So, this new Healthcare Marketplace is going to take some work. Not only to implement, but also to navigate. If you ask 10,000 trans-identified people to tell you about their experience, you’re going to get 10,000 different individual experiences – and this is what the Healthcare Marketplace is going to be.
According to NCTE, “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.” How many people do you know who avoid going to the doctor because they can’t afford it, or are worried about being discriminated against because of their gender identity? I know many people.
The Affordable Care Act (ACA) will prohibit discrimination on the basis of gender identity in the regulations implementing the law, will expand coverage for HIV/AIDS treatments, will provide free preventive care and clearly states that individuals cannot be denied health insurance because of pre-existing conditions.
All plans in the Marketplace are required to cover the same essential health benefits which include at least the following items and services:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (such as surgery)
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.
The ACA and its laws protect you in the following ways:
- Creates the Health Insurance Marketplace, a new way for individuals, families, and small businesses to get health coverage
- Requires insurance companies to cover people with pre-existing health conditions
- Helps you understand the coverage you’re getting
- Holds insurance companies accountable for rate increases
- Makes it illegal for health insurance companies to arbitrarily cancel your health insurance just because you get sick
- Protects your choice of doctors
- Covers young adults under 26
- Provides free preventive care
- Ends lifetime and yearly dollar limits on coverage of essential health benefits
- Guarantees your right to appeal
Medicaid and Ohio (Applies only to Ohio residents)
Ohio is one of the states that has chosen NOT to expand its Medicaid program at this time.
Here are some good resources to read about how Ohio’s lack of Medicaid expansion affects you:
You can find out whether you qualify for Medicaid under Ohio’s current rules 2 ways:
- Contact your state Medicaid agency
- Fill out an application for coverage in the Health Insurance Marketplace.
If you reside outside of Ohio, you can find out how your state is managing Medicaid online at (https://www.healthcare.gov/).
While there are some common steps for people to take to get signed up, people’s individual plan choices will make each person’s experience unique.
Male or Female?
When I created my online account, one of the questions was, of course, the infamous binary question: Male or Female. I chose how I identify and wondered if I selected correctly, thinking that if I need additional preventative care for my body, did I make the right choice? I connected with Andrew Cray who is a Policy Analyst at the Center for American Progress and asked him about what do Trans people select – Male or Female?
According to Andrew Cray, “When Trans people are applying for coverage through the Marketplace, they should use the sex on their social security card. It’s intended for matching against tax records. No physician will see the sex indicated on that application, and it shouldn’t be relevant to insurance companies regardless, because insurance companies can’t charge more based on gender, and because discrimination in coverage based on gender identity and sex are prohibited by federal regulations. Because of those protections, we’re fairly certain that gender no-matches for preventive screenings shouldn’t be an issue with plans sold through the marketplace. But if people are denied coverage, we’re happy to help folks with basic info about appeals, and the Marketplace will have that information as well.”
Here are the steps you need to follow in order to create your online Marketplace account:
If you are living in Ohio, you’ll use the Heatlhcare.gov website (https://www.healthcare.gov/).
Keep in mind that Plan information and costs will be available on October 1, 2013. So, you can at the very least, create an online account and be set to go when the Marketplace opens! (If you reside outside of Ohio, you can check how your state is going to manage its own Marketplace also at https://www.healthcare.gov/)
Create an account
You’ll need to provide some basic info and select a username, password, and security questions.
Apply for Marketplace coverage
Of course, you’ll need to provide info about you and your family, including your income, household size, etc. (There is a generic checklist available to help you gather the info you’ll need).
Pick a plan
Next, you should get a list of all the health insurance plans and programs you’re eligible for. Make sure you take a look at all the plans and compare them to one another! Depending on your income, you’ll also find out if you are eligible for lower costs on Marketplace coverage — again, it’s all based upon income and household size.
(**Note: there is a Subsidy Calculator available online at http://kff.org/interactive/subsidy-calculator/ — The Kaiser Family Foundation is solely responsible for the tool. The Kaiser Family Foundation has no connection with Kaiser Permanente or any health care provider.)
Select an insurance plan that meets your needs and enroll! (Looks like actual enrollment will open in November.)
Simple, right? Seems like it, but, it’s going to take some time and research on our own part, as individuals (or as a household) to find a plan that works best for each of us.
That said, NCTE adds that the “ACA reforms will eliminate many barriers to coverage access for trans 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 trans.”
A new campaign called Out2Enroll (http://out2enroll.org/) is in its final days before launching on October 1, 2013. Out2Enroll will be available for every state and is a collaborative project between the Sellers Dorsey Foundation, the Center for American Progress (CAP), and the Federal Agencies Project to educate the lesbian, gay, bisexual, and transgender community about their options under the Affordable Care Act.
I recommend visiting their website and signing up for an email. When Out2Enroll launches, you’ll be able to receive updated information as it pertains to the ACA and being Trans (or bisexual, lesbian or gay).
Personally, I think that this is going to be pretty complex system to implement and I think it’s going to work.
Do I believe that it’s a perfect system for Trans-identified persons?
- No, I don’t think so.
Will it cover surgery for people?
- Most likely, definitely not. And never say never. Maybe someday.
Will it provide mental health and physical health medical coverage for Trans-identified persons?
- Yes, definitely.
Will Trans-identified people be able to access preventative health care?
- Yes, I definitely believe so.
Will Trans-identified people be able to access mental health professionals?
- Yes, I believe they will.
Do I believe that Trans-identified people who want access to hormones be able to get access to them safely?
- Yes, I believe they will.
If you ask me if I believe if there will still be discrimination facing individuals in our Trans community…Yes, I unfortunately believe that there will be and there will be a way to report and address it. While the ACA addresses some basic needs and access to health care for our community, we still have a way to go in making sure that more than just our basic healthcare needs are met.
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.
Here are some resources that are available online for reference, research or if you have a general interest in how this is going to work at a larger scale: