What You Need to Know About ACA Enrollment in 2017 Presented by Karl Cooper October 31, 2017 >>> Good afternoon. Welcome to our Webinar today. What CIL and consumers need to know about open enrollment for healthcare reform in 2017. The Webinar is presented by the Collaborative on Health Reform and Independent Living. Our presenter today is Karl Cooper, with the American Association on Health and Disability. We'll have a more complete introduction of Karl just as we begin our Webinar. I'm Richard petty. I'm your host. I'm with independent living research utilization. ILRU. Our Webinar facilitator is Carol Eubanks, in designer. Before we move to the Webinar topic, this is the inaugural using a new Webinar platform, Zoom. We believe it will increase the user experience for you, and make it more comfortable and more usable. We believe it adds accessibility features we did not have previously. You will be able to ask questions today in the Webinar by using the Q and A tab on your main screen. Closed captioning will be available in the CC tab also on the screen. And IRLU will continue the practice of offering captioning through the live stream, text, full text captioning feature, which is a separate window. You'll find a link to that window both on this page, and on the page that you linked to from the announcement that you received. You can also find a copy of the PowerPoint presentation that will be presented on the screen. If you're presenting  excuse me. If you are applying by phone, you may want to print out a copy of that presentation and have it in hand while you are listening. That's also where you'll find the alternate format accessible copy, it is available on that page. One final bit of information before we begin, and it is a request from us. Near the end of the Webinar, you will see links to evaluation and there wills are links on the Webinar page. We ask that you complete that evaluation. We use that information to make our future Webinars better. We take it very seriously, and we will appreciate it. If you will complete the evaluation for us. Now, Karl, if we move to slide two, please. Again, this Webinar is presented by the collaborative on health reform and independent living. CHRIL. It is a disability rehabilitation research project, or DRIP, funded by the national institute on disability, independent living and the rehabilitation research. It is a fiveyear project, and this is year three of the project. As health reform has progressed through different administrations, it has become clear that the decision to initiate this project three years ago by the project lead, jay Kennedy at Washington state university, and by the decision to fund that project was quite pressing. It is a very timely and very important topic for people with disabilities. Let's move to slide three, please. The objective of the CHRIL to working age people with disabilities about decisions that they will make about healthcare coverage. Let's move to slide four, please. The purpose is similar. It is to conduct essential research and share the findings of that research with people with disabilities, especially working age people with disabilities and the organizations that support them. Again, as I said, this has become even more timely, even more important to the disability community, as healthcare reform, healthcare reform has progressed. Let's move to slide five, please. The partners in the collaborative on healthcare reform and independent living are Washington state university, that's the lead organization. George Mason University, the University of Kansas, independent living research utilization, ILRU. This is a group of experts and disability research and independent living, and we believe that we are bringing a fresh and important look at healthcare reform, and related issues. Let's move to slide six. The CHRIL has several institutional partners. Those include the national council on independent living. The association  American association on health and disability. The association of programs for rural independent living. The disability research interest group of academy health. And the urban institute. All of these partners have added greatly to the work of the collaborative, and you'll see a good example of that in the presentation that we have today. Let's move so slide seven. Our presenter today is Karl Cooper. He is with AHD. He is director of public health programs there. One of the roles that he has had as the leader of an important project to help organizations around the country to train navigators to provide assistance, to individuals with disability whose are making decisions and working to secure health insurance for themselves. Karl has held other health and employmentrelated disability leadership roles within Washington, D.C. area. He is especially wellqualified to make this presentation to us today. Karl, welcome to the Webinar. >> Thank you, Richard. And I guess everyone, I should say happy Halloween, or more appropriate, I should say a happy open enrollment eve, as it starts tomorrow. As Richard said, I'm the director of public health programs at the American association on health and disability. For those of you familiar, we are located in Washington, D.C., it is to advance health promotion for children and adults with disability. Cross disabilities and we also work across the age and the lifespan of individuals with disabilities as well. We do that through four main objectives. We work to help reduce work disparities, include inclusion, work promote full accessibility and also then try to do what we can to integrate disability into the broader public health agenda. There has been a lot of misinformation about the Affordable Care Act, or as I'll call it, the ACA, since the election that happened last year. There was several attempts to repeal, replace, and modify it this year. However, none of those passed as a law. And while there may still be efforts that may be revived in