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Does being lesbian, gay, bisexual, or transgender (LGBT) affect my health insurance coverage and options? What if I am legally married to my same-sex partner?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

The Affordable Care Act (ACA) and other federal policies provide protections for LGBT individuals and their families.

Health insurance Marketplaces, which are 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 and sex-stereotyping (which in some cases may include sexual orientation) in all health programs that receive federal funding, such as Medicaid and Medicare, among other programs.

There are also other federal policies designed to protect you and your family.  Virtually all hospitals must now allow visitation by a same-sex partner (whether or not you are married) and same-sex partners must be afforded the same treatment as other spouses for long-term care, such as nursing home care under Medicaid.  In addition, same-sex couples (whether or not you are married) now have the same rights as others to name a representative to make medical decisions on a patient’s behalf.

Supreme Court Rulings and What They Mean for Your Insurance Options if you are Legally Married to a Same-Sex Partner:

Beyond the protections under the ACA, the Supreme Court’s June 2013 ruling (overturning part of the Defense of Marriage Act (DOMA) in United States v. Windsor) and subsequent June 2015 ruling (in Obergefell v. Hodges that same-sex couples have the right to marry in all states) mean that same-sex marriages are  recognized under federal and state law.  This has implications for the health care Marketplaces as well as for Medicaid and CHIP, Medicare, and coverage through your employer:

Health Care Marketplace: 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.  Tax credits are calculated based on your federal income tax filing, so marketplaces must recognize same-sex marriages and base eligibility on a married couple’s income.  In fact, legally married couples, including same-sex couples, must file a joint tax return to gain access to these tax credits. If you are not legally married – if you are in a domestic partnership, a civil union, or another relationship –you may still be able to get these credits but will need to apply for them separately as individuals 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: All states must recognize same-sex marriages when determining whether or not you meet your state’s income eligibility requirement for Medicaid and CHIP.

Medicare: If you are married to your same-sex partner, you may now qualify for Medicare coverage based on your spouse’s work history.

Health coverage through an employer: All federal employees, federal contractors, members of the military, veterans, and state employees who are legally married to a same-sex partner may now obtain spousal health benefits for their partner. In addition, all health insurance issuers who offer coverage to opposite-sex spouses must also offer coverage to same-sex spouses.  However, there remains some question about whether private employers can legally limit spousal coverage to opposite-sex spouses only, many experts believe that an employer who does so would likely found to be in violation of federal Civil Rights law.

Department of Veterans Affairs:  The VA recognizes same-sex marriages and will extend benefits to same-sex spouses of Veterans, including CHAMPVA health coverage, survivor compensation, and burial benefits

My partner and I are unmarried. Can we buy a policy that covers us both? Are we counted as a household of two?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

The rules for premium tax credit eligibility will be the same in all states; however the type of policy you can buy will depend on where you live.

Because you are not married, you will be considered two separate households for the purposes of determining eligibility for premium tax credits and Medicaid. Assuming that neither of you are claiming any dependents on your tax returns, you will each be considered as a household of one and your own income will be used to determine eligibility for premium tax credits and Medicaid as well as the amount of any premium tax credit and cost-sharing reduction you may qualify for. If you are eligible for premium tax credits, you will each receive a separate determination of the amount of your credit and whether you are eligible for a cost-sharing reduction. Whether you can use your credits to buy a family policy rather than two individual policies will depend on the offerings in your state Marketplace.

My partner and I are unmarried and we have two children. How do we count our household size and income when we apply for subsidies in the Marketplace? Can we buy one policy to cover the whole family?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

Assuming you are eligible for premium tax credits, the amount of your credit will be calculated based on how you file your taxes. If for example, you each claim one of your children, you each will be considered as a household of two. The income of each household would be evaluated separately to calculate eligibility for and the amount of premium tax credits and cost-sharing reductions.  Using a different example, if you claim both children as dependents on your tax return, then you and your children will be considered a household of 3, your income will be the basis for determining subsidy eligibility for the 3 of you. Your partner will be a household of one and his/her eligibility for premium tax credits will be determined separately. As for the type of coverage your family can purchase, that may vary based on the Marketplace rules where you live. For example, some insurers may offer family coverage only to married couples. If you buy one policy for the entire family, all the tax credits you are eligible for can be used to reduce the premium for that policy. If you buy separate policies, you can allocate the premium tax credits across two plans.

