Health Insurance Marketplace – 2021 Coverage

Yes, You Can Enroll in the Health Insurance Marketplace (ObamaCare) for 2021

“People with multiple sclerosis who do not have health insurance should absolutely consider enrolling or renewing their coverage in the 2021 Health Insurance Marketplace through the Affordable Care Act,” states Chris Sloan, Associate Principal from Avalere Health. Avalere is a widely respected healthcare consulting firm that has assisted MSAA in developing resources around the issue of copay accumulators and other important healthcare topics.

According to Mr. Sloan, the pending Supreme Court hearings Continue reading

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Medicare Open Enrollment 2020

As the year comes to a close, MSAA would like to remind everyone about two important upcoming deadlines. The open enrollment period for Medicare and the Health Insurance Marketplace is quickly coming to an end. Continue reading

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Important 2018 Insurance Deadlines

As the 2017 calendar year starts coming to a close, we would like to remind everyone about two important enrollment deadlines that are approaching for 2018 health insurance coverage:

Medicare
Medicare Open Enrollment ends on December 7th for coverage that begins on January 1, 2018.

Health Insurance Marketplace
Private insurance through the Affordable Care Act’s Health Insurance Marketplace has a December 15th deadline in order to receive coverage that begins on January 1, 2018. If you do not enroll in a marketplace plan by December 15th, you cannot enroll in a plan for the rest of 2018 unless you qualify for a Special Enrollment Period.

Ensuring that you have health insurance coverage to manage the many medical expenses that can accompany MS is crucial. You can visit these sites in order to enroll or re-enroll in a health insurance plan that meets your needs.

To help you better understand the complexities of health insurance coverage, you can also visit our website section My Health Insurance Guide or call the MSAA Helpline at (800) 532-7667, ext. 154. This is an important time, so please be sure to enroll in a health insurance plan that is right for you!

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Insurance Open Enrollment is Coming!

That’s right, it’s almost here again-that time of year when individuals can enroll in a Marketplace health insurance plan. The open enrollment period to sign up for 2017 health insurance coverage begins November 1, 2016. Those who are uninsured can search for insurance plan options and assistance through the Marketplace to find a plan that works for them. Some may even qualify for lower costs on insurance premiums depending on your household information. Be sure to review the deadlines to sign up for insurance coverage to ensure that you are covered on a plan beginning January 1, 2017.

marketplace-enrollment-periodAs this is an important time for those who are uninsured, it is too for those who have previously purchased health insurance through the marketplace. For the latter, if you are not satisfied with your current plan purchased for 2016 and would like to make a change, now is the time to do so.  During open enrollment you can review other insurance plans to see if another plan better matches your needs.

For those currently enrolled in marketplace plans, you may receive a letter from your insurance company explaining if the company will either automatically re-enroll you for 2017 coverage, or if you will not be automatically re-enrolled. If your insurance company plans to automatically re-enroll you for coverage but you would like to make a change, it’s important to review other policies during the enrollment period and take action to change it by December 15th to ensure coverage beginning January 1st.

Whether you’re notified that you’ll be re-enrolled in your current plan or not, you do have to update your expected income and household information for the 2017 coverage year. This is to ensure that your premium tax credits are correct and that you will receive the appropriate coverage costs and plan options for the next year. A letter from the health insurance marketplace is also sent out to individuals currently enrolled that better explains the actions needed to receive the accurate premium tax credits for 2017.

In addition to updating your own income and household information, be sure to take the time to review the different insurance plan policies and prices for the new 2017 coverage year as these do change. You can also find helpful information with MSAA resources like My Health Insurance Guide and The Affordable Care Act and Multiple Sclerosis brochure that provides an overview of the insurance planning process and steps to help you PLAN ahead.

Resources:

https://www.healthcare.gov/ 

https://www.healthcare.gov/lower-costs/

https://www.healthcare.gov/quick-guide/dates-and-deadlines/

https://www.healthcare.gov/keep-or-change-plan/

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Insurance Open Enrollment Begins!

It’s that time of year again when individuals can enroll in a Marketplace health insurance plan. The open enrollment period to sign up for 2016 health insurance coverage begins November 1, 2015. For those who are uninsured, this marks the time when you can search for insurance plan options and assistance that may be right for you within the Marketplace. You may even qualify for lower costs on insurance premiums depending on your household information. Be sure to review the deadlines to sign up for insurance coverage to ensure that you are covered on a plan beginning January 1, 2016.

According to the U.S. Department of Health and Human Services, the Affordable Care Act is working and continuing to increase access to healthcare. Millions of people were able to obtain healthcare coverage through the Marketplace as of March 2015 and this has decreased the rate of those uninsured. Insurance affordability has increased also, with the eligibility to qualify for lower premium costs, the expansion of Medicaid coverage and additional plan options to choose from being key factors in this act.

While this open enrollment period is a significant time for those uninsured, it marks an equally important time for those who have previously purchased health insurance through the marketplace as well! If you are not satisfied with your current plan purchased for 2015 and would like to make a change, now’s the time to do so! During open enrollment you can review other insurance plans to see if another plan better matches your needs.

