ACA update: Tips, Tricks, and Myths

By Emily McKinley, Health Information Specialist

Open  enrollment for Marketplace plans is in full swing. Consumers have until March 31 to enroll in a qualified health plan unless they experience a qualifying event thereafter. As the enrollment period has unfolded, we’ve heard and experienced reports of the good, the bad, and the ugly. Here are some tips, tricks, and myths we’d like to share:

·         Open enrollment ends March 31. Consumers must purchase a plan by the 15^th of the current month if they want coverage to be effective the first of the following month. In other words, plans purchased on or before February 15, will be effective March 1.

·         Consumers are allowed a three-month coverage gap during the year without incurring tax penalties. That said, Family Voices encourages consumers to carefully consider the risks associated with gaps in coverage, to include extreme financial consequences in the event the consumer requires medical care during the coverage gap.

·         Once consumers enroll in a plan, they may choose to switch plans, provided they do so before the coverage effective date, generally the first of the month. In that vein, we do encourage consumers who have purchased plans to double-check those plans after purchase. If necessary, contact the insurance provider to obtain the member identification and plan policy numbers. Use that information to then check provider directories and plan brochures to ensure the purchased plan meets your needs and is, in fact, the same plan as was advertised to you.

·         Individuals who have Medicaid coverage (without a spend-down) are considered to have minimum essential coverage (MEC). Those with MEC do not need to purchase a Marketplace plan. That said, families may choose to purchase a Marketplace plan in order to supplement coverage and/or expand provider options. In these cases, the individual(s) with MEC may purchase a plan on the Marketplace but is not eligible for premium tax credits or cost-sharing subsidies. In the event that the family will be purchasing a family plan, cost-sharing subsidies and premium tax credits will apply to all other eligible family members.

·         In the event that consumers encounter issues with the insurance plan or provider, there is a multistep process to filing complaints and remedying the situation. It may be necessary to work with both the insurance provider and the Marketplace to resolve the issue. As the issue is shared and escalated, we advise families to record details of the conversations that occur, including names and identification numbers of individuals on the call, what was said, time and date of the call, and any resolution or impending actions. Further, it may be necessary to request to speak with supervisors. If a resolution is not reached, consumers may file complaints with the Indiana Department of Insurance. More information is available here: http://www.in.gov/idoi/.

We’d love your feedback—what tips, tricks, or myths have you encountered? Let us hear your voice so that we may better serve you!

If you have questions about the ACA, the aforementioned items, or any topic regarding your family member with special health care needs, please contact Family Voices Indiana, at 317.944.8982 or via email (info@fvindiana.org). We also encourage you to visit our website for fact sheets and guides on these and other topics.