As we wrap up the final months of 2021, we have also entered the season of health insurance enrollment. Open enrollment on the Health Insurance Marketplace began Nov. 1 and runs through Jan. 15, 2022; and Medicare enrollment began Oct. 15 and runs until Dec. 7.
Members of the LGBTQ+ community face some unique health care needs that will influence the types of plans that should be chosen.
With hundreds of plans available and the confusion many of us feel while examining the plethora of options and coverage levels, it’s important to know that help is available at Corktown Health.
Key factors to consider
At Corktown Health, which operates the only LGBTQ-focused health clinic in Detroit, our certified application counselors work with patients and community members to put them into the best possible health care situation, and our approach always revolves around the needs of each individual.
First and foremost, we ask what is non-negotiable to each person. For example:
- Do you require gender-affirming hormone therapy?
- Are there certain physicians you won’t give up?
That information allows us to specifically seek out health care plans that best meet your needs.
Also, it’s important to think ahead. We’ll guide you through questions like:
- Do you anticipate any changes in your health care needs in the coming year?
- Are you starting a new job?
- Are you getting married?
- Will you be on your parents/guardian’s insurance plan?
All of this information is important because it will impact your annual income, and income-based Marketplace insurance plans look ahead one year, not behind. Consider your 2022 income when enrolling.
You will need to select a premium that fits your monthly income, while also considering your deductible. If your deductible is too high, and you have medical visits or surgery coming up, it will likely come out of your pocket. The key is finding the sweet spot between your monthly premium and your deductible, while also factoring in co-pays (for things like office visits and prescriptions) and co-insurance (percentage of costs owed even after your deductible is met) into your overall annual health care costs.
Consider emergency care, too, as some plans — especially Medicare plans — have separate deductibles for emergency services.
LGBTQ+ health care concerns
There are also issues that are especially important for some members of the LGBTQ+ community to keep in mind while enrolling in their health care plan for 2022:
- Transgender and/or non-binary individuals may need certain hormones and medications to become who they truly are, and will need to confirm those medications are covered under the plan they choose.
- Consider any hoops you might need to jump through to get those medications, such as prior authorizations, specialist visits and annual testing. This red tape can serve as a deterrent and negatively impact health care outcomes for LGBTQ+ individuals.
- People living with HIV, or at risk for HIV, may have a regimen of medications (preventative or antiretroviral), visits with specialists and blood draws to consider. Confirm these services are properly covered before signing up, to limit the risk of treatment delays.
- In the area of mental health, challenges tend to be more severe for LGBTQ+ individuals, in large part due to the prejudices they face daily. With this in mind, making sure adequate mental health coverage is offered in their chosen plan is especially important to many individuals in the LGBTQ+ community.
COVID coverage and other considerations
Health care costs are rising for Michigan residents. Recent polling conducted on behalf of Consumers for Quality Care found that 77 percent of Michiganders agree that the amount they pay for health care seems to be going up every year. So it has never been more important to weigh the options and take considerable care when choosing a health plan.
Making matters worse is that many of Michigan’s biggest insurers announced they were no longer waiving costs for treatment of the virus, leaving patients to pick up the bill with rising co-pays and deductibles.
With an estimated one-third of COVID-19 survivors identifying as having lasting effects from the virus, Michigan residents must be wary of inadequate health plans like short-term limited-duration insurance plans (STLDIs) that often exclude coverage of pre-existing conditions. These plans entice consumers with lower premiums, but often leave them without adequate coverage when they need it most.
During open enrollment, be aware of the potential pitfalls that exist, including changes to COVID-19 coverage, surprise medical bills, health plans that fail to cover pre-existing conditions, and plans that only offer coverage for emergencies. Though the state recently passed a ban on most surprise out-of-network bills, many patients continue to face unexpected bills. For many members of the LGBTQ+ community, especially those with limited income, any surprise bill can have serious long-term negative impacts on their ability to meet basic needs such as food, shelter and child care.