What’s in the Health Care Marketplace for Trans People?

Health Care Marketplace Enrollment Starts Oct. 1st

Photo: Ted Eytan

Photo: Ted Eytan

Last Thursday, NCTE and dozens of LGBT groups from around the country attended a White House briefing on the new health insurance marketplaces, which will be open for enrollment starting Tues. October 1st.  Valerie Jarrett, Senior Advisor to the President, gave the opening remarks and was followed by Secretary of the Department of Health and Human Services, Kathleen Sebelius.  Both expressed their excitement about the upcoming enrollment period and explained the importance of access to quality health care for LGBT people.  Currently, transgender people are less likely to have health insurance than non-transgender people, and 48% of transgender people have avoided going to the doctor when they were sick because they could not afford it.

Several panelists described how the federal government and community organizations can take steps to ensure that LGBT people are aware of their health care rights and health insurance enrollment options.  The new health care marketplaces are a result of the Affordable Care Act (ACA), which makes health care more affordable and accessible for LGBT people in many ways.  The ACA prohibits discrimination on the basis of gender identity in the regulations implementing the law, expands coverage for HIV and AIDS treatment, provides for free preventive care, and states that individuals cannot be denied health insurance because of pre-existing conditions.

The ACA also requires that all U.S. citizens have health insurance or pay a penalty.  Fortunately, with the new health care marketplaces, many people will be able to secure highly subsidized or even free health coverage if they enroll through healthcare.gov.  The marketplace insurance plans will cover all essential health benefits, including doctor visits, preventative care, hospitalization, prescriptions, mental health and substance use disorder services, emergency services, and more.

ACA reforms will eliminate many barriers to coverage access for transgender people and will provide avenues for people to file discrimination complaints. No longer will plans be able to refuse to sell you insurance, charge you more, or deny coverage for routine preventive or emergency care because you are transgender. While it is not yet clear what impact the new reforms will have on insurance exclusions that unfairly target transgender people, NCTE will continue to press to eliminate these practices. NCTE encourages anyone who experiences discrimination in insurance enrollment or access to covered services under their plan to use our resource on Health Care Rights and Transgender People and to file a complaint.

To compare your health insurance options and enroll in a plan, visit healthcare.gov or call the 24/7 Consumer Call Center at 1-800-318-2596 starting Oct. 1, 2013.  You can also visit out2enroll.org to get more trans-specific information about the new marketplaces.   

NCTE will continue to stay updated about the implementation of the Affordable Care Act to ensure that we all have equal access to the quality health care we need.

14 Responses to What’s in the Health Care Marketplace for Trans People?

  1. Cheryl CC-E says:

    But I still have yet to have my question answered as to what transgender individuals who live in ‘Red States’ who have not accepted Medicaid expansion are to do when they have no “established/dependable” income (considering this demographic is plagued with unemployment). Are they still stuck with “ER Health Care”??

    • This article says alot, but most of it is smoke..Insurance companies have exclusions for a reason and will not change them, and provide free care to trans..Medicaid and medicare are going broke, so this free ride will stop. ACA is a disaster and will bankrupt the country..

  2. Rebecca Juro says:

    My understanding is that there are no protections for trans people against being denied the care we need such as hormones and SRS in the ACA, so how isn’t this just benefits for non-trans people while basically nothing changes for us?

    Is NCTE supporting this kind of thinking? Isn’t it time we started calling out the obvious holes in this law that are large enough to drive a truckload of transphobia through?

    • Rita Speaks says:

      I have to agree with Rebecca here. Almost 2 years after your post and I’m trying to help a friend who signed up for an ACA plan here in KY (red state) and did not have her care covered. She had a big copay on her Endo visit and a $750 lab bill which I found to be outrageous. She dropped her insurance to pay for the lab bill instead of fighting it. Now I’m tasked with helping her find a new plan than will cover those costs.

