Skip to main content

ACA update: Piecing together the puzzle

By Emily McKinley, Health Information Specialist


The insurance Marketplaces (also known as Exchanges) opened on October 1, and in the past month, they have been problematic. Unfortunately, design flaws have plagued the federally-run exchange site, www.healthcare.gov, which has contributed to increased criticism of the Patient Protection and Affordable Care Act as well as frustration and, in some cases, panic from consumers. Family Voices is closely watching the activity of the exchanges and wishes to help the families we serve as they consider their insurance options. In that vein, we wish to share tips and updates about ACA deadlines and policies.

·         Have patience. Truly, we are all anxious to see how the law plays out, and we are all hoping for the best. Having limited access to the web-based application has frustrated many consumers (including us!). If you do not wish to purchase insurance on www.healthcare.gov or do not have the patience to do so, you have other options. To apply by phone, call  1-800-318-2596. For in-person assistance, search https://localhelp.healthcare.gov/ to find an assistor who can help you complete an application and review your insurance options. Finally, you may also  print and mail an application.

·         Use the exchange, if only as a starting point. Individuals and families with incomes between 100 and 400% federal poverty level are eligible for premium tax credits. Those whose incomes are at or below 250% FPL are also eligible for cost sharing reductions. In other words, if your child qualifies for Children’s Special Health Care Services and you are shopping for insurance, it is likely you will qualify for both. To take advantage of these benefits  you must purchase an exchange plan. So, use the exchange as a starting point. If you are not happy with your options or the cost of those options, then look to other sources, such as insurance agents and companies for additional choices.

·         Know who is assisting you. Do you know the difference between a navigator, certified application counselor, and agent? Do you know their allowable relationships with insurers? If not, check out our previous update to understand the various roles.

·         Check the boxes. If you think you or family may be eligible for Medicaid programs, follow up with the Division of Family Resources. Due to technical issues, the federal exchanges and state Medicaid programs have not been sharing information as planned. The systems are predicted to be sharing data by November 18. If you think you or your family members may be eligible for Hoosier Healthwise or the Healthy Indiana Plan, we encourage you to visit http://member.indianamedicaid.com/ and/or your local DFR office for more information and to follow-up on your insurance applications.

·         Breathe. You have time. If you purchase and pay for insurance prior to January 1, the coverage will start on January 1. Due to the high volume of consumers entering, or, in many cases, re-entering the market, it is recommended that you purchase the insurance no later than December 15. That said, if you are currently covered by ICHIA, Indiana’s high risk plan, Governor Pence has extended that plan until February 1, 2014, to help facilitate the transfer of consumers to Marketplace plans while avoiding gaps in coverage. Finally, open enrollment will continue until March 31. Individuals who have a 3-month or shorter gap in coverage will not incur tax penalties. Please note, Family Voices does not suggest or endorse coverage gaps for consumers.

Family Voices encourages consumers to be informed. If you have additional questions about the ACA and how it affects you, please peruse our previous ACA updates on our blog, read our Guide to Purchasing Insurance, visit our www.fvindiana.org, or contact us at info@fvindiana.org or by calling 317.944.8982.

Popular posts from this blog

Pandemic Snap benefits: Free and Reduced Lunch Recipients

Pandemic Snap benefits: Those that have children on free and reduced lunch will receive their EBT card in the mail by the end of May if you are not already receiving SNAP benefits. It will be $319 per school aged child. You do not need to apply for this benefit. The DOE will provide your information to FSSA. https://www.in.gov/fssa/dfr/ 5767.htm?fbclid= IwAR0zhdr9tS1wMovtNNPngc55HCms QSX_4k_E_ GRAjPpNRHWF5ExZgCLUjOE

Sample Medical Order, Letter of Medical Necessity and Appeal Letter for #ABA Services

From The Arc Autism Insurance Project in collaboration with Family Voices Indiana and About Special Kids Feel free to contact Family Voices Indiana at 317 944 8982 or info@fvindiana.org if you need additional resources or support. Sample Medical Order, Letter of Medical Necessity and Appeal Letter for ABA Services – Medicaid under EPSDT (ages 0-21) EPSDT – Early, Periodic Screening Diagnosis and T reatment MEDICAL TREATMENT ORDER SAMPLE FORMAT The prescribing physician should include: Physician’s order for ABA therapy Letter of medical necessity written by the physician or ABA provider, which includes: Patient history Diagnosis and prognosis Description of recommended services and explanation of why the services are medically necessary What the benefit to the patient will be, and Recommended length of time for the services Medical Necessity According to the Health and Human Services website: Medical Necessity under EPSDT   In a rep