the future, for now, ACA or Obamacare is still the law of the land, and there is some important things we need to know as a result of that. Since it is still the law of the land, there are important things that that means. That means that healthcare.gov will be open for business for people to be able to purchase health insurance on the health exchange. Premium in the form of tax credits is still available to individuals, and in the states where they have expanded Medicaid, that coverage will still be available, and will still remain in place for those individuals. It is also important to know a few other things that were attempted to be changed as part of the repeal and replace efforts, and that is, there a requirement that everyone must have some sort of health insurance policy or they could face a potential tax penalty. So that is still in place as well, so all of these things still remain in place. They still remain the law of the land. And even some of the repeal and replace efforts, in fact, most weren't going to change, most of these things except for the mandates. They weren't going to change any of this for a few years anyway, so it would still be in place, even had those laws passed this past year that were being considered by Congress. So let's go over some basics of what we know about the upcoming open enrollment dates as we enter them. As I said before, this is open enrollment eve, which means that tomorrow, open enrollment will begin. So open enrollment will run from November 1st through December 15, 2017. Now, that's important to know, because there is a major distinction there from prior years. And prior years, the open enrollment period has been longer. The last few years, it started November 1st, and ended January 31st of the following year. This year, it has been shortened to go from November 1st to December 15th. Now, the one thing that hasn't changed, though, that still existed from before is even in prior years, if you wanted to have coverage by January 1st of the upcoming year, you still had to have  you still have to have been enrolled by December 15th. So in some respects, nothing has changed for those people that wanted coverage to begin right at the beginning of the year, and not have anything happen to their coverage that there would be a lapse in coverage. So for those issues, nothing has changed in that respect, and for  for folks that were doing that before, they will be following essentially the same plan that they had prior. So but the open enrollment, it is important to know, the open enrollment will end on December 15th, 2017, and then all coverage that people sign up for throughout the whole open enrollment period will begin January 1st of 2018. As you see on the slide, there is an as trick there and that's complicating matters further the fact that healthcare.gov, the states on the marketplaces, which currently is the vast majority of them. But there are some states that run their own statebased marketplaces, and some instances, those statebased marketplaces decided to follow the federal government, for instance, I live in Maryland and they have a statebased exchange and it is following the same dates that the federal government is. But there are eight states that are indicated on the slide that have  that will have different open enrollment dates than what the federal government will use. In all of those, November 1st is the beginning date. So that is consistent across the country. So tomorrow, no matter where you live, you will be able to start to enroll for health insurance on the exchange, whether federal or statebased marketplace. That will remain the same. But these eight states have decided to extend open enrollment beyond December 15th of this year, so that people can continue to enroll for coverage beyond that date. If you're interested in knowing the specifics about that, I'll be talking about my project's Website in a bit and we do a blog that we put up there that has the dates for these eight states if you're interested in knowing about that, go to that Website and find that specific information out. Now, what if someone misses the open enrollment, say, for instance, someone comes to you on December 16th and you're in one of the markets places that doesn't have the extended dates, and they say to you, I need to sign up for health insurance. Are they out of luck? Well, the bad news is there is going to be very limited circumstances where they could enroll for health insurance. But there are still instances where someone can enroll for insurance outside of open enrollment, and that is a big qualify for a special enrollment period or SEP. They are available for a number of reasons, these would include, if you lose your job, so say for instance, you had employer based health insurance and those individuals  you were getting your coverage through that. For individuals that are in that situation and they lose their coverage, as a result of a loss of their job, they will be able to sign up for coverage through the marketplace, and that's the same as it had been before. If there a change in marital status, if you get married throughout the course of the year, that does trigger a special enrollment period. If a child is born, you can also change  you can also enroll that child through a special enrollment period. If you're moving to a different state, or even in some states, if you're moving to a different part of the state, you could be eligible for a special enrollment period, and that has to do with the fact that obviously depending on where you live in a state, premiums may be different, as a result, if premiums are different, that could affect your ability to receive some of the premium tax credits, and if you are available for  if you are eligible for tax credits that maybe you weren't eligible for before, then that would trigger a special enrollment period. One thing you need to remember, though, throughout all of this, Medicaid