What You Need to Know About the Affordable Care Act: New Year Edition

You can still sign up for health insurance. Open enrollment goes until March 31, and millions of people have already signed up. You may have heard about a December deadline—but that was only to ensure coverage starting January 1. Check out your options now at HealthCare.gov or your state’s Marketplace website. (Yes, the site is way better now.)

  1. Transgender exclusions are still out there, but we’re making progress. While 5 states (CA, CO, CT, OR, VT) and DC have put plans on notice that exclusions are no longer allowed, and many employers and schools are eliminating them throughout the country, exclusions are still a reality in most individual plans. Information on exclusions won’t usually be available in the plan summaries you can find on HealthCare.gov or your state’s enrollment site, so the best way to find out is to look at the “benchmark plan” that plans in your state are based on. You can find summaries of state benchmark plans on the Center for Consumer Information and Insurance Oversight website. If your state’s benchmark doesn’t seem to have an exclusion, it may be worth the effort of tracking down detailed plan documents as you select a plan.
  2. Even with exclusions, insurance is worth having. The reality is that at least in 2014, most of us buying individual plans are going to end up with exclusions. While NCTE and our allies are working hard to get rid of these exclusions, getting some coverage right now is essential to protect your health and financial security. Transgender people need routine screenings and treatment when we’re injured or ill—in fact we are more likely to face many health problems—and all plans will cover these needs.
  3. Preventive care is covered at no cost, regardless of gender. Transgender people have often had coverage denied for screenings or treatments typically associated with one gender or another, such as breast or pelvic exams. As the saying goes, “If you have it, check it.” The ACA requires all preventive care to be covered with no co-pays, and regardless of the gender listed with your insurance company. The federal government has made it clear, for example, that transgender women should be able to get breast exams. However, sometimes a person or a doctor will need to call an insurance company about having this care paid if the insurance company initially denies the coverage because it confuses their computer system. (Speaking of gender markers, we believe it shouldn’t matter which gender you give when you enroll as it won’t be matched with any database, but if you want to be extra cautious you could list the gender in your Social Security record. Either way, this information shouldn’t go to your doctor or affect your coverage.)
  4. It may be more affordable than you think. Subsidies are available to many people to make plans affordable, or even free for some—and 26 states are also expanding Medicaid coverage. Many people with moderate or low incomes, especially those with existing health conditions, will have far lower premiums than before. While a few people could see premiums go up, their plans will also have more generous coverage, including no-cost screenings and other preventive care. While you may have heard about a penalty for not buying coverage by March 31, those who can’t afford the modest penalty are exempt.

For more information, visit Out2Enroll.org, which is a go-to resource for LGBT people on enrolling.

One Response to What You Need to Know About the Affordable Care Act: New Year Edition

  1. […] What do I need to know about Obamacare?  More information from Transgender Equality. […]

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