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Affordable Care Act Implementation Continues

As we get closer to the October 1, 2013, the open enrollment date for the state health insurance marketplaces (also referred to as exchanges), implementation of the Affordable Care Act (ACA) continues on many fronts.

NHF Joins Patient Community in Department of Labor Letter

Recently, the Obama administration announced that the annual limit on out-of-pocket expenses applies to all non-grandfathered health plans--those in the individual, small and large-group market and self-insured plans.  But, for the first plan year starting in 2014, the Department of Labor announced that group plans that have separate service providers to administer different parts of the benefits (such as a pharmacy benefit manager for pharmacy benefits) can impose an out-of-pocket limit.  Each cap can be as high as the overall out-of-pocket limit, so some plans can effectively double the out-of-pocket limit established by ACA.  This policy would undermine this important patient protection.

NHF joined with more than 100 patient and provider advocacy groups to send a letter to the Department of Labor expressing concern about this policy and advocating that the single out-of-pocket maximum apply to the entirety of the plan.  To see the letter, click here.

Application Form Released

On April 30, 2013, the Department of Health and Human Services released the final version of the standardized application form that will be used in all health insurance marketplaces starting in October.  The “no wrong door” policy means that single application can lead a person to private health insurance, Medicaid or the Children’s Health Insurance Program.  There are three forms: 1) individuals applying for coverage and who may qualify for financial assistance (i.e., premium assistance, tax credits or public health insurance programs); 2) families applying for coverage who may also qualify for assistance; and 3) individuals or families applying for coverage only. 

The new applications are significantly shorter than the draft ones released a few months ago. They can be completed online, in person or over the phone.  The forms are available here: individual applying for coverage and financial help; family applying for coverage and financial help; individual applying for coverage only.

More Details Emerge about Navigators

The ACA requires that marketplaces have resources to help consumers understand and enroll in the new coverage options.  These resources include in-person assisters, certified application counselors and navigators. They will provide consumers with unbiased information about insurance coverage options and assist in the enrollment process.  They will be trained and certified through the Centers for Medicare and Medicaid Services (CMS). CMS recently announced that $54 million in funding was available to support navigators in federally facilitated and state partnership marketplaces.

As implementation moves forward, it is important that chapters and community leaders help NHF determine which organizations (for instance, hospitals, state agencies, nonprofits) will be pursuing these positions. NHF’s goal is to work with these entities to ensure that they are properly educated about the needs of individuals with bleeding disorders and which coverage options work best. To learn more, NHF encourages you to visit the Navigator and In-Person Assister Resource Center by Families USA.

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