I am currently uninsured and plan to purchase coverage through the health insurance Marketplace. Do the insurance plans in the Marketplace cover abortions?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

It depends on where you live and the specific plan you choose. Some states allow plans in the Marketplace to cover all abortions and some states prohibit or limit plans’ coverage of abortion to certain cases. In half the states, Marketplace plans are prohibited from offering coverage that includes abortions, or are restricted to covering abortions in very limited circumstances. You should check the plan details to find out whether your plan covers abortion services.

How do I project my household size/income for next year if I’m pregnant now? I’m married and this pregnancy will be our first child. We want to find subsidized coverage in the Marketplace.

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

During Open Enrollment, you and your spouse will apply as a household of two. When the baby is born, you can update your family information with the Marketplace to reflect that you have become a household of three. At that point, you may qualify for a larger premium tax credit. (For example, if you and your spouse together expect to earn a 2019 income that is twice the federal poverty level for a household of two ($32,920), you would be required to contribute about 6.54% of your household income toward the premium for the benchmark plan in the Marketplace. Once the baby is born and you are a household of three, that income would constitute just 158% of the federal poverty level for a family of three and you would only be required to contribute about 4.15% of your income. When you report your new family status to the Marketplace you will also have a 60-day special enrollment opportunity to add the baby to your plan and increase your advanced premium tax credit amount.  You will also have the option of enrolling your baby in a different plan.  However, you and your spouse generally will not be able to change health plans as a result of the “newborn” special enrollment period.

I have been trying to get pregnant. Will the plans on the exchanges cover infertility services?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

This will vary by state. Some states have requirements that plans cover some infertility services, but there is no national requirement for coverage of infertility services. If you need these services and are shopping for coverage, check the plan details about coverage and out of pocket charges for infertility care.

I am pregnant and plan to breastfeed my baby. How does the ACA affect breastfeeding services?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

The ACA requires that all new ACA-compliant plans, including those in the employer market, individual market, and health insurance Marketplaces, cover lactation counseling and breast pump rental without any charge. Check your plan details to find out the specific number of counseling sessions and type of breast pump that it covers, or if your plan covers purchase of a breast pump. If you are nursing and work for a large employer (50 or more employees), your employer must provide access to a private room (that is not a bathroom) and break time for you to express milk.

Short-term health insurance policies do not have to provide benefits required by the ACA, including breastfeeding services.

I just found out that I’m pregnant and my baby is due in March. Can I enroll in a plan though the health insurance Marketplace?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

Yes.  However, you may only enroll during Open Enrollment period (November 1, 2016 – January 31, 2017).  Once enrolled, your plan will be required to cover maternity services.  You may also qualify for a premium subsidy, depending on your family income and your eligibility for employer coverage.  Once born, you can add the baby to the plan.  You will also be allowed to change plans at that time.  Birth of a child is a qualifying event that allows you to enroll in or change your coverage, no matter when during the year the baby is born.  Your special enrollment period will last for 60 days from the date of birth.  Adding the baby will change the plan premium and also your subsidy, assuming you qualify for premium tax credits. Depending on your income and the state you reside in, you might also qualify for Medicaid and there is not a limited open enrollment period for Medicaid.

I’m covered as a dependent under my parent’s plan and I’m pregnant. Will my parent’s plan cover my prenatal care and delivery? Will my parent’s plan cover my baby after he’s born?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

The rules are somewhat different depending on the plan your parents have.

If your parents are covered under a small employer plan (less than 50 workers) provided by an insurance company through the Marketplace or outside of the Marketplace, or if your parents are covered under a nongroup policy they bought themselves, then your parent’s plan is required to cover your prenatal care and delivery.

However, if your parents are covered under a group health plan offered by a large employer (50 or more workers), then your parent’s plan is only required to cover your prenatal care, but is not required to cover the delivery. Medicaid covers prenatal and delivery services in all states. You could see if you can qualify for Medicaid on your own.

Your parent’s plan, regardless of the source, generally won’t be required to cover your child as a dependent. You will be responsible for obtaining coverage for your baby. Depending on your income, your child may be eligible for coverage under the Medicaid/CHIP program in your state. Or, you can buy a family policy through the Marketplace and, depending on your income, you may be eligible for a premium tax credit to reduce your cost of that coverage.