Affordable Care Act/Health Care Reform 2014 & HRT?

[janellebell]

I'm sorry if this has been asked before, but I couldn't find any relevant current information on this topic.

In the USA, by 2014 ALL Americans must have health insurance whether this means you exchange your current health plan (with a government program's version) or you purchase it from your state of residence.

Here in California they have extended Medicare even further than the federal limit in Medi-Cal and I'm sure similar states will follow with this. But in general insurance has/will be changing forever.

The documentation is very vague, and insurance plans will be required to cover "medically necessary" medication as well as provide free preventative care regardless of your insurance plan.
Preventative care covers both male and female preventions like check ups, physicals, prostate exams, breast, etc.

So I'm wondering does this apply to trans people too? Would HRT checkups be considered "preventative" as a prevention to... well death or serious complications?

Will these insurance plans cover HRT and/or SRS?

Finally what does this mean for free health clinics who operate on the basis that someone has no health insurance. In 2014, everyone will have insurance, then what?

[TerriT]

I have no idea and it's part of the reason I wanted to get my act together before '14.

[ZoeM]

It means the gov't decides what treatment gets covered. Also it means almost doubled premiums.

But, y'know, it might result in 'free' HRT for all in four to eight years.

[Jamie Marie]

Personally I wouldn't mind free hrt and low cost srs if it was reasonably priced like 75-150 a month or less. I have blue cross/blue shield on the best plan out of four where I work and prescriptions max out at $35 out of pocket and $150 for ER visits which saved my but when I was there for 3 days this year.

Better and cheaper coverage would be great.

[Arch]

Right now, the HRT/SRS situation is far from my biggest concern. I'm still trying to figure out what this act means for casual employees like me who have only intermittent health insurance. For instance, even if I'm covered for the school year, I'm not covered during summer or quarters when I'm not hired. It's entirely possible for me to be covered for three months, then not covered for three months, then covered, then not covered...what a freaking mess.

[TerriT]

Your understanding of the Affordable Care Act is incorrect.

Please elaborate. The OP had several questions, none of which have been answered.

[janellebell]

I have no idea and it's part of the reason I wanted to get my act together before '14.

I agree I'm in the middle of transition and boy would it be scary to just drop out especially if I can't get the hormones other than buying it directly, but then how will that work with all these new laws. I'm so confused as I know many are.

Right now, the HRT/SRS situation is far from my biggest concern. I'm still trying to figure out what this act means for casual employees like me who have only intermittent health insurance. For instance, even if I'm covered for the school year, I'm not covered during summer or quarters when I'm not hired. It's entirely possible for me to be covered for three months, then not covered for three months, then covered, then not covered...what a freaking mess.

From what I understand the employer is going to be required to cover employees full time unless they're independent contractors but the gov't getting stricter on that too. But I understand this is a huge mess.

Personally I wouldn't mind free hrt and low cost srs if it was reasonably priced like 75-150 a month or less. I have blue cross/blue shield on the best plan out of four where I work and prescriptions max out at $35 out of pocket and $150 for ER visits which saved my but when I was there for 3 days this year.

Better and cheaper coverage would be great.

I totally understand ! I'd love it to be cheaper or even free considering the amount of money we may have to pay (it's on a sliding scale). Currently my HRT is $5 a bottle and I'm going to miss that. I have Kaiser, and from my understanding states where Kaiser operates, kaiser will be one of the major providers. Kaiser covers HRT and SRS (I believe SRS is practically free, depending on your deductible) so I wonder what's going to happen here.

It means the gov't decides what treatment gets covered. Also it means almost doubled premiums.

But, y'know, it might result in 'free' HRT for all in four to eight years.

Precisely so, I understand the government will control everything (what a surprise) but hopefully they'll also say "free" HRT on all plans.

[Arch]

From what I understand the employer is going to be required to cover employees full time unless they're independent contractors but the gov't getting stricter on that too. But I understand this is a huge mess.

Well, the operative word here is "employee." If I don't get any classes one quarter, then I'm no longer an employee and won't be covered. Same with summers--if I teach in the spring, I'm terminated in June and (if I'm lucky) rehired three months later. No coverage for three months.

[Flan]

Not much really changed other than companies finding new ways to screw people over again. Medicaid already covers mental health and hrt in most states (finding a practitioner who accepts is another can of worms).

Surgery benefits are far and few in-between and gender related surgery is usually excluded on "cosmetic" or "experimental" grounds because the feds won't cover it under medicare (and again, with the reimbursement rates, finding a doctor who accepts the piss poor pay will be difficult at best). A good example is orchiectomy which is covered under medicare (when medically indicated):

Max coverage: $645.90
Minimum coverage: $418.85

I'll let you do the math

[tgchar21]

Your understanding of the Affordable Care Act is incorrect.

Ditto this. You are not "required" to have health insurance, but rather you'll have to pay more on your income tax if you don't have sufficient coverage (and don't fall under one of the exemptions, one of which is if insurance would cost more than a certain percentage of your income out-of-pocket). Although the ACA originally did "mandate" people to buy insurance (albeit with no criminal penalties for not doing so*), the famous SCOTUS ruling from last year said that it is perfectly "legal" to go without health insurance as long as you pay the amount originally proscribed as a "penalty" under the law instead (seen as a fee for ensuring everyone pays their fair share to help out those with less fortunate health and/or income). Another analogy are deductions like those for interest on a home mortgage - your tax may be lower if you buy a house with a mortgage than those who don't, but it doesn't "force" anyone to do so (just like if you buy health insurance your tax will be lower, once again favoring those who engage in certain commerce).

*If the mandate did have jail time and/or other penalties that made you a criminal for not having health insurance that would've most likely been struck down based on the Supreme Court's opinion.

So your question on what will happen to those "free clinics" is they'll probably still be around - there will still be those who are exempt from the penalty because their income is too low (mainly in states that refused to expand Medicaid, which the Supreme Court said that states can do) and those "freeloaders" that opt to pay the "tax" instead (which for some young and/or healthy people may indeed be a rational choice, since under the law insurers cannot deny you because of pre-existing conditions and you could get insurance whenever necessary; the main gamble you'd be taking is if you were for example to get severely injured before you could buy insurance). (Quite frankly I think that many liberals do want to see the health insurance industry go belly up, since single-payer is their ultimate goal but could not be implemented under the current political climate.)

[tgchar21]

Right now, the HRT/SRS situation is far from my biggest concern. I'm still trying to figure out what this act means for casual employees like me who have only intermittent health insurance. For instance, even if I'm covered for the school year, I'm not covered during summer or quarters when I'm not hired. It's entirely possible for me to be covered for three months, then not covered for three months, then covered, then not covered...what a freaking mess.

As with anyone else without coverage you should be able to buy some from your state's exchange (with subsidies if your income qualifies).

[Simon]

I (like most Americans) have no idea what is going to go on when Obamacare goes into effect. I receive all of my cancer care at a Government funded research hospital and even they don't know what exactly to expect out of the Government plan. It's going to be a mess for awhile.

I don't expect SRS to be covered but I think HRT will. It will be nice to have my Endo appointments covered but my hormones are cheap without coverage ($65 a vial) so not really worried if they cover it or not.

If SRS is covered (a big if) I think it'll be an oversight on their part and they'll close that loophole quickly.

[Lorri Kat]

http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions

What are the statutory exemptions from the requirement to obtain minimum essential coverage?

1.Religious conscience: You are a member of a religious sect that is recognized as conscientiously opposed to accepting any insurance benefits. The Social Security Administration administers the process for recognizing these sects according to the criteria in the law.

2.Health care sharing ministry: You are a member of a recognized health care sharing ministry.

3.Indian tribes: You are a member of a federally recognized Indian tribe.

4.No filing requirement: Your household income is below the minimum threshold for filing a tax return. The requirement to file a federal tax return depends on your filing status, age, and types and amounts of income. To find out if you are required to file a federal tax return, use the IRS Interactive Tax Assistant (ITA).

5.Short coverage gap: You went without coverage for less than three consecutive months during the year. For more information see question 21.

6.Hardship: A Health Insurance Marketplace, also known as an Affordable Insurance Exchange, has certified that you have suffered a hardship that makes you unable to obtain coverage.

7.Unaffordable coverage options: You can't afford coverage because the minimum amount you must pay for the premiums is more than eight percent of your household income.

8.Incarceration: You are in a jail, prison, or similar penal institution or correctional facility after the disposition of charges against you.

9.Not lawfully present: You are neither a U.S. citizen, a U.S. national, nor an alien lawfully present in the U.S.

On the brite side..

  " In 2014, The Patient's Bill of Rights will prevent insurance companies from denying coverage based on pre-existing conditions. What's more, the ACA will bring Title VII federal nondiscrimination protections to the healthcare field. The Department of Health and Human Services, responding to both pressure from LGBTQ advocacy groups and precedents set by recent federal court cases, recently confirmed that this policy will ban discrimination based on gender identity. This will not only help transgender and gender non-conforming people obtain coverage but will also outlaw the discrimination Kallio and so many others have suffered when pursuing treatment. Considering that one in five transgender people have been refused medical care based on their gender identity, these discrimination protections are critical."


http://www.thenation.com/article/169391/what-affordable-care-act-means-transgender-people

[janellebell]

Regarding : Health Care Reform 2014

This is mainly for California residents.

I called the hotline on www.coveredca.com and asked them about HRT and/or SRS coverage.

From their understanding, whichever health provider you chose will determine whether or not you can get HRT/SRS covered. For example Kaiser still/will be covering HRT during/after the insurance exchange but your rates may very for the co-pay on the HRT and or the deductible for SRS.

If you qualify for medi-cal (or medicare in other states) ($17,000 net income per year) then Medi-cal will have to provide whatever the insurance carrier decides it "medically necessary" and likely will fall under the categories "mental health" or "necessary prescription drugs".

The further you fall from the poverty line the less your payments (up to $27,330 for an individual)

That's all I got so far but hopefully this helps especially for younger trans people like myself with very low income.

Please note anyone under 65 will qualify for medi-care/medi-cal if you make less than 110% - 400% of the federal poverty line (I believe it's up to $40,000 depending on age, according to Covered CA )

[janellebell]

Tgchar21 is correct in what I was thinking at the time.

If anyone would like some "light" reading, I would suggest you sit down and actually read the nearly one thousand pages of the statute.

It's a horrible piece of work and it will have innumerable unforeseen consequences.

I agree its a horrible work but there is some good news

http://www.americanprogress.org/issues/lgbt/report/2012/11/15/44948/ensuring-benefits-parity-and-gender-identity-nondiscrimination-in-essential-health-benefits/

[Lorri Kat]

 As janellebell wrote, HRT/SRS coverage will be determined by what insurance provider you choose, or are stuck with, and likely what level of coverage you buy..   HRT is a fairly simple go-around by knowledgeable Dr's as is therapy being covered with the 'right coding' even if your with a religious based insurance company.    SRS  would require you haveing the 'right' insurance for it to be covered though and the deductible may be higher as well as the premiums.   

[Arch]

5.Short coverage gap: You went without coverage for less than three consecutive months during the year. For more information see question 21.

This might apply to me. If I work for the whole academic year, I think my coverage extends to the end of June (I'm not positive) and picks up again in late September or October 1. If I don't get work in spring (it's always iffy), then I'll be uninsured for some six months or more and will need to do something about it.