Open Enrollment in "Health Insurance Marketplaces"
By Nate Herpich
October 1, 2013 marks a major milestone in the implementation of the Affordable Care Act (ACA), as open enrollment for the legislation's "Health Insurance Marketplaces" begins. Here, in the first of a series of articles about the ACA, we provide an introduction to just what these Marketplaces are, as well as a timeline of key dates and upcoming events.
What is a "Health Insurance Marketplace?"
According to healthcare.gov, a Health Insurance Marketplace is "a new way to find quality health coverage. It can help if you don't have coverage now or if you have it but want to look at other options. With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll."
The health reform law requires that all American citizens have the opportunity to shop online (or by phone) for the best available insurance to fit their individual needs and budget. Depending on a person's income, the coverage options provided through the Marketplaces may be a better choice than the plans currently offered through an individual's employer, but they may not be. Of course, the Marketplaces will also offer the uninsured choices they may not have been privy to in the past. Depending on where you live, the Marketplace in your state will be accessible through a website operated by either the federal or state governments.
Where can I get started?
HealthCare.gov will direct you to the Marketplace in your state, pretty seamlessly. It's certainly the best place to get started.
Here's how the Marketplaces basically work: individuals interested in learning more about buying private insurance can go online and compare health insurance options, select a plan that meets their needs and budget, and enroll in coverage (you may also sign up via mail or in-person; forms will be available starting October 1, 2013). The plans are required to be presented through a "metal tier" system – "platinum" plans are the most expensive but offer the most comprehensive coverage, while " bronze" plans are the least expensive but require the highest out of pocket costs.
The Marketplace sites will ask you basic questions about your income, your family, where you live, etc. and will provide an overview of the insurance options (both private and public) for which you qualify. But ultimately, you will have to make decisions based on your own needs, the needs of your family, and your budget. (We'll follow-up next week with a blog on some important things to consider before choosing a plan).
Are there any particular items of interest the paralysis community should be aware of with regards to marketplaces?
Under the health reform law, starting on January 1, 2014, most insurance plans are not allowed to, by law, deny coverage to Americans with pre-existing conditions. "For many with disabilities, private insurance plans weren't even an option in the past," Rachel Patterson, a policy analyst at the Association of University Centers on Disabilities, tells the Reeve Foundation. "This new law is revolutionary." Lifetime and annual benefit caps will also be prohibited, she explains, good news for those who know how fast healthcare costs associated with rehabilitation and medical devices can pile up.
What are the key dates to be aware of?
Starting October 1, 2013 you can log in to the Marketplace in your state to learn more about your coverage options. But there's not necessarily a rush to sign in and make a decision. "It's very important to be prepared, and have a strong idea of what you'll need from your plan, as well as your budget," explains Patterson. Fortunately, you'll have until December 15th to enroll in plans to ensure your coverage starts on January 1, 2014. So take the time to make sure you know what your current coverage provides, and also, what a potential new plan offered through the Marketplace might offer, and how these plans might differ.
HealthCare.gov is staffed with a hotline, as well as an online chat option, to help you answer any questions you might have.
Open enrollment for the first year of the new Marketplaces ends on March 31, 2014. After December 15th, the formula is a bit complicated, but basically, if you enroll between the 1st and 15th of a given month, your coverage will start the first day of the following month. If you sign up between the 16th and the last day of the month, your coverage will begin the first day of a full month later. (So, for example, if you were to enroll on February 17th, your health coverage would begin April 1st).
Next, we explain how to access the Marketplace in your state, as well as suggest some important things to consider before selecting and enrolling in coverage. Prepare for enrollment here!
Affordable Care Act
What the paralysis community needs to know.
- Health Insurance Marketplaces open
- If I have Medicare, Does ACA Impact Me?
- How to prepare for enrollment
- Do I Have to Purchase Health Insurance Under the Affordable Care Act?
- Does the ACA Require My Employer to Offer Me Health Insurance?
Arkansas Spinal Cord CommissionThe mission of the Arkansas Spinal Cord Commission is to administer a statewide program to identify and meet the unique and lifelong needs of people with spinal cord disabilities in the state.
CareCure CommunityCareCure Community features a SpinalNurse bulletin board with informed comments on matters of the bowel, and all issues of paralysis.
Canadian & American Spinal Research OrganizationPromotes and supports funding research to ultimately find a cure for paralysis. Also publishes journal of latest research they fund. Call (800) 361-4004 or use the link above.
Canadian Paraplegic AssociationAssists people with spinal cord injuries and other disabilities to achieve individuality, self-reliance and full community participation. Call (613) 723-1033 or use the link above.
