It’s sad but true: The LGBTQ+ community has always been, and is still, underinsured when compared to the general public — despite the LGBTQ+ uninsured rate being cut in half in 2020. Members of the LGBTQ+ community, many having the same medical needs as everyone else, have been hit particularly hard by the COVID-19 crisis. Health insurance is in great need, but it can be difficult to find affordable health care providers after the consumer’s sexual orientation becomes a part of the mix.
The good news is that LGBTQ+ insurability rates are going up. Recent changes both politically and legally have helped cut uninsured rates within the community, but there is still work to do. Associations like the Gay and Lesbian Medical Association (GLMA ) are helping to find the best health insurance for people in the LGBTQ+ community.
The Best Health Insurance for the LGBTQ+ Community
You cannot be turned down for health insurance if you are a member of the LGBTQ+ community. Likewise, you cannot be charged higher rates. If you’re gay and have HIV, that’s no reason for your health insurance provider to charge higher monthly premiums or turn you down for coverage altogether. The Affordable Care Act leveled the playing field for all Americans, no matter who they are.
If you’re gay, your spouse cannot be turned down either. The U.S. Supreme Court decision of Obergefell v. Hodges ruled that same-sex couples have the right to marry in all states and have all the same privileges as heterosexual couples. Same-sex marriages are recognized by federal law and health insurance companies. This holds true for:
- Private individual insurance
- Family insurance
- Medicaid and Children’s Health Insurance Program (CHIP)
- Employer-based health coverage
- Veterans Affairs
No matter who you have health insurance with, whether it be private or public, all the same rules apply. Spousal benefits are available for gay couples just the samne as their heterosexual counterparts, whether they be federal or state employees, members of the military or private citizens.
- Best For:Nationwide coveragesecurely through Blue Cross Blue Shield Health Insurance's website
- Best For:No enrollment period health insurancesecurely through Sidecar Health Access Plan's website
Plans referred to above are excepted benefit fixed indemnity insurance products marketed and administered by Sidecar Health Insurance Solutions, LLC and underwritten by Sirius America Insurance Company or United States Fire Insurance Company, depending on the state. As an excepted benefit plan, it does not provide comprehensive/major medical expenses coverage, minimum essential coverage, or essential health benefits. You cannot receive a subsidy (premium tax credit and/or cost-sharing reduction) under the ACA in connection with your purchase of such an excepted benefit fixed indemnity insurance plan. Also, the termination or loss of this policy does not entitle you to a special enrollment period to purchase a health benefit plan that qualifies as minimum essential coverage outside of an open enrollment period. Coverage and plan options may vary or may not be available in all states.
- Best For:Access to Kaiser medical specialists
- Best For:Same day coverage available
- Best For:Pharmacy programs
What the LGBTQ+ Community Should Look for in Health Insurance
In most cases, members of the LGBTQ+ community are looking for the same health insurance coverage as anyone else. While members of the LGBTQ+ community still need to look for health insurance that covers chronic illnesses, their overall healthcare needs are pretty much the same as anyone else.
Whether you’re shopping in the healthcare marketplace or through a private insurance firm, you’re looking for coverage that will help with gender identity and gender identity disorder, hormone therapy, reproductive health services, gender-affirming care, mental health services, other LGBTQ health services and more. Transgender patients may need hormone replacement therapy. Whether you’re purchasing insurance for single individuals or a same-sex couple, you need to look into each carrier carefully before buying a policy.
Moreover, you have a right to look into coverage for sex reassignment surgery or other transition-related surgeries. Keep your options open and ask as many questions as you need.
What the LGBTQ+ Community Needs to Know About the ACA
Since the implementation of the Affordable Care Act (ACA) in 2010, equality when it comes to health insurance has been getting better. The ACA has made it possible for all kinds of people who could not get health insurance before to have it now. Some facts about the ACA that the LGBTQ+ community should know include:
- No more discrimination: Because of the ACA, insurance marketplaces, both state and federal, can no longer discriminate against members of the LGBTQ+ community. You cannot be charged more money for health insurance for preexisting conditions.
- Important dates: Open enrollment for ACA health coverage starts Nov. 1 and ends Dec. 15 each year. Don’t miss your chance to enroll during this open period. If you do, you can enroll in a special enrollment period if you have mitigating circumstances.
- Compliant plans and short-term plans are not the same: If you have to fill an insurance gap, a short-term plan can help ensure there is no lapse in coverage. Do not confuse this with a fully compliant plan. Short-term plans offer less coverage, and less protection.
- Know your coverage: Make sure you’re aware that complete coverage does not include dental, vision and hearing. These must be insured separately.
- ACA and the Marketplace: The Marketplace, or Healthcare.gov, is where you find private health insurance and whether you qualify for subsidies. Do not confuse private health insurance with public plans like Medicare and Medicaid.
Mistakes to Avoid When Purchasing Health Insurance
What kinds of mistakes might members of the LGBTQ+ community make when purchasing health insurance? The same mistakes anyone else might make. Common mistakes include:
1. Lack of research
Just because you’re a member of the LGBTQ+ community doesn’t mean you don’t need to do your due diligence. Dive deep into different policy coverages and find the one that’s right for you. The key is to spend time learning the ins and outs and which coverage is right for you.
2. Hiding your medical history
Now that the stone age is over, there’s no need to hide your accurate medical history. In fact, doing so can only harm you when it comes time to use your health insurance. Members of the LGBTQ+ community may have felt the need to hide their medical conditions in the past but no more.
3. Not having enough coverage
This applies especially to those who get their health insurance through their employer. What happens when members of your family need extended coverage that your work-based policy won’t cover? There’s no reason you can’t have additional personal coverage alongside your employer-based policy.
4. Waiting too long to get health insurance
Unfortunately for many people, the idea of health insurance doesn’t come up until they’re older. This is a big mistake. You never know when you’re going to need health insurance, and waiting until you’re older not only makes it more likely and more expensive. Just like with life insurance, the best time to purchase health insurance is when you’re younger and don't think you need it.
5. Getting the monthly premium/deductible levels backwards
This may sound a little complicated, but it’s not really. Yes, it’s a good idea to get health insurance when you’re younger, even if you’re not going to need it. Make sure, however, that you’re getting the best bang for your buck. What this means is: Make sure you have a high deductible when you’re young. Higher deductibles lead to lower premiums. After all, you’re not actually expecting to use it; you just need to have it there in a pinch. Choosing a higher deductible can save you a fortune in monthly premiums over the years. Perhaps, when you get older, start thinking about lowering your deductible, when you plan on using your insurance more.
Special Health Considerations for the LGBTQ+ Community: The Sad Reality
The sad reality is that members of the LGBTQ+ community, even with the ACA, are still less likely to have health insurance. Today, nearly 1 in 5 LGBTQ+ adults lives below the poverty line. This means, generally speaking, they don’t qualify for employer-based, group health insurance. With little money, they can ill afford health insurance on their own.
What this translates to is that more members of the LGBTQ+ community wind up never going to the doctor so they don’t know if they even need medical care. Being uninsured doesn’t mean just not knowing whether members of the gay community have an illness; not having health coverage means being impacted by all kinds of disease — most recently COVID-19.
Recent data shows members of the LGBTQ+ community have been impacted more than others by COVID-19. Besides not being insured, as many as 40% of the LGBTQ+ community work in the restaurant business, an industry hit hard by COVID-19. Members of the LGBTQ+ community: If you think you can’t afford health insurance because it's too expensive, think again. Subsidies are available through the ACA and the Marketplace. Millions have enrolled through Healthcare.gov for just dollars a month — some even free.
Frequently Asked Questions
Is there separate health insurance tailored just for the LGBTQ+ community?
Of course not. Members of the LGBTQ+ community are looking for the same things in their health insurance plans as anyone else. What the Affordable Care Act did was make it so no one could be discriminated against for their lifestyle or preexisting conditions..
Does someone with HIV or AIDS have to pay more for health insurance coverage?
There was a time when someone with preexisting conditions like HIV or AIDs would have to pay more for health insurance coverage — a lot more — or they were denied coverage altogether. Since the passing of the ACA back in 2010, this no longer holds true. No one, whether they be a member of the LGBTQ+ community or not — no matter what type of preexisting condition they might have, be it AIDS or cancer — no one can be denied coverage or charged a higher rate.
About Philip Loyd, Licensed Insurance Agent
Loyd has written for Forbes.com, Red News Real Estate, Therapist.com, IRA.com, McGraw Hill, TheStreet.com, WikiHow, GOBankingRates.com, S.R. Education, Society of Petroleum Engineers and BioTech Fortunes. He is a licensed insurance agent and financial advisor with both his series 6 and 7 certifications.