What Is New With Open Enrollment
Health Insurance Marketplace Enrollment Has Started – this time with SOGI questions!
The Affordable Care Act’s (ACA) open marketplace enrollment began on November 1st and goes until January 15th. However, apply for coverage by December 15th if you want your coverage to start January 1st. Outside of this annual enrollment window, you may be able to enroll or make changes to your health insurance if you have a qualifying life event such as marriage, birth of a child, or loss of other coverage. This year the marketplace enrollment form will ask 3 new, optional questions focused on sexual orientation and gender identity (SOGI). Gathering SOGI information has been encouraged by the Biden-Harris Administration to better assess, understand, and meet the needs of LGBTQI+ individuals who have long been overlooked.
Here is what you can expect:
The introductory screen will feature an explanation for why the form is asking SOGI questions:
“How this information will be used. We share responses to “sex” with the insurance company when you enroll in a plan. This information may also be shared with agencies like your state Medicaid or CHIP, if anyone in the household is eligible for these programs. If a person is pregnant, be sure to select Female so that they can tell us about the pregnancy later in the application. That way, we’ll make sure they’re eligible for coverage to keep them and their baby healthy.”
The new questions you will see on the open enrollment form with their answer options:
Sex assigned at birth: “What was (first name)’s sex assigned at birth?”
A sex not listed (free text option)
Prefer not to answer
Gender identity: “What’s (First Name) gender identity?”
A gender identity that is not listed (free text option)
Prefer not to answer
Sexual orientation: “What’s (first name) sexual orientation?”
Lesbian or gay
A sexual orientation that is not listed
Prefer not to answer
The inclusion of SOGI questions for Open Marketplace Enrollment is an effort to better understand LGBTQ+ communities and our healthcare access needs. LGBTQ+ communities have historically faced health insurance coverage disparities. For example, prior to the implementation of the Affordable Care Act (ACA), LGBTQ+ individuals routinely faced discrimination in health insurance such as being denied coverage or charged higher premiums due to having pre-existing conditions like HIV/AIDS, gender dysphoria, mental health issues, and substance use disorder. The nondiscrimination protections through Section 1557 of the ACA as well as the expansion of Medicaid have been critical steps forward in addressing these insurance disparities. The ACA prohibited insurers from denying coverage or charging more based on pre-existing health conditions, and also mandated coverage for essential health benefits. After the ACA’s coverage expansions went into effect, the percentage of LGB+ people without insurance decreased substantially, from 17.4% in 2013 to 8.3% in 2016.
While the ACA helped make significant strides in expanding insurance coverage for LGBTQ+ people, uninsured rates in this population increased after 2016 and many insurance challenges still persist. For example, insurance companies still routinely refuse to cover many gender-affirming services that are life-saving and necessary for trans people. Based on a 2020 survey by CAP, coverage for gender-affirming care was denied for 46% of transgender respondents, and only partially covered for 48% of transgender respondents[S1] [BJ2] . These rates of denial and partial coverage were even higher for transgender people of color. Additionally, many health insurers continue to exclude coverage for specific medical services that could be considered “cosmetic,” but are often necessary and effective for treating gender dysphoria. For example, one study of 101 U.S. health insurance carriers found that nearly half (47%) of the carriers had broad exclusions for hair removal therapies regardless of medical necessity, compared to just 12% of carriers that covered medically necessary facial hair removal.
[S3] [BJ4] Insurance coverage for PrEP has also been a recent area of concern for many LGBTQ+ individuals. For example, a recent court ruling in Texas (Braidwood v. Becerra) overturned the ACA requirement to cover PrEP—and other preventive services—at no cost-sharing. The case is already being appealed and many states have already taken action to preserve access to preventive services. Even so, for those in need of PrEP, this ruling creates a lot of uncertainty around insurance coverage and access to PrEP. Lack of insurance is a major barrier to PrEP given how expensive the medication can be.
Gathering SOGI information during open enrollment is crucial for tackling these ongoing insurance challenges. This data provides insights into demographic information, health conditions, geographic disparities, socioeconomic status, utilization patterns, barriers to care, health insurance coverage disparities, and trends over time. This data can be used to identify and address insurance coverage disparities and it supports targeted outreach to LGBTQ+ communities. This information will also assist policymakers in effective planning and implementation of strategies to ensure accessible and tailored healthcare for diverse populations. The information shared in enrollment surveys is safe, secure, and cannot be shared with state entities that could cause harm to these communities. The ACA marketplace ensures the security of enrollment data through measures like data encryption, strict access controls, and privacy protections.
For more information, check out the following resources: