Insurance Open Enrollment is Fast Approaching

Open enrollment is fast approaching! November 1, 2015 marks the first day to enroll in a 2016 Marketplace health insurance plan.

During the 2015 open enrollment period 11.7 million people had enrolled in a Health Insurance Marketplace plan. While many of these enrolled individuals will continue with their selected plan, if you are unhappy with the insurance plan purchased for 2015, the open enrollment period exists to allow those who had previously purchased health insurance through the marketplace to make a change to their current plan. Maybe your doctor has changed, or you would like to try a new MS treatment. Searching for plans that match your needs can easily be completed using the Healthcare.gov Marketplace.

From November 1st, through January 31st 2016 individuals can make changes to their current plans. While the changes made do not take effect until January 1st, this provides individuals with the time needed to make a decision on which plan will work best for their needs.

For those who are new to the Marketplace and purchasing insurance for the first time, MSAA’s Health Insurance Guide, is a valuable resource aimed at assisting the MS community with understanding the many details surrounding today’s health insurance options. Using the PLAN Ahead model (Prepare, Look, Analyze, and Name), MSAA’s Health Insurance Guide provides a comprehensive overview of what should be evaluated when purchasing a plan.

Still confused about the Affordable Care Act, or how the Insurance Marketplace affects you? MSAA has created an informative webinar to better explain the process titled What You Need To Know About The Affordable Care Act. Additional webinars can be found within the MSAA Health Insurance Guide, including The New Insurance Marketplace and MS .

References:
http://kff.org/interactive/mapping-marketplace-enrollment/

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Insurance and Planning with Multiple Sclerosis

As we highlight and discuss various insurance related topics this month, we wanted to share some additional material that has been written over the years to continue to educate the MS community and to continue the thought process around planning with MS.

In Planning for the Future: Long-Term Care and Advance Directives a difficult topic is discussed around end-of-life care and making arrangements for a nursing home while still relatively young and relatively healthy. While the topic of advance directives can be a morose one, it is important to at least discuss your wishes with your family. Unfortunately, we do not have a crystal ball to tell the future, but having a plan can at least ensure your well-being.

“Nobody ever really wants to think about what needs we may have in the future, but there comes a time when each of us should consider what future plans we would like to make if challenging circumstances do arise.” In the Advanced Planning blog from 2012, we continue the discussion of planning with MS to discuss how examining issues before they arise provides control over our wishes.

For some individuals, there may be a time when MS symptoms create change that requires additional assistance in the home, to try to help manage daily activities and duties of the household; Getting Help at Home When You Have MS discusses the various types of supports to individuals in their homes, and ways to navigate the assistance.

Continue to check back with the MS Conversation blog this month for more helpful information and guidance.

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Dental and Vision Insurance

This month as we focus on health insurance, it is also important to discuss two of the often underinsured areas of healthcare, dental and vision services. While we understand the importance of dental hygiene and multiple sclerosis, many individuals still don’t receive the much needed care.

Dental insurance plans can be purchased through the health insurance marketplace as a stand-alone insurance during open enrollment OR if you are planning to make changes to your health insurance plan for the 2016 year, a plan can be selected that includes dental care. Unfortunately, if vision coverage isn’t part of your health insurance plan, it cannot be purchased through the marketplace. To learn about available stand-alone vision plans, contact your state’s Department of Insurance, or a local agent or broker.

Check out the following tips on how to find dental care for the underinsured:

  • Check for a local federally qualified health clinic which offers dental services. To search for a health clinic, use the HRSA website.
  • Look into local dental schools. Most of these teaching facilities have clinics that allow dental students to gain experience treating patients while providing care at a reduced cost. Experienced, licensed dentists closely supervise the students
  • Dental Lifelines Network offers information about free dental services in the area for those that qualify. You can look up information about your state’s program on the program’s website: http://dentallifeline.org/
  • Dial 2-1-1 and connect with your local United Way. You may be directed to free or reduced cost dental services

Check out the following tips on how to find vision care and eyeglass services for the underinsured:

  • VISION USA, coordinated by the Optometry Cares – The AOA Foundation, provides free eye exams to uninsured, low-income workers and their families. For more information about VISION USA, call 1-800-766-4466.
  • Lions Clubs International provides financial assistance to individuals for eye care through its local clubs. You can find a local Lions Club by using the “club locator” feature on the organization’s website.
  • New Eyes provides free eyeglasses to more than 8 million people in the U.S. and around the world. For more information about New Eyes, call 1-973-376-4903 or visit the New Eyes website.
  • EyeCare America, a public service program of the Foundation of the American Academy of Ophthalmology, provides free eye exams for qualifying seniors. To see if you qualify, please visit the EyeCare America website.
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Battling the Health Insurance Appeal

Insurance companies are like a business. They are out to make money and with that being said, they are looking out for their assets. If insurance companies approved every claim that came through, they would burn through their resources very quickly. This is why insurance companies work the way that they do. By providing a set list of covered benefits, they control the amount of claims that come through and can control the amount of money spent on those benefits.

