What if I am gay, lesbian, bisexual, or transgender (LGBT)? Will that affect my health insurance coverage and options?
The Affordable Care Act (ACA) and other new federal policies put in place important new protections for LGBT individuals and their families.
Health insurance marketplaces, which are new organizations set up in every state to create more organized and competitive markets for buying coverage – are prohibited from discriminating on the basis of sexual orientation and gender identity. You cannot be turned away or charged more for being lesbian, gay, bisexual, or transgendered. You also can’t be denied coverage or charged more because of any pre-existing health condition, such as your HIV status. Insurers can’t limit how much they’ll spend on your medical care – over a year or over a lifetime.
Under the ACA, these protections extend to the health benefits provided in the Marketplace plans, which cannot discriminate based on sexual orientation, gender identity, or health status in how they design their essential health benefits.
In addition to these marketplace protections, the ACA prohibits discrimination based on gender identity in all health programs that receive federal funding.
The Defense of Marriage Act Supreme Court Ruling and What it Means for Your Insurance Options:
Beyond the new protections under the ACA, the Supreme Court’s June 2013 ruling overturning part of the Defense of Marriage Act (DOMA) means that same sex marriages are now recognized under federal law. They are treated the same as heterosexual marriages, and in many cases, this recognition exists whether or not you live in a state that recognizes same sex marriage. This has implications for the new health care Marketplaces as well as for Medicaid and CHIP:
Marketplace: Because of the DOMA decision, legally married same sex couples can apply jointly for tax credits in the marketplace. These tax credits help you pay the costs of your health plan, and are available even if you currently live in a state that does not recognize same sex marriage. Tax credits are calculated based on your federal income tax filing, so if you are legally married to someone of the same sex, you can claim credits jointly with your spouse. If you are not legally married – if you are in a domestic partnership, a civil union, or another relationship –you’ll still be able to get these credits but will need to apply for them as an individual instead of as a couple; depending on your state Marketplace, you may be able to use your individual credits to buy a family policy rather than two individual policies.
Medicaid and CHIP: States may now choose to recognize same-sex marriages when determining whether or not you meet your state’s income eligibility requirement for Medicaid and CHIP.
There are also other new federal policies designed to protect you and your family. Hospitals must now allow visitation by a same sex partner and same sex partners may be afforded the same treatment as other spouses for long-term care, such as nursing home care under Medicaid. In addition, same sex couples now have the same rights as others to name a representative to make medical decisions on a patient’s behalf.