Ask Lambda Legal – The Affordable Care Act & You

Leslie Gabel Brett/Directora de Educación y Asuntos Públicos
Foto: Lambda Legal
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Leslie Gabel Brett/Director of Education and Public Affairs  Foto: Lambda Legal

Leslie Gabel Brett/Director of Education and Public Affairs
Foto: Lambda Legal

By: Leslie Gabel Brett/Director of Education and Public Affairs— Dear Ask Lambda Legal, Q: I’m transgender and also have HIV, and am wondering if Obamacare is an option – I haven’t had health insurance in a long time. What does the law provide for people like me? A: Thanks to the Affordable Care Act, LGBT people and people living with HIV will have access to more affordable insurance coverage with no exclusions based on pre-existing conditions.  And in many states, expansion of the Medicaid program will offer no-cost care to more people with very limited incomes. Here are a few important things you should know:

  • Starting Oct. 1, 2013, there is a first-time open enrollment period of six months, through March 31, 2014. (Each year after that, there will be shorter open enrollment periods.) If you enroll, your new insurance coverage will begin as soon as Jan. 1, 2014.
  • You cannot be denied health insurance or charged more for having a pre-existing condition such as HIV or a diagnosis of gender dysphoria or just for being LGBT.
  • Insurers can no longer put a lifetime cap on coverage, even if you have a chronic medical condition like cancer, asthma or HIV.
  • Undocumented immigrants are not eligible for the Affordable Care Act but may still qualify for local or state programs such as community and migrant health clinics, public hospitals, and specific public health services programs (treatment of communicable diseases like tuberculosis, HIV, or other STDs; immunizations).

If you are transgender, you have the right to expect that your insurance will cover medical services for you that are covered for other people in your plan, including mammograms, Pap tests, prostate exams and probably hormone therapy. Some plans — but not all —may cover surgery related to gender transition. We will know more when the U.S. Department of Health and Human Services (HHS) issues regulations in the coming months. Figuring out what coverage is available to you, what it costs, and whether you are eligible for a federal subsidy has now been made easy — you can shop online or over the phone. You’ll find more information at Healthcare.govCuidadoDeSalud.gov, or by calling 800-318-2596. If you are a person living with HIV, you may want to consider contacting an AIDS service organization (ASO) in your area to obtain assistance in selecting the plan in your state best suited to people living with HIV.  To find an ASO in your area, use the search engine available through POZ.com. Since the Supreme Court struck down the Defense of Marriage Act (DOMA), if you are in a same-sex couple and got married in a state or country where it is legally recognized, you may apply for federal tax credits to subsidize the cost of your insurance on the same basis as all married couples. If you feel that you have been discriminated against or unfairly denied coverage based on your sexual orientation, gender identity or expression, or any disability including HIV, you have some options: You can appeal any decision through your insurance carrier or your state department of insurance. You can file a complaint through HHS’s Office of Civil Rights. And you can contact Lambda Legal’s HelpDesk. Click here to read this article in Spanish.