With that being said, it does not mean that an individual cannot receive coverage for a needed device or treatment. It is just that the insurance company wants to know that this device or treatment is really needed AND is going to be helpful.

For example, the Bioness or WalkAide device used for the treatment of foot drop. For many, if they were to contact their insurance provider and inquire as to whether the device was covered under their plan, they would be told ‘no’. This can be very discouraging and can spark some anger in those who struggle with foot drop. But if we look at ‘why’ the insurance companies deny this device initially, it can make sense.

The Bioness or WalkAide devices have not been FDA approved for the treatment of foot drop in MS, meaning that there have not been clinical trials to prove that this device is clinically effective for those with MS. Unfortunately, without the FDA approval insurance companies may have the upper-hand. They are trying to protect their assets and don’t want to provide an expensive device and have that device not be effective.

So what can you do?

Insurance companies require what is called a ‘burden of proof’, meaning that you must provide enough proof and evidence to the insurance company that the device or treatment is helpful to you in your situation. Using the example of the Bioness or WalkAide, by locating a physical therapist that works with this device, or one that can assist with receiving a trial, you can help to build your case against the insurance company. Physical therapy reports of the devices effectiveness can be used in the appeal process to provide the burden of proof needed for the case.

While insurance appeals can be a challenge and possibly delay treatment or assistance from a medical device; decisions can be overturned and won. By understanding the system and how and why an insurance company requires this information, you give yourself the advantage in the appeals process.

 Have you won an insurance appeal? What steps did you take to ensure your success?

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Health Insurance Marketplace: Special Enrollment Period

As individuals prepare their taxes for the 2014 year, many who did not purchase or enroll in a qualified health plan may be facing the penalty fee. According to the HealthCare.gov website, if you did not have health insurance coverage in 2014, you will be responsible for the higher of these two amounts:

1% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.)
$95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.

On February 15th the Marketplace closed for enrollment in 2015 plans, leaving those who did not enroll to face a penalty again when filing taxes next year. The Health Insurance Marketplace is providing individuals and families who owe the fee when they file their 2014 taxes with one last chance to get covered for 2015 to avoid a future penalty for the 2015 tax year.

While the fee for the 2014 year cannot be avoided, this special enrollment period offers individuals another chance to possibly avoid a future fee.

For those interested in enrolling, visit The Health Insurance Marketplace website at https://www.healthcare.gov/screener/. This special enrollment period is only available through April 30th.

References:
https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/

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Insurance Enrollment and the MS Community

While the 2014 year slowly comes to an end and individuals start to make their end of year plans, there are still two important dates to keep in mind in regards to open enrollment for health insurance. For those who are uninsured, or who possibly want to make some changes to a pre-existing Medicare plan, open enrollment allows individuals to make changes without penalty.

Medicare open enrollment ends Sunday, December 7th. Up until this date, changes can be made allowing an individual to switch from Original Medicare to a Medicare Advantage Plan, or vice versa. A switch from one Medicare Advantage Plan to another Medicare Advantage Plan or to a plan that offers different drug coverage can be made as well. This is especially important to the MS community as medications can often change. If the doctor prescribes a medication that is not covered under a drug formulary, other drug coverage options can be explored that may be more suited to your prescription needs. To explore options, contact Medicare directly at (800) 633-4227 or visit www.medicare.gov.

For more complex issues with Medicare, the Medicare Rights Center offers a helpline to answer your questions about insurance choices as well as Medicare rights and protections. You can reach the Medicare Rights Center at 1-800-333-4114 or visit www.medicarerights.org.

The Open Enrollment Period for individuals eligible to enroll in the Marketplace for a Qualified Health Plan for coverage starting in 2015 is now through February 15, 2015. Individuals can enroll in a plan in the Marketplace by visiting www.healthcare.gov, or by calling (800) 318-2596. These plans are available to those who are uninsured, losing insurance, or who would like to make a change to their existing plan. If you purchased a plan in the previous Open Enrollment period and were not happy with that plan, now is the time to review other options and make a switch if available.

For more information regarding insurance, MSAA’s My Health Insurance Guide is aimed at assisting the MS community with understanding the many details surrounding today’s health insurance options.

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If you need health insurance…

Don’t forget that Open Enrollment for purchasing health insurance through the new Health Insurance Marketplace ends this year on March 31st. 

If you need health insurance_blog

If you need health insurance and have not already visited the website www.healthcare.gov or called an Insurance Navigator at (800) 318-2596, do it now! Give yourself time to make an informed decision about the best options for you. Five million Americans have already enrolled.