For those currently enrolled in marketplace plans, you may receive a letter from your insurance company explaining if the company will either automatically re-enroll you for 2016 coverage, or if you will not be automatically re-enrolled. If your insurance company plans to automatically re-enroll you for coverage but you would like to make a change, it’s important to review other policies during the enrollment period and take action to change it by December 15th to ensure coverage beginning January 1st.

Whether you’re notified that you’ll be re-enrolled in your current plan or not, you do have to update your expected income and household information for the 2016 coverage year. This ensures that your premium tax credits are correct and you will receive the appropriate coverage costs and plan options. A letter from the health insurance marketplace is also sent out to individuals currently enrolled that better explains the actions needed to receive the accurate premium tax credits for 2016.

Besides updating your own income and household information, be sure to take the time to review the different insurance plan policies and prices for the new 2016 coverage year as these do change. MSAA has resources that can help you in the decision making process with the My Health Insurance Guide and The Affordable Care Act and Multiple Sclerosis brochure that provides an overview of the insurance planning process and steps to help you PLAN ahead.

Sources:

https://www.healthcare.gov/lower-costs/

https://www.healthcare.gov/marketplace-deadlines/2016/

http://www.hhs.gov/healthcare/facts-and-features/fact-sheets/aca-is-working/index.html

https://www.healthcare.gov/keep-or-change-plan/

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Medical Necessity: Advocating For Needed Treatments

By: Meagan Freeman

As a Nurse Practitioner, I became extremely familiar with dealing with the often-frustrating denials by insurance companies, particularly when it comes to prescription drugs. After all, I am the one who holds the professional medical degree, and I am the one who should be determining what treatments my patients required, not an insurance adjuster.

The problem is, insurance companies often have a policy of “automatic denial” for expensive prescription drugs. This policy means that no matter what the circumstance might be, they will always issue a denial when an expensive medication is ordered. This policy may be a deterrent for new providers and patients, and may lead to an unnecessary change in treatment, opting for a less expensive drug that is less effective.

When dealing with insurance companies, my experience has led me to realize that it is incredibly important for providers to immediately argue the case, rather than to simply accept this automatic denial of needed treatment. I often find that a simple phone call to the insurer, with my insistence that the treatment was a medical necessity, and that no other alternative would be acceptable, is all that is needed for an eventual approval. These automatic denials are in place in order to save unnecessary expenses for insurers, whose main focus is always the bottom line. These are not medical professionals on the other end of the phone, and their opinion is not more important than your treating provider’s.

With the new affordable care act, all insurers are required to offer at least one covered medication in each disease category, and cannot deny patients needed medical treatments. Thankfully, no patient can be denied for coverage any longer due to a pre-existing condition such as MS. Our illness is one of the most expensive diseases to treat, with drug prices often exceeding $50,000 per year. This means that we need to become very skilled at advocating for ourselves as patients. If you are told that a necessary treatment was denied by your insurer, let your provider know that you would like them to make a call and argue the medical necessity of the treatment. A simple phone call is often enough to sway the initial opinion, and this simple step is well worth the time if it leads to coverage for a needed multiple sclerosis treatment. If your provider will not take the time to appeal a denial, you may need to consider finding a new provider. Your provider should always be your advocate, no matter what the circumstance may be.

*Meagan Freeman was diagnosed with RRMS in 2009, at the age of 34, in the midst of her graduate education. She is a Family Nurse Practitioner in Northern California, and is raising her 6 children (ranging from 6–17 years of age) with her husband, Wayne. She has been involved in healthcare since the age of 19, working as an Emergency Medical Technician, an Emergency Room RN, and now a Nurse Practitioner. Writing has always been her passion, and she is now able to spend more time blogging and raising MS awareness. She guest blogs for Race to Erase MS, Modern Day MS, and now MSAA. Please visit her at: http://www.motherhoodandmultiplesclerosis.com.

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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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Need health insurance? Join MSAA for our live webinar:

Don’t forget to sign up and attend MSAA’s live webinar, “The New Insurance Marketplace and MS” tomorrow evening 11/19 from 8PM – 9PM EST.  The webinar provides the ins and outs of the Marketplace, explaining everything from common insurance terms down to MS specific policy pitfalls.  So, register today and come find out what the insurance Marketplace means for you.

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If you have Medicare, get the information you need to know:

Tomorrow, October 15th, is the first day of Medicare Open Enrollment for plan year 2014. The plan that you select now will impact your medical coverage and costs for an entire year. Don’t forget to tune in to our live Webinar tomorrow evening from 8-9PM EST for important information on Medicare Open Enrollment and specific tips for people living with MS.

To register for the Webinar, go to the following link: support.mymsaa.org/aca1

If you cannot attend the live program, don’t worry, you will be able to watch the archive and download the presentation slides from our MSi page after the live program:  https://mymsaa.org/manage-your-ms/videos/.

This year, be prepared. Learn from Medicare experts who can try to help you understand what questions to ask and how to select your best options.

 

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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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