enrollment is open year round. So if the individual does qualify for Medicaid, or if they are going to qualify for Medicaid and that includes the Medicaid expansion, they can go ahead and enroll year round. You don't need to wait for open enrollment period to enroll for that coverage. Richard mentioned earlier, the project that I was working on, and that's referred to as the national disability navigator resource collaborative, or as I'll referred to it for the remainder of the presentation 2346789DNRC, it came out of disability organizations that navigators and other people helping folks enroll and health insurance would not have a sufficient knowledge base to able to assist people with disabilities as they made their healthcare enrollment decisions. Several of these national organizations began discussing ways to do outreach and training to these organizations to help them better prepare to assist the population of people with disabilities. Because  and all that is because of when the Affordable Care Act was passed in 2010, 3.5 million people between the ages 16 and 65 were uninsured and had some preexisting condition or disability and they were going to face a lot of different options that not available to them before. They were able to be shut out because of their preexisting conditions. Since they were able to receive whatever care they wanted, they receive different options under the Affordable Care Act. This includes traditional Medicaid in the state, the Medicaid expansion in their state, possible Medicaid buyin in their state and it also includes the private coverage that's available on the health insurance exchanges. So it is the mission of the NDNRC to provide cross disability information and support to navigators and other enrollment specialists to ensure people with disabilities receive accurate information when selecting and enrolling. So who makes up the NDNRC, these are the partner organizations that make up the collaborative. There are ten partner organizations. On the screen right now is the logos for those organizations. I'll list those organizations now. They include my organization, American association on health and disability, which is the lead organization on the project. There is also the association of university centers on disabilities, or AUCD. Autism speaks, Christopher and Dana Reeve foundation, the disability rights education and defense fund or DREDF, family voices, the national alliance on mental illness or NAMI, the national multiple sclerosis association. You can see the cross disability makeup of the partners, so we have folks that are in a wide array of disability population groups. And we're proud of that, because then able to help us really understand a lot of the different issues happening to many of the different populations that these different organizations represent. One of the  most of the resources that we have available on the NDNRC can be found at our Website, which you can see the home screen shot is on this slide. The Website for the project is www.nationaldisabilitynavigator.org. You can see on this slide, there is, like I said, a screen shot of the home page, and there are several dropdown menus you can see across there, the about us, the partner organizations, as well as the friend organizations, which are organizations that have helped us get the message out about the NDNRC, as well as community outreach collaboratives, which are local and state disability organizations that are helping us with specific enrollment projects on the ground. We also have conversations tab that you can see there, and under there, you can go to submit to ask a question. We also have some frequently asked questions there, you can access our blog that I was talking about earlier, that has the article about the date for the statebased marketplaces and those that are having different dates than the federal exchange. We also have a news to use tab that you can look at. And we have a newsletter that we put out every Friday, and you can find the archived newsletters as well. Under the NDNRC materials tab, you can find information about some of the materials I'll talk about, specifically our guided fact sheets. And then you can see across the middle there, there is a slider that changes, obviously the screen shot is not going to change here, but you can see right now, it is on the shot for the disability guide, but that changes, so you can  that's where you can go to also access our disability guide as well as our fact sheets. We also have a slider on there for the statement we put out on the Affordable Care Act after the election last year, as well as information about our community outreach collaboratives, which are those local and state organizations that help us do the outreach work. So you can access all of those from that slider as well. As I said, one of the resources we're most proud of is the guide to disability, and on this slide, you can see a copy of the cover of that guide. It's a document that I think is around  it is over 40 pages long that has a lot of different information about it that is meant to sort of provide disability 101 for people doing enrollment work. It really goes over some of the special considerations. People with disabilities face as they shop for healthcare coverage. And it is really meant to sort of supply a lot of background information that navigators may not have because most of these navigators didn't have any experience with disability issues before, so it is meant to sort of act as a disability 101 for these individuals. Since I have this up there, it does have the logo for the Robert wood Johnson foundation on the cover for the disability guide, and that's because the foundation did fund this project for the first three years of its excess tense from 2013. Thanks to our partner organizations, the disability rights organization fund, they are the ones that wrote this guide and we're grateful to them for having supplied their expertise in preparing it. Some of the other resources I mentioned regard the fact sheets that we put out, and we have 17 topical fact sheets that are done in sort of a Q & A format, I'm not going to go through and read all the names, these are really just here for your information. But for those who are unfamiliar with health insurance and assisting individuals, as the first three fact sheets are really meant to help those individuals and really get the answers about what a plan covers, so it deals with a lot of the documents that are very specific to health insurance coverage, and understanding the benefits that the coverage provides, and how much outofpocket costs will be and all those types of things. So if you're trying to figure out where do I get answers about what a health plan covers, I would encourage you to read these fact sheets, they help you get a background understanding what you need to know about health insurance specifically, and getting the answers to those questions. And then some of the other topical fact sheets deal with a wide variety of areas that people with disabilities will probably need their health insurance cover, such as rehab, prescription meds, later on, issues on substance health, excuse me, mental health and substance abuse coverage. Also deals with some of the issues you come up with in terms of Medicaid and the eligibility process and what happens when you're applying for coverage through the marketplace. We also have the  what happens in terms of the process for Medicaid eligibility, as well as what happens with the Medicaid buyin available in some states. So a lot of those different types of projects or excuse me, different types of issues that people come up with. The other thing I will point out for the fact sheets is the 16th fact sheet is moving from coverage to care for people with disabilities. This is the only fact sheet that is really geared to the consumer itself. The other topical fact sheets are meant to provide assistance to navigators or helping people with enrollment. If you are in a CIL and helping a consumer look at their options as it relates to health insurance, a lot of those fact sheets will be helpful to you, but if you're  if you want to have something that you could give to a consumer, or if you're consumer yourself and trying to understand about now that I have coverage what, do I do, fact sheet number 16 is very helpful in that, in that it helps say to a person, now that I have coverage, what do I do to receive the care I need. So that's what that fact sheet is designed to do to help you move from coverage to care. It is geared toward the consumer. It is the only fact sheet that we have that's offered in Spanish as well. All the other fact sheets are not. But since that one was geared specifically toward consumers, decided to make that one available in Spanish as well. One of the things that we realized when we were going through the process of helping consumers and helping the navigators and some of the resources that were being used, we noticed that some of them, the fact sheets got a little more used than others were the ones that were more geared toward specific issues. So for instance, the one on rehabilitation habilitation and medical devices was one of the most downloaded. In recognizing that in year one, we decided you know what, people may be looking something specific that they're meeting with, and that's when we came up with the idea of making population specific fact sheets, so what to know when assisting a consumer with, and then multiple conditions. I'm not going to read all of these that are on the slide, but you get a basic idea of some of these various areas we covered and some of the specific medical issues that they come up with. For all of these except the veterans one, they follow a very identical pattern, so they answer the same questions. So some basic information about the back ground of the population that has that particular disability. As well as some of the providers that they were going to be seeing. That also addresses some of the basics as it relates to the prescription medications that they might have, as well as some of the other services and support that they may be interested in. So if you're unfamiliar with a specific group of, you know, a lot of people understand maybe if they have their own disability about their own disability, but they might not necessarily fully understand what all the needs are for another group than you might want to look at one of these population specific fact sheets to help you understand their medical needs better, because then you'll have a better idea to what they need to think about when looking at health insurance plans when assisting one of these particular types of consumers. Because those are the folks that are going to really need help and direction in trying to understand what it is about health insurance that I need to make sure gets covered. So all of these things are available and these population specific fact sheets. We sort of did it in a similar manner so they're easy to use, and then they will point you to some of the topical point sheets if a specific group has an issue. For instance, if you are reading the one about spina bifida, it leads you. If you want a type of coverage that individual will need, you can find it in these fact sheets. At this point, we're going to take our first break to see if there are any questions. So Carol, if you'll let me know if there are any questions for anyone. >> I sure will. We do have a couple of questions. One of them was submitted by Scott, and he asks  how do you know when an SEP is or a special enrollment period? >> That's a really good question. And there are a bunch of different things that trigger a special enrollment period. There are resources that are available out there, there are some on our Website. What I could do is I'll look through those, if you want, and I can send you maybe some of