“Should I sign up for health insurance through Obamacare?”
“Will it cover my hormones? What if I need surgery?”
“How do I find a plan that doesn’t discriminate against me?”
At the National Center for Transgender Equality, we know that the answers to these questions aren’t as simple as they should be. With open enrollment through HealthCare.gov running through January 31, here’s what we need to know as trans people to get the health coverage and care we need.
Every trans person knows that, until recently, almost every health insurance plan completely locked us out of coverage for even basic health care services. This is wrong — we know it, the doctors know it, and policymakers and the general public are increasingly understanding it too.
Transgender exclusions harm transgender people and force many of us to go without the health care we need — or spend our retirement savings, put off our education, or get health care on the street or online, without help from a medical professional to make sure we’re making safe choices.
This is becoming less common as more employers begin to offer inclusive plans and some states take action to ban exclusions that target us for denials of coverage. But many of us have still faced a dilemma when choosing a plan: Trans-specific exclusions are still widespread, and finding out whether a particular plan has one — and exactly what it says — before enrolling can be next to impossible.
When the federal government proposed rules in September that would ban trans exclusions in nearly all plans nationwide, we were thrilled because this rule has the power to make that dilemma a thing of the past. That’s why thousands of transgender people and allies filed comments supporting the rule and sharing their own stories of discrimination.
So the proposed rule has the potential to be a huge game-changer — but how soon?
Soon, but not soon enough to answer all those key questions during the current open enrollment period. Because the federal rule is still in the “proposed” stage, many plans haven’t eliminated exclusions from their 2016 plan documents — and the relevant plan documents are still hard to find. This is true even though the underlying law banning discrimination is already in effect.
This is an extremely frustrating situation for all of us. But two important facts remain: First, we aren’t far from the day when these transgender exclusions will be a thing of the past. Even if you enroll in a plan that currently has a written exclusion, pretty soon it won’t be legally enforceable.
And second — right now, today — everyone should get covered. All of us have many health care needs, even besides transition-related health care, and taking care of ourselves is one of the most powerful things we can do.
So here’s our advice to transgender people and folks with trans family members:
1. Go to HealthCare.gov and look into it for yourself. There may be a good option for you — or there may not be — but you owe it to yourself to look into it. Things have changed a lot in the last year: The penalty for not having insurance has gone up. The HealthCare.gov website is vastly improved. And if you make up to almost $50,000 per a year (for an individual; it’s higher for families), you can apply for financial assistance to help pay your monthly insurance premium.
2. Find a plan that works best for all your needs. Start at HealthCare.gov to find out what kind of financial help you might be eligible for. If you need more help figuring it out, you can find free local help at http://out2enroll.org/enrollment-help/. Open enrollment runs until January 31, 2016 (though you need to enroll by December 15 to get coverage starting January 1.
3. You may have to do extra work to track down any trans-related exclusions. The plan summaries available on HealthCare.gov may not have these details — instead, you may need to check the insurance company’s website for the documents (often called a certificate of coverage, evidence of coverage, or contract of insurance) for the specific plan you’re looking at, or call the insurance company and ask for details. But remember, these exclusions may no longer be valid — so even if you buy a plan with exclusions, you have the right to fight back.
4. If you need transition-related care, be prepared to fight. Change is happening, but we still need to fight for our rights. Once you’ve enrolled in a plan, you can file complaints with the HHS Office for Civil Rights and your state Department of Insurance if you’re denied coverage for the health care you need. You can also appeal the denial—make sure to get the denial in writing, and then work with your health care provider to submit a letter to the insurance company describing why this health care is medically necessary (this is a key phrase!) for you. If your first appeal is denied, you can file a secondary appeal (also sometimes called an external appeal), complain to federal or state authorities, or contact an LGBT-friendly legal organization for help.
5. Urge policymakers to fix the problem. While the comment period for the federal discrimination rule has closed, NCTE and many other advocates across the country will continue to press federal and state policy makers to take definitive action to ensure equal coverage for trans people nationwide. Let your state legislators or members of Congress know this issue affects you and your family.
We can’t say it enough: If there’s any way for you to get insurance coverage, we think you should. It may be a hassle. You may be turned off by things you’ve heard. But as we continue to fight to eliminate all trans exclusions from health insurance plans, you can rest easier knowing that your coverage will be there for you if you get sick or hurt—and you won’t have to pay the fine for not being covered!
We are winning—but the fight isn’t quite over yet. There are still obstacles for too many of us in trying to access the health care we need. But for more and more people every day, it is possible. And we will keep working every day to make sure that the law delivers all the changes we’ve hoped for—and all the changes we need.
HARPER JEAN TOBIN is the director of policy at the National Center for Transgender Equality.