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Spinal Cord Injury Paralysis Resource Center

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How to Prepare for Health Insurance Marketplace Enrollment

By Nate Herpich

Open Enrollment for Healthcare Marketplaces

Last week, we reminded you that open enrollment in "Health Insurance Marketplaces" began on October 1, 2013. Starting immediately, most Americans now have the opportunity to comparison shop for private health insurance plans online. The deadline to enroll to ensure your coverage starts on January 1, 2014 is December 15, 2013 which gives you some time to properly prepare for, and research, what insurance plan might be best for you or your family.

Here, 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.

Get started at Healthcare.gov
The best place to start is HealthCare.gov. Some states have chosen to set up their own Marketplace, while others have chosen to let the federal government run the website for them. Fortunately, HealthCare.gov will get you where you need to go -- regardless of your state's decision. Starting at HealthCare.gov will also help ensure that you don't accidentally log on to a copycat website that might be looking to steal critical information. Be careful of these fraudulent sites that are bound to pop up. PC Magazine has some tips for staying safe while perusing Health Insurance Marketplace offerings online.

Bring basic information with you when you first log on
You'll need to have some basic information to get started with the enrollment process -- whether you choose to enroll online, or by phone. Of course, you'll need information like your social security number and where you live. But you'll also need income information for all of the members of your family who need coverage (i.e., from pay stubs, W-2 forms, tax statements, etc.). This information will help you determine if you're eligible for private insurance through the Marketplace, a public health coverage program (such as Medicaid), and/or for financial assistance from the government to help pay for coverage.

Budget, budget, budget!
When you log on to the Marketplace, you'll be presented with plans from a number of different insurers. These plans will be organized by price, benefits, and other features. Plans will be presented in four categories – bronze, silver, gold, and platinum – to make comparing them easier. Platinum plans will pay the highest percentage of your medical costs, but will also have the highest premiums. On the other hand, bronze plans will cost you less each month, but will require you to pay a higher percentage of your medical costs out-of-pocket when you receive care.

Be smart about how much money you can put aside per month to cover your medical costs, and those of the rest of your family. Knowing what you can afford to pay -- both for monthly premiums, as well as out-of-pocket costs -- will help you make the best decisions.

Research available plans. Ask questions
While all plans in the Marketplace are required to offer a set of "Essential Health Benefits," it's important to keep in mind that specific plan benefits may be different in each state. And even within the same state, there can be small differences between plans. This can make choosing a plan extremely intimidating -- especially for people living with a spinal cord injury who often require a significant amount of rehabilitative services, medications, therapies and equipment. It's important that you know which services you will have access to under each plan, and this may not be obvious online.

The good news is Health Insurance Marketplaces are staffed with individuals who should be able to answer very specific questions about what a certain plan does, and doesn't, cover. You can reach out to these staffers in real time via online chat, or by phone. Don't be afraid to ask questions! This is a key part of doing your research so that you find the best coverage for you.

Ask away to find out!
Know that the ACA includes important changes for individuals living with paralysis.

The biggest news for many coming out of the Affordable Care Act (ACA) is that, starting January 1, 2014, no one can be excluded from health insurance based on a pre-existing condition. In the past, many with spinal cord injuries were uninsurable. But, thankfully, this is no longer the case.

Also, ACA plans should provide for increased coverage for rehabilitative and "habilitative" services and devices. Ask a HealthCare.gov professional about which plans are best for you -- especially if rehabilitation represents a critical portion of your care.

Think about health insurance needs holistically, and how a change in coverage might affect your family.

It seems like a pretty basic idea, but it's easy to get caught up in the shopping process and forget to include all parts of the equation. So don't forget the needs of your family!

This can be a key piece to the budgeting process, and should help inform your decision. Do your children or a spouse have an illness or condition that will require a significant level of health care services over the coming year? If so, you should consider this when selecting coverage for you and your family.

Marketplace plans aren't right for everyone
Remember: You aren't required to purchase insurance through a Marketplace. It certainly can't hurt to do your research, but if you're happy with your current insurance plan, you can keep it. It's possible that this plan is still the best for your needs.

Stay tuned for future articles on how ACA legislation affects those living with paralysis, and how you can get the most from the new law.

A Reeve Foundation Fact Sheet on Adjustment to SCI (PDF)

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A Reeve Foundation Fact Sheet on Medicare, Medicaid and Insurance (PDF)

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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, in support of The Consortium for Spinal Cord Medicine, offers authoritative clinical practice guidelines for bladder management. Consumer guides are available to download.

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.

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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 Eastern U.S. Time. International callers use 973-467-8270. You may also schedule a call or send a message online.

This project was supported, in part by grant number 90PR3001, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.