Health Insurance Marketplace Open Enrollment has started! You can enroll now for a child only plan for an affordable rate.
A word about Insurance
If your current plan excludes ABA therapy, such as the example of many self-funded plans, this is a great opportunity to look at alternative options that can increase your loved ones access to services.
Insurance can be complex, which is why we figure it out for you including checking your current policy as well as alternate funding sources if required.
We accept insurance coverage from most providers including Horizon, Aetna and Emblem amongst others. Our billing department is set up to handle all insurance needs from authorizations to ongoing claims and billing.
Affordable Care Act (ACA)
Year 2 – implications for our families
A lot of our families have asked us questions about the (now not so new) Affordable Care Act.
Here are a few pointers that we’ve gathered together that might help.
Disclaimer: Please note that most people out there including the experts are still trying to piece together the effects of this new legislation. We are by no means close to being experts on insurance law… these are just pointers based on what we’ve gathered along the way and should only be used to supplement your own research and/ or advice from professionals.
Insurance can now be purchased through what are known as ‘MarketPlaces’
- The best place two places to find plans and compare rates are:
- https://www.ehealthinsurance.com. This website also helps you compare rates and purchase insurance (just like you would through a broker)
- The government run marketplace is https://www.healthcare.gov for Indiana. If you qualify for a subsidy – then you must go through this site (or their 800 number) (which platform you use is dependent primarily dependent on income considerations and if you are eligible for a subsidy)
- A common misunderstanding is that health insurance is now purchased through the government. This isn’t true.
- All plans are administered by insurance companies.
- All plans must comply with new federal wide guidelines – such as not getting denied for pre-existing conditions, deductible levels etc.
- Important – you must sign up and purchase insurance during the open enrollment period! So the marketplace effectively closes down after the open enrollment (you can only get insurance if you have a qualifying life event outside open enrollment)
Major changes over how insurance used to work back in the day
- You can now put your dependent/child on his or her own policy. This is quite a big change in that now the child can have his or her own policy. Depending on your individual circumstances, this could actually lower your out of pocket expenses. This is a big benefit of ACA.
- There are no lifetime maximum limits to coverage; there are also caps on out of pocket maximum spend for covered individuals/ families
- You cannot be denied coverage for pre-existing conditions
- You cannot sign up for insurance outside open enrollment – unless you have a qualifying life event
- The process is pretty straightforward regardless of which website you use
- Step 1 – navigate to the website
- Step 2 – provide your child’s age, gender and zip
- Step 3 – review quotes (some more helpful tips below about this)
- Step 4 – sign up
Sample comparative from ehealthinsurance.com:
Tips on plan selection
- Assess if it is cheaper to put your dependent on their own separate policy
- Make sure whatever you pick is an New Jersey based plan (so the mandate applies). Generally it should be – but doesn’t hurt to make sure!
- Before you sign up for anything – please get all the important policy information! Make sure you look at not only the monthly premium but also the deductibles and out of pocket maximum on the policies you compare.
- If you are eligible for a cost-sharing subsidy, you need to pick a silver plan or above
- Review the out of pocket maximum and not just the deductible (because the out of pocket is what you could potentially be… “out of pocket” for!)
- Regardless of your circumstances, we believe you should research and compare all your options. Even if you receive employer provided coverage, you might still want to research the new options that have been created out there
Other useful information:
- Depending on your individual circumstances (income, # dependents etc), you might be eligible for credits and tax subsidies
- Individuals and families whose income falls at or below 250% FPL ($28,725 for an individual, $58,875 for a family of four) will be eligible for cost-sharing reductions. http://www.cbpp.org/cms/index.cfm?fa=view&id=3190
- Those eligible for this subsidy can take advantage of it by purchasing a silver-rated (or higher) plan (there are different tiers of insurance available – platinum, silver, bronze. Platinum pays for 90% of expenses, silver 80% and bronze 70%)
- Coverage starts Jan 1st, 2015
- You can also purchase insurance directly through the providers (Anthem, etc)
When should I use healthcare.gov?
- If you expect to get a subsidy (based on income level) then generally you must use healthcare.gov to purchase insurance
- If your employer provides coverage currently that qualifies under the ACA act then you are automatically disqualified for a subsidy
- If you think you are eligible for a subsidy (see table at: http://www.cbpp.org/cms/index.cfm?fa=view&id=3190); then create an account at healthcare.gov and shop around for rates; You can also call 800-318-2596
Additional reading and links (note: some of the info on these websites has not been updated to reflect the second year of ACA.)
Options for ABA therapy coverage through the Open Enrollment marketplace include the purchase of a family or child only plan, dependent upon the needs of the each individual.
Health insurance sold through the Marketplace must cover at least 10 categories of “essential health benefits” (such as behavioral health treatment, habilitative services, and prescription drugs). ABA therapy falls under the scope of mental health services.
Visit the marketplace now to research on your own, or talk to a health insurance broker who can help guide you toward the plan that best suits your family’s needs.
While Build N Care’s insurance team is unable to counsel you on a specific plan, we are here to support and answer any questions you may have pertaining to ABA therapy and our consumer intake process.Contact our insurance team today for more information on these items.