Cost and Coverage
The questions below can help you figure out what is included in a healthcare plan, what the copays and other out-of-pocket expenses are, and what the network of healthcare providers is like. Many of these questions would apply to someone of any sexual orientation or gender identity evaluating a plan, but we have also included targeted questions about the cultural competency of the providers and plan network in serving LGBT individuals and their families.
- Am I eligible for financial assistance to help me afford coverage? Am I eligible for lower premiums? Am I eligible for a reduction in my out-of-pocket costs?
- How much is the plan going to cost (beyond the monthly premiums)? What are all my out-of-pocket costs on the plan?
- Is there a deductible in this plan before coverage kicks in, and what is the amount of the deductible?
- Is there a wide network of providers on the plan?
- If you have a healthcare provider you would like to keep, ask if your provider is covered under the plan.
- If you don't have a current healthcare provider, but would like to find an LGBT-knowledgeable provider, check out GLMA. They keep a list of self-identified providers with experience working with the LGBT community. Once you identify a provider on the GLMA list, you can ask which plans work for that provider. RAD Remedy is also available as a resource.
- Someone in my family needs language translation to access care. Does the plan provide translators who are both linguistically and culturally competent?
- Are there urgent care facilities in this plan? What's the cost to me for a visit to urgent care?
- What's the cost for a visit to the emergency room in this plan? What about in-network vs. out-of network?
- Does the plan include dental coverage?
- Can I purchase a stand-alone dental policy?
- I use tobacco products. How does this change the cost of the insurance plan?
- I would like to quit using tobacco products. What kinds of services and programs are available?
- How is billing handled? Which services are explicitly named or billed separately?
Questions in red are ones that assisters may not be able to answer because this kind of information is not gathered consistently from healthcare providers. However, we included them because we know that these kinds of questions can make a critical difference in creating a trusted relationship with your healthcare provider.« Previous Section: How to Use This GuideNext Section: Reproductive Healthcare »