Frequently Asked Questions

Yes. The Affordable Care Act is the first federal law to prohibit discrimination based on sex, including against LGBTQ people, in the health system. The law protects LGBQ and transgender, gender nonconforming, non-binary, and intersex individuals. This includes most types of health insurance coverage and most types of health care providers. If you face discrimination at any point during the enrollment process, please let us know at info@out2enroll.org.(mailto:info@out2enroll.org) If your coverage is denied, appeal with your health insurer – learn how here.(https://transhealthproject.org/trans-health-insurance-tutorial/appealing-a-denial/) If you face discrimination by an insurer or health provider, contact a legal organization here.(https://tldef.org/our-work/trans-health-project/)

Every plan sold in the Marketplace must provide a link to its directory of health providers. If you already have an LGBTQ-affirming provider that you know and trust, you can use your insurer's directory to find out if your provider is included before you sign up for coverage. To find an LGBTQ-affirming provider, check out the LGBTQ Healthcare Directory (https://lgbtqhealthcaredirectory.org/)where providers who sign up affirm their commitment to equality for LGBTQ+ patients.

If you experience any form of discrimination, you should contact a legal organization here (https://transhealthproject.org/contact-us/contact-tldef/)and let us know at info@out2enroll.org.(mailto:info@out2enroll.org) You should never face discrimination when it comes to health insurance or healthcare. Learn more about your rights and what you can do to fight discrimination here.(https://www.out2enroll.org/consumer-resources)

If your plan refuses to cover medically necessary services that are recommended by your doctor, you have the right to appeal this decision and have it reviewed by an independent third party. You have the right to: • Ask the insurer to reconsider its decision. • Know why an insurer denied your claim or ended your coverage. • Know how to challenge the insurer’s decision. Typically, you must first go through a process called the “internal appeals process,” where you appeal directly to your insurer. If you are unhappy with the result from the internal appeal, you can then request an “external review” from an independent third party. We recommend going through this process because many denials are overturned during the appeals process. If you need help filing an internal appeal or external review, contact your state’s consumer assistance program or insurance department.(out2enroll.org/consumer-resources) If you are denied coverage for gender-affirming care or discriminated against at any point in this process, contact a legal organization here.(https://transhealthproject.org/contact-us/contact-tldef/)

Every plan sold in the Marketplace must provide a link to its drug formulary (the list of drugs that are covered). If you need a certain drug, you can use this formulary to find out if your drug is covered before you sign up for coverage. If you have a specific health need, we encourage you to take advantage of free help (either in-person or by phone) from a trained assister (https://out2enroll.org/enrollment-help/)to help you consider your options. If your doctor prescribes a drug for you but your insurer doesn’t cover the drug, you may be able to appeal for an exception to get the drug covered. To do so, contact your insurer. If you want help with your appeal, contact your state’s consumer assistance program or insurance department.(out2enroll.org/consumer-resources)