HRC Blog

What’s in the ACA for Transgender People?

Post submitted by Jessica Jeanty & Harper Jean Tobin, National Center for Transgender Equality

Are you or is someone you know living without insurance coverage? Have you been refused any coverage, or charged higher premiums, because you’re transgender? Have you had to fight to get routine tests, doctor visits, or treatment for injuries or illnesses covered by your insurer because they say it is somehow related to being trans and therefore excluded?

For thousands of transgender people around the country, the wait is over for health coverage that is more accessible, affordable, and comprehensive than before. Too many trans people still live without any health insurance at all – and many are now eligible for free or low-cost coverage through their state health insurance marketplace.

Marketplaces are open for enrollment in every state—right now—and are unaffected by the partial shutdown of the federal government. While we’re still fighting to end unfair exclusions in most plans that target trans people, the new marketplaces provide enormous opportunities—right now—for many trans people to get some health coverage for the first time, or to get better, cheaper coverage. With income-based subsidies available in every state, and expanded Medicaid eligibility in 26 states, getting covered may cost much less than you think, or may even be free.

So what do the new marketplace plans cover?

The marketplace insurance plans will cover several broad categories of benefits, including doctor’s visits, preventive care, hospitalization, prescriptions, mental health and substance use disorder services, emergency services, and maternity, newborn, and pediatric care.  Unfortunately, most plans still have unfair exclusions regarding transition-related care and deny coverage for transition-related surgeries. In California, Colorado, Oregon, Vermont, and D.C., however, new rules are in place to eliminate many transition-related exclusions, and we expect to see more states join this trend in the coming years.

While LGBT advocates are fighting to end these harmful and baseless exclusions wherever they exist, transition-related exclusions have never been the only barrier to affordable health care for trans people. Too many people are going without many types of health care, or are paying out of pocket for routine visits or unforeseen illnesses. The new marketplace coverage options present real, new choices right now for many trans people and their families. While we continue the struggle for fully equal treatment, we urge everyone to check out their options now.

Healthcare is more affordable

Many people will be able to secure highly subsidized or even free health coverage through the new healthcare marketplace.  Check out the subsidy calculator developed by the Kaiser Family Foundation.

To avoid problems when being evaluated for a subsidy, it is important that transgender applicants carefully answer the first question on the healthcare.gov website above, which can be a troublesome question for many: “What is your gender: M or F?”  On this question, trans applicants should select the gender marker that is listed in their Social Security Administration record.  This is only used to match an applicant’s information against tax records for subsidy eligibility: no physician will see the gender marker indicated on that application.  In addition, the ACA’s new rules prohibit insurance companies from discriminating based on this information, such as by denying services that are generally covered by your plan but are typically associated with a different gender than the one listed for you. 

Last but not least, healthcare will also be more affordable for those who now qualify for Medicaid.  Because of the Affordable Care Act’s reforms, 26 states are expanding Medicaid so that more people can be eligible for the program.  You can learn if your state is participating in the Medicaid expansion here.

While you may have heard about a penalty being applied to those who don’t get coverage, very few people will actually pay the penalty. If you already get coverage through an employer, Medicaid, Medicare, the Veterans Administration, or another program, or if you cannot afford to buy coverage despite the available subsidies, you will be exempt from the penalty.

There are protections against discrimination

Finally, the Affordable Care Act and its implementing rules prohibit plans from discriminating on the basis of sex, sexual orientation, and gender identity. They also prohibit discrimination by many health care providers, such as doctors, hospitals, and clinics.  Unfortunately, the new rules have not yet been interpreted to mean that discrimination includes denying someone transition-related surgery.

However, transgender people who have experienced discrimination in insurance enrollment, coverage, or services can file a complaint that the Department of Health and Human Services will investigate. 

Overall, the Affordable Care Act and the current open enrollment period for the health insurance marketplace are a big deal for all Americans, but especially for transgender people.  These health care reforms will eliminate many of the barriers to coverage access that transgender people have experienced in the past and will provide avenues for people to file discrimination complaints. We strongly urge transgender people and their families to explore the options available through their state marketplace. Our ultimate goal is to ensure that all trans people have access to quality, affordable care that meets all of their health needs.

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

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