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LGBT Health Insurance

Medicare Advantage for LGBTQ+ Health Care

Posted on August 23, 2022 by Austin Lang

New Trends Are Improving Healthcare for LGBTQ Populations.

LGBT Health Insurance: 3 Ways Medicare Advantage Can Support LGBTQ+ Individuals

Access to equitable healthcare has always been difficult for the LGBTQ+ community, even if that struggle isn’t always evident to the world at large. Take the struggle for same-sex marriage, for instance. To someone unfamiliar with LGBTQ+ history, the legalization of same-sex marriage set by Obergefell v. Hodges in 2015 is a more symbolic victory: a recognition that same-sex couples exist and are accepted by the federal government. Many people don’t realize the impact that banning same-sex marriage had on civil rights, especially when it came to LGBTQ and healthcare. 

Unfortunately, many laws and procedures are written with language that explicitly defines gender and sexuality, often in a manner that excludes vast swathes of the population. For instance, Similar laws and language, some of which exist for no other reason than to deny the rights of LGBTQ+ individuals, can be found in law and policy worldwide if you know what to look for. Mercifully, however, things are finally starting to change.

New provisions in Original Medicare and Medicare Advantage policies are explicitly designed to provide equitable healthcare coverage to the LGBTQ+ community. Here are three ways these new provisions can help you.

You Can Save Money on Medicare Premiums

Wedding Topper with two grooms

Many people take the fact that you can benefit from your spouse’s work record when enrolling for Medicare for granted, but this is a big deal in the fight for LGBTQ healthcare rights. So long as you’ve been married for one year, you can qualify for $0 Premium Medicare Part A based on your spouse’s work history. You can also qualify to keep said benefits after a divorce, provided you’ve been married for at least a decade. We’re still not up to the ten-year anniversary of Obergefell v. Hodges yet, but couples married in states or countries which allowed same-sex marriage before 2015 can qualify. 

Marriage also combines your household income to determine Part B premiums, with the threshold for increased premiums being double the threshold for individual premiums. For instance, say your income before retirement was $100,000 a year, while your partner made $60,000 a year. When filing separately, your higher income would push you into the next tier of premium costs. However, when filing as a married couple, your household income is below the threshold for increased premiums. This isn’t just a perk for the fabulously wealthy either. Income from real estate sales counts toward this limit. If you and your spouse are downsizing or simply moving to a better retirement destination, your marriage can save you money. However, be aware that combining incomes can affect your Medicaid and Extra Help eligibility. 

Medicare Advantage plans have plan-specific premiums, so this particular perk isn’t as useful, though it can keep your premium low enough to be covered by the Give Back Benefit. 

You Can Get the Care You Need, Regardless of Gender

Medicare Card

When Medicare introduced a new style of card in 2017 to prevent identity theft, they removed more than just your Social Security number. Gender is no longer listed on any Medicare card, including those provided through Medicare Advantage plans. It’s a small change, but it has massive health ramifications.

In the past, medical services were prescribed by gender. If you were a transgender woman who had gone through the process of gender affirmation and was listed as female on all official documents, you could be denied critical medical services like prostate exams. Now, it is illegal for a medical provider or insurance provider to deny medically appropriate services based on gender presentation. Your gender is not your body; your body is a way of expressing your gender identity, but your brain is the only organ that cares if you’re male, female, or anything else. The rest of your organs are just dumb meat focused on the task of keeping you alive, and meat doesn’t care what letter is printed on your driver’s license. If you are denied coverage on the basis of gender, file a complaint with the HHS immediately.

You Can Seek Out Gender Affirming Care

Trans Flag

We covered this topic in detail earlier this month, but as a quick recap: Medicare now covers treatment for gender dysphoria in some instances. For Original Medicare, this can be somewhat limited, though the ‘experimental’ designation has been lifted from gender-affirming surgery, it is only covered if deemed medically necessary, and certain masculinizing or feminizing hormones are not usually covered. However, certain Medicare Advantage plans do cover hormone therapy, and others may cover services Original Medicare deems cosmetic, like facial reconstruction.

What About Sexual Health Services?

LGBTQ Couple

While Medicare covers many sexual health services, including STI testing and PrEP, these services aren’t specific to the LGBTQ+ community. Many people mistakenly assume that LGBTQ healthcare issues are inherently sexual in nature, due to the sexualization of LGBTQ+ people in the public eye. For many people, particularly non-gender conforming individuals or those who identify as asexual but still experience romantic attraction, sex may not even be a factor. If it is, it’s no more a part of a person’s life than it would be for a heterosexual or cisgender individual. The bigger issues facing the LGBTQ+ community are those of equity: ensuring that all people have the same rights and access to healthcare, regardless of their identity. 

If you are curious about how Medicare can help you maintain a healthy sex life, we invite you to read our FAQ article on the subject. If you’re curious about the ongoing fight to provide equitable healthcare to the LGBTQ+ community, or are looking for more information or support, this fact sheet provides links to a variety of organizations and advocacy groups that can help.

Regardless of your sexuality, gender, or identity, we want to ensure you get the health coverage you need. Our licensed insurance agents can help you navigate the Medicare enrollment process and find a plan that works for you. Call us today at (800) 950-0608 or enter your zip code in the form below to begin your search.

About the Author

Austin Lang

Austin is dedicated to breaking down complex topics, like Medicare, in a way that's easy to understand. He graduated with an M.A. from Florida Atlantic University in 2018.

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