assistance is established, you can go back into your account on HealthCare.gov (or your state-based marketplace) and update your gender marker at that time. If you face discrimination at any point during the enrollment process, contact a legal organization here and please let us know at info@out2enroll.org.

Yes, hormone replacement therapy should be covered by marketplace plans.* 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 gender-affirming care. If you are denied coverage for gender-affirming care or discriminated against at any point in this process, contact a legal organization here. *If you are under the age of 18, it depends on the laws in your state.

Yes, it should be. According to the Affordable Care Act, plans must cover preventive services 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. (If you've got it, you've got to get it checked!) This is true even if your plan has an exclusion for gender-affirming care. If you are denied coverage for preventive care or gender-affirming care or discriminated against at any point in this process, contact a legal organization here.

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. To help you understand your options, we’ve created state-specific Transgender Health Insurance Guides and encourage you to make an appointment with an LGBTQ-affirming enrollment assister who can help you enroll for free. If your gender-affirming care is denied, learn how to appeal a decision with your health insurer here. If you face discrimination by an insurer or health provider, contact a legal organization here. If you want more information on what your insurance company might cover, check out these medical policies from Advocates4TransEquality – but make sure you look at your own policy too since that’s what will really determine what services are covered.

Currently, 24 states have bans that restrict access to gender-affirming medications and surgical care for transgender youth. Additionally, 16 states + D.C. have state "shield" laws that protect access to care. You can refer to the Movement Advancement Project's website for more information on these laws.