Under the federal Affordable Care Act, an “Exchange”—an organized marketplace designed to help people shop for and enroll in health insurance coverage—will be operating in every state starting in 2014. New York has chosen to set up its own Exchange, called the New York Health Benefit Exchange. Individuals, families and small businesses will be able to use the Exchange to find the best possible health insurance plan for themselves and their families, and, if eligible, apply for financial assistance to pay for it. Insurance coverage can be purchased through the Health Benefit Exchange beginning in October 2013 and will become effective January 1, 2014.
Starting in September, LGBT consumers who need affordable coverage will be able to contact facilitated enrollment specialists, Exchange Navigators, who will provide information and assistance in finding the best insurance plan. New York State has funded 50 community organizations around the state to provide Navigators. In New York City, these include the LGBT Community Center, Callen-Lorde Community Health Center and APICHA. All the enrollment navigators around the state will be trained to provide LGBT consumers with sensitive and affirmative assistance.
Here are some things LGBT consumers should know about enrolling in health insurance coverage; these have been adapted from the recommendations made to the NYS Health Exchange by the LGBT Task Force at Health Care for All New Yorkers (HCFANY).
1. The Affordable Care Act prohibits discrimination against applicants, including on the basis of gender, sexual orientation and gender identity.
2. Some questions may touch on sensitive personal areas, such as gender identity, pregnancy status and HIV status. This information is necessary to the application process and may actually qualify you for particular insurance programs—but will not be shared or used for any other purpose.
3. Because New York is a marriage-equality state, married same-sex couples are entitled to apply for family health plans.
• There may be special issues in defining households for LGBT applicants who have children.
• Since many LGBT families have sperm donors or surrogate mothers, or may not have birth-parent information, it is important to clarify who counts as the “other” parent for the “parent living outside the home” question.
4. For transgender applicants:
• For purposes of the enrollment application, the applicant will need to use the name and gender listed on specific government records, even if that does not match the person’s current name or gender. Medicaid uses what is on Social Security records, so it is important to apply under that name.
• Transgender applicants need to be aware that Medicaid does not cover some trans-specific care, including gender reassignment surgeries.
• Transgender applicants should check with their preferred health providers about which health plans they accept, and then contact those plans about whether trans-specific care is covered before completing the enrollment application and choosing a plan.
5. An HIV-positive applicant may qualify for a Medicaid Special Needs Plan (SNP) and/or specialized programs, such as the AIDS Drug Assistance Program (ADAP).
For more information or for assistance finding an Exchange Navigator, contact Beth Israel LGBT Health Services at (212) 844-6389 or e-mail Bwarren@chpnet.org.
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