Craig HospitalWith funding from the US Department of Education's National Institute on Disability & Rehabilitation Research, has developed educational materials to help people with spinal cord injuries live in the community maintain their health. Topics include skin care, exercise, heart disease, weight control, alcohol abuse and conditions related to the aging body. Use the link above and click on SCI Health and Wellness.
The Center for Medicare Advocacy, Inc.The Center for Medicare Advocacy, Inc. provides education, advocacy, and legal assistance to help elders and people with disabilities obtain necessary healthcare.
Features information on the State Children's Health Insurance Program (SCHIP), known as Title XXI, which offers health insurance coverage for eligible kids. Also provides information and resources specific to Medicaid and Medicare along with helpful tools to navigate the system.
Determined 2 HealProvides helpful information for the newly spinal cord injured.
Insure Kids Now!Insure Kids Now! is a national campaign to link the nation's 10 million uninsured children -- those from birth to age 18 -- to free and low-cost health insurance.
FacingDisability.comFacing Disability is a web resource with more than 1,000 videos drawn from interviews of people with spinal cord injuries, their families, caregivers and experts. I know that this is a lot to ask, but we'd be so grateful for your help. I'm looking forward to discussing this link with you, and to answering any questions you may have.
Kaiser Family FoundationFactsheets for consumers on Medicare. Covers prescription drug law, Medicare Advantage program, Medicare and women, etc.
Model Systems CentersA federally funded program of 14 specialty medical and/or rehabilitation centers across the US. The SCI Care System collects and submits acute, rehabilitation and follow-up (annual, long-term post-discharge) data on SCI patients who received care in the these centers following injury.
The Miami Project to Cure ParalysisThe Miami Project to Cure Paralysis has studied functional electrical systems for exercise.
MedicareThis is the official government site for people with Medicare.
MedicaidMedicaid is a federally supported healthcare program administered on the state level.
The Medicare Rights CenterThe Medicare Rights Center (MRC) is a not-for-profit organization working to ensure that older adults and people with disabilities get affordable health care.
The National Spinal Cord Injury Statistical Center (NSCISC)NSCISC supervises and directs the collection, management and analysis of the world's largest spinal cord injury database. Headquartered at the University of Alabama, Birmingham.
National Spinal Cord Injury Association (NSCIA)At NSCIA, we educate and empower survivors of spinal cord injury and disease to achieve and maintain the highest levels of independence, health and personal fulfillment. We fulfill this mission by providing an innovative Peer Support Network and by raising awareness about spinal cord injury and disease through education.
New York Online Access to Health (N.O.A.H)Offers information and links related to spinal cord and head injury treatment, rehabilitation, and children. Materials in Spanish.
Neuroscience for KidsOffers an understandable look at the segments of the spinal cord; from University of Washington.
Paralyzed Veterans of America (PVA): Spinal Cord InjuryFor more detailed information on the clinical practice guidelines on respiratory management with spinal cord injury you can request booklets from the Paralyzed Veterans of America. These booklets also provide guidelines on proper weaning from a ventilator.
SpineUniverseAt SpineUniverse our goal is to help patients and their families understand their back or neck problems. In clear, straightforward language we aim to explain what causes spinal problems and how they can be treated. We are committed to ensure that all of the information we present is trustworthy and of the highest quality.
Spinal Cord Injury Information NetworkThe Spinal Cord Injury Information Center features clinical information about bowel management and all other medical issues of paralysis.
Tri-State AdvocacyPrivately funded non-profit for spinal cord and burn injured survivors and amputees. Helps families on specific provisions of their health insurance policy. Services are free.
United Spinal AssociationOur mission is to improve the quality of life of all Americans living with spinal cord injuries and disorders (SCI/D), including multiple sclerosis, spina bifida, Lou Gehrig’s Disease (ALS), and post polio.
U.S. Department of Veterans Affairs Fact Sheet: VA and Spinal Cord InjuryOf the more than 250,000 Americans with serious spinal cord injuries and disorders, about 42,000 are veterans eligible for medical care and other benefits from the Department of Veterans Affairs (VA).
Paralysis Resource Center The Reeve Foundation Paralysis Resource Center Information Specialists are reachable business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm ET. You may also schedule a call or send a message online.
Reeve Foundation Online Paralysis Community Connecting people living with paralysis, families, friends and caregivers so we can share support, experience, knowledge, and hope.
Quality of Life Grants DatabaseFind resources within the PRC Quality of Life Grants Database. Search by Zip Code, State or an Entire Category.
Library Books and VideosFind resources within the PRC library catalog.
Check out programs in your area on our one-of-a kind online searchable Quality of Life program database. You can search by location or topic. GO