Remember, once the 2014 Open Enrollment period closes, you will not be able to purchase insurance until 2015 Open Enrollment begins, unless you have a qualifying life event (such as the loss of a job or the birth of a new baby). 

Need more information? You can also review MSAA’s website for important information about how the ACA impacts you.

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Dental Hygiene and Multiple Sclerosis

dental

Dental issues can create a problem for anyone, but especially for individuals with MS.  Gum disease, abscesses, and decay can all lead to infections, which may cause MS symptoms to increase.  Often in the management of other health-related issues, dental issues are overlooked.  In coordinating MS doctors’ appointments and follow up’s, it is often a challenge to coordinate dental care as well.

Overall dental health is important for many reasons.  It promotes healthy eating and digestion, allowing our bodies to absorb the right amount of nutrients.  It is also an important factor in enhancing the enjoyment of food and being social.

Individuals with significant fatigue and/or mobility impairment may find office visits beyond those required for their MS care to be particularly difficult to manage. It may be helpful to inform the doctor or office staff of any difficulties you may have with fatigue or mobility.  For many, sitting in the dental chair for an hour can be quite uncomfortable due to these symptoms. Talk with the office staff about ways that this can be managed.  Perhaps, many of the initial “question and answer” type things can be performed while sitting or standing in a more comfortable position.

If the symptoms of MS are impacting the ability to brush and floss, speak with your doctor about other tools or adaptive devices that may be helpful.  If the grip on your toothbrush is too small, perhaps wrapping something around the base such as tape or an ace-bandage may assist with making the grip better.  You may also cut a tennis ball and place the toothbrush through the ball for a larger grip, or fasten a bicycle-type handle to the base.

Although it is recommended to brush and floss, don’t forget about the power of mouth wash.  Many washes offer an antiseptic quality that assists with fighting gum disease.  With gum and infections causing many dental issues, mouth wash may be an appropriate additive to your brushing routine to help try to prevent infections and inflammation.

With the changes in the Affordable Care Act and individuals now receiving greater access to medical care, it may be helpful to contact your insurer to learn about your dental benefits.  For those without coverage or without insurance, there are still many ways to be seen by a dentist.

Check out the following tips on how to find dental care for the uninsured:

  • Check for a local federally qualified health clinic which offers dental services
  • Look into local dental schools. Most of these teaching facilities have clinics that allow dental students to gain experience treating patients while providing care at a reduced cost. Experienced, licensed dentists closely supervise the students
  • Dental Lifelines Network offers information about free dental services in the area for those that qualify.  You can look up information about your state’s program on the program’s website: http://dentallifeline.org/
  • Dial 2-1-1 and connect with your local United Way. You may be directed to free or reduced cost dental services
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The Affordable Care Act and Multiple Sclerosis

The Patient Protection and Affordable Care Act (PPACA or ACA for short) passed in Congress as a landmark piece of legislation with the intent of securing more accessible healthcare for all Americans. At MSAA, we often receive calls with clients curious and/or concerned about what these changes to the healthcare landscape may entail for them. The Affordable Care Act has enacted numerous changes to both private and public health care coverage (this includes Medicare and Medicaid).

On the private insurance side, here is a short list of just a few reforms that will be enacted starting October 1st:

1. Pre-existing condition exclusions have been eliminated, and insurers can no longer deny applicants based on their MS disease status.
2. Insurers must justify any monthly premium increase of 10% or more before it can take effect.
3. No consumer will be subject to yearly or lifetime benefit caps, which was a major issue for those with MS.
4. If you need to purchase a private plan insurance, it will now be offered through an Enrollment Marketplace in each state.

For Medicare and Medicaid:

1. The percentage for what you pay inside the Medicare Donut Hole will be decreasing every year until it is closed in 2020 and the out of pocket expense will be 25% of the plan’s medication cost.
2. Medicare beneficiaries will receive free wellness exams every year to ensure adequate preventative care.
3. As for Medicaid, for those states that elected to participate, the eligibility criteria will expand to 138% of the Federal Poverty Level or $32,499 for a household of four, for example.

These are just a few of the major reforms that will be taking place under the provisions of the ACA. MSAA has enacted a new initiative to expand education on this topic, including webinars that will focus individually on the changes to Medicare and private insurance.
The first webinar, “Understanding Medicare in the New Era” will take place on October 15th at 8 pm and will be presented by Katherine Fitzpatrick of the Medicare Rights Center and MSAA Client Services Manager, Margaret Weisser and registration is currently open. Registration information for the second webinar on the new State Marketplaces and Private Insurance is forthcoming.

You can register for the Medicare Webinar at: support.mymsaa.org/aca1
We look forward to “seeing” you there!

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