Tuesday, October 1, 2013

It’s Heeeerrrreee - What Families Need to Know about Healthcare Reform NOW!

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It’s fortuitous that my blog due date is the same as the launch of the Marketplace for healthcare reform.  Families will be able to pick plans by shopping at the “Marketplace” or “exchange” which will compare health plans starting October 1 for coverage that will be effective 1/1/14.  You can still keep your current insurance from your job or switch to a new plan.  Getting healthcare for your child with special needs as well as the rest of your family will help all family caregivers.

There are different levels of plans ranging from bronze to silver to gold to platinum.  Keep in mind that the plans with the lowest cost will mean families have to pay more “out of pocket” for copays (your part of the bill) and deductibles (how much you have to pay each year before the insurance covers.)    And remember you can’t be turned down if you have a “preexisting condition” (a health problem you had before signing up.) 

People under age 30 can apply for a “catastrophic” or “bare bones” plan and there are also exceptions for people who cannot pay for insurance.  However, 90% of people without insurance will be eligible for free or lower cost care. 

You can also get dental care as part of your plan or pick a separate dental plan. 

You can have someone help you pick out a plan but please see this tip sheet on preventing fraud http://marketplace.cms.gov/getofficialresources/publications-and-articles/protect-yourself-from-fraud-in-health-insurance-marketplace.pdf

 What Else Families Need to Know 

-Make sure your doctors are in the plan you choose.

-You may get help paying for plans based on your income.  The Marketplace will automatically figure out if your family is eligible for “tax credits’.

 Plans will cover 10 “essential health benefits:” 

  • ambulatory patient services

  • emergency services

  • hospitalization

  • maternity and newborn care

  •  mental health and substance use disorder services, including behavioral health

  • prescription drugs

  •  rehabilitative and habilitative services and devices (such as physical/occupational/speech therapy)

  • laboratory services

  •  preventive and wellness services and chronic disease management

  • pediatric services, including oral (dental)  and vision care
Also preventive services like screening or shots must be covered by your plan without a co-pay!

Note for People with Disabilities

The Marketplace will only pick one type of plan.  People with special needs may also be eligible for Medicaid and/or Medicare as well a private insurance.  If you have questions,   contact your Family-to-Family Health Information Center found at www.familyvoices.org/f2f-grantees.


Healthcare.gov www.healthcare.gov or 24 hour hotline (800)318-2596
Information on the Marketplace and getting help to pay for insurance
Find out what healthcare terms mean. 

To find the Marketplace in your state and see how to apply online:
Finding help in your state:
Certified Application Counselors (local help)

 Health Centers
Having insurance results in better health and preventing illness from becoming more serious.  Sign up today at the Marketplace!
Remain Hopeful,
Lauren Agoratus is a parent/advocate who serves as the NJ Coordinator for Family Voices, a national network that works to “keep families at the center of children’s healthcare” at www.familyvoices.org or FB www.facebook.com/pages/Family-Voices-Inc-National/137783182902269.  She also serves as NJ representative supporting caregivers across the lifespan for the Caregiver Action Network (formerly National Family Caregivers Association) in a volunteer capacity at http://caregiveraction.org/ or FB www.facebook.com/CaregiverActionNetwork.


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