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Financial Help

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.

Do I qualify for financial help?

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 approximately $12,00 and $47,000 (or more based on the number of people in your family). 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.

Don’t forget that it’s the law to have health insurance. If you choose to go without coverage, you will have to pay a penalty of either 2.5 percent of your income or $695, whichever is greater. Since most people qualify for financial help, it may be cheaper to enroll in health insurance—and have the peace of mind that comes from being covered—than it is to pay the penalty.

Can I include my child when I apply for financial help?

Yes, if you claim your child on your federal taxes, you should list them on your Marketplace application, regardless of your legal 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. 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 you cannot find a plan that covers 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.

Discrimination

Does the Affordable Care Act protect LGBTQ people from discrimination?

Yes. The Affordable Care Act is the first federal law to prohibit discrimination against LGBTQ people in the health system. The law contains explicit protections for transgender, gender nonconforming, non-binary, and intersex individuals as well as LGB people based on sex stereotyping. This includes most types of health insurance coverage and most types of health care providers.

But we all need to pitch in to make sure that these protections are being honored. 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 – visit http://bit.ly/2hGFuWn. If you face discrimination by an insurer or health provider, contact a legal organization at http://bit.ly/2hHkLxi.

Read about Section 1557 of the Affordable Care Act to learn more about nondiscrimination protections.

 

What if my plan refuses to cover benefits and services related to gender transition?

You have rights. The coverage of transition-related 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 transition.

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 transition-related care 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.

Read about Section 1557 of the Affordable Care Act to learn more about nondiscrimination protections.

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.

What if my plan doesn’t carry the prescription drug that I need?

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.

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 at http://bit.ly/2hHkLxi and let us know at info@out2enroll.org.

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 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.

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.

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.

Same-Sex Couples

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.

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 approximately $16,000 and $64,000. 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.

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, 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.

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 at http://bit.ly/2hHkLxi and let us know at info@out2enroll.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.

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 at http://bit.ly/2hHkLxi and let us know at info@out2enroll.org.

HIV/AIDS

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.

What if I have a preexisting medical condition, such as HIV?

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.

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 depends on your income. You may qualify for financial help if you and your spouse’s annual income is between approximately $11,000 and $47,000. 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.

Do Marketplace plans cover benefits and services related to HIV?

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 will 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.

Will my prescription drugs be covered by my Marketplace plan?

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 will 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.

How can I find an LGBTQ-friendly doctor who takes my 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, 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.

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.

What if my plan doesn’t carry the prescription drug that I need?

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.

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 at http://bit.ly/2hHkLxi and let us know at info@out2enroll.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.

Penalty

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.

Is there a penalty for not having insurance?

It’s the law to have health insurance. If you choose to go without coverage, you will have to pay a penalty of either 2.5 percent of your income or $695, whichever is greater.

For many people, it is cheaper to enroll in health insurance—and have the peace of mind that comes from being covered—than it is to pay the penalty. This is because 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 your household 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.

You may be exempt from the penalty under certain circumstances. For example, you won’t have to pay a penalty if you’re uninsured for less than 3 months in a year or if you don’t file a tax return because your income is too low. If you think you might qualify, you can obtain a “certificate of exemption” from the Marketplace.

Young People

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.

Do I need health insurance, especially if I’m young and healthy?

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 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.

How can I find an LGBTQ-friendly doctor who takes my 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, 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.

Why should getting covered matter to you as an LGBTQ young person?

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.

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 depends on your income. You may qualify for financial help if you and your spouse’s annual income is between approximately $11,000 and $47,000. 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.

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 at http://bit.ly/2hHkLxi and let us know at info@out2enroll.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.

Small Business Owners

What does health reform mean for small business owners?

Small business owners have new opportunities available under the Affordable Care Act. Employers and employees can compare their options and shop for coverage through the Small Business Health Options Program (SHOP).

When you offer coverage through the SHOP, you can choose what level of coverage (i.e., bronze, silver, gold, or platinum) to offer, and then your employees can select any plan offered through the SHOP at the same level. You may also qualify for a federal tax credit for providing coverage to your employees.

Want to know even more about what the Affordable Care Act means for LGBT small business owners? Check out our joint fact sheet with the Small Business Majority and the National Gay & Lesbian Chamber of Commerce.

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