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. 

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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

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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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