    • Richie Two Feet says:

      yeah …… The War on Women only counts if you are a Cis Woman …. I haven’t seen any of these Liberal Blow Hards stand up for us on the Morning Talk Shows …… makes you resentful to pay into ANY system that treats you like trash – Tax’s – Healthcare – ect …….. Insurance Companies ONLY do the RIGHT THING when they are forced

  3. Vincent Villano says:

    Ending discriminatory exclusions in health insurance is one of the top priorities of NCTE and other trans advocates. We are starting to make real progress, not just with big employers and universities but also with state regulators in 4 states + DC saying exclusions violate state nondiscrimination laws. Outside those states, though, exclusions remain the rule for individual plans, with very few exceptions. This is one of our toughest and most critical battles, and much of the work is behind the scenes. We expect to see more states follow suit and put an end to exclusions in many individual plans, but this will likely happen one state at a time over the coming years.

    In the meantime, there will be tremendous benefits for many trans people, even in states where exclusions remain common. Transition-related care is not our only health concern, and some coverage is better than none if you have a chronic medical condition or suffer an accident. So getting more trans people on any kind of coverage is very important. We also have new tools to fight plans that use exclusions to deny even routine preventive care, or care that is totally unrelated to gender. We encourage folks to consult our Health Care Rights and Transgender People resource regarding these types of problems.

    • Rebecca Juro says:

      I just worry that we’re crossing a fine line between general support for health care reform and endorsement of the law in its current state. History teaches us that later changes to existing laws that add trans protections and benefits to the law don’t tend to fare well (see New York, Maryland, New Hampshire, etc.).

      I’m concerned that by endorsing this law as it stands we are also endorsing its discriminatory exclusions. Given that we hear very little about these amidst all the cheerleading for the Obama Administration, I think it’s time we (and yes, I include myself as a trans media person) started making more of an effort to let trans people know not only what they get from this law, but also what they don’t.

      • Harper Jean Tobin says:

        NCTE strongly supports the law as it is. The law in no way blesses or allows exclusions – in fact, it prohibits sex-based discrimination. But many of the provisions haven’t been fully implemented yet, and federal and state officials will need to make decisions from year to year about what constitutes discrimination that isn’t allowed under the law. Both the legal thinking and the political and social context are evolving, and we will win. We are laying the groundwork while working to get as many health needs covered for as many people as possible, as quickly as possible – and that means helping trans folks who are totally uninsured get enrolled in plans that are available now where they live.

  4. Connie Rice says:

    I’m wrapping up my surgical transition in January. I paid for everything myself. I see no benefit here for me, and in fact my taxes will go up to pay for others.
    If you are one of the people who will benefit at my expense, excuse me if I don’t buy your arguments and see them as self-serving.

    • Sounds great..most of us have to pay for our surgeries and I doubt the ACA is going to benefit any trans in that way…I now have BC/BS FEHB and it only covers blood work(Labs) and a portion of my Doctor visit.. NCTE is trying to get the Gov ‘t and the VA to cover all medically needed services, will have to see how that goes..Most Insurance carriers in the ACA will have exclusions for GSR,FFS, Electrology and so forth.. Too bad..

    • Richie Two Feet says:

      Amen ! I am sick of seeing the War on Women cry about paying $4 co pays for Birth Control while we sit out hear having to pony up $40,000 ….. complete BS – We are the ones who are treated as if we are not worthy and deserve to be treated poorly

  5. Kwyn Meagher says:

    Along with transgender issues… healthcare.gov asks for your gender… which is only male or female. This is inherently problematic. Also trans* health care often is not covered in most insurance plans i.e. hormones, surgery and mental health.

  6. April Kester says:

    Who I am is defined, in part, by my need to get health care specifically for the one legitimate diagnosis that I have, and that is still completely denied me in health insurance coverage. Out2Enroll was very helpful in letting me know I am not included with the other letters.

    • Richie Two Feet says:

      Yeah, isn’t it great ? If you smoke and eat like crap they’ll cover your Bypass Surgery and feel sorry for you …… if you are Trans they don’t think you deserve anything but demands you pay premiums for the smoker, fat slob to nail you for $100,000 in Medical Care and probably $3000 in disability – sucks

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