the best ones, and maybe you could distribute those after the Webinar so people have a better idea of how to identify those specific issues. I went over some of the highlights in terms of areas that are going to be the most common that come up with special enrollment periods, but there are others that may  that I might not have covered that are not quite as frequent as the ones that I covered in that particular slide. >> We do have one more question, but I do want to remind our participants that if you do have a question, submit it in the Q & A box on the main Webinar screen. Our other question comes from Lashonda, and she asks what is Medicaid expansion? >> Medicaid expansion was something that was written into the Affordable Care Act as a means to cover low income individuals. The Affordable Care Act was designed in a specific way that has been altered since then. Mainly through court decisions and then the way states have decided to implement it. The way the Affordable Care Act was initially written, the idea was that everybody up to 100% of the federal poverty level, people that are 100% of the federal poverty level and lower will be covered under the Medicaid expansion. People between 100% to 400% would get the premium tax credits. I'll talk about that later in the presentation. But in terms of the Medicaid expansion, that covers people that are really in the lower income levels. Now, what happened was some of the states didn't like the fact that the federal government was requiring them to expand their Medicaid programs to cover these lower income folks, and they challenged that in court. In 2012, the Supreme Court ruled that the Affordable Care Act was unconstitutional for the federal government to require states to expand Medicaid. So what happened was Medicaid expansion became basically voluntary to the states. So states  the Supreme Court said Medicaid expansion as a whole went out, it just says that the requirement would no longer be valid so states could opt into it. So states that have opted into the Medicaid expansion, it covers folks that are lower income levels. Before, if you were in a lower income level and you received Medicaid, it was either for children it would apply or people that had a disability, or for people that qualified in some other way, for instance, mother of children could get on the CHIP program, so they were understand the Medicaid program. What that did it expanded it to everyone in the lower income group. At this point, majority of states have expanded Medicaid, but it is possible if the person is not familiar with Medicaid expansion, that they could be living in a state where Medicaid has not been expanded. And if that's the case, then unfortunately, there is no coverage for those people that are below 100% under the federal poverty level, because the law is written in such a way that they can't receive the tax credits for it. With that said, they do have a waiver from the individual mandate tax, so they don't have to worry about paying the penalty, it is just unfortunate they can't get coverage. If you want to know whether or not your state has expanded Medicaid, there is a lot of different organizations that have put out maps and all those things. The easiest thing I could tell you, if you're trying to learn whether your state has it or not, if you go to my projects Website, the Website I referenced earlier with the URL, it is www.nationaldisabilitynavigator.org, you'll see a state map, or excuse me, a U.S. map of the states. Click on your individual state, and that will take you to a state page. On the state page, it tells you whether or not your state has expanded Medicaid or not. Medicaid expansion has been very important for people with disabilities. What it has done is since it is now based on only on income to apply for the Medicaid expansion, you no longer have to worry about an asset test, the traditional test before, it is only based on income, and you don't have to qualify in terms of disability status, so people with disabilities now, if they can get coverage through the Medicaid expansion, they can go and work, and make some money rather than, you know, feeling like they have to stay out of work to be able to stay in traditional Medicaid. It has provided a lot of flexibilities to these individuals. There is an article that was put out that our friends at the University of Kansas did. It really underscored this fact. That is the fact that the states where expanded  Medicaid has been expanded, the employment rate is higher in those states and we believe that's because those people have a lot more flexibility now with their coverage. They don't have to worry about qualifying for disability to be able to get Medicaid, they can stay on Medicaid and still make some money as long as they don't go over the dollar threshold that would take them out of Medicaid expansion. So that's a very important part of the ACA, and that is available in your state, it is something you should know about, because it does provide a lot of flexibility to folks with people with disabilities. >> Karl, this are Richard petty. It seems like this year may be a year to register early during the open enrollment period. Can you offer any encouragements for doing that? >> Absolutely. I'm going to deal with some of the issues that could potentially come up in terms of open enrollment throughout this year. But suffice it to say, that is something that do it as early as you can. There could become problems. There is always a major rush at the end, because unfortunately, we as humans generally procrastinate. So you know, don't wait until December 14th and 15th to sign up, because there might be a lot of people trying to sign up on those things. And as a result, there might be issues, and that's something you don't want to get caught in. If you could enroll earlier, you're better off doing that, and that would be a suggestion that's very, very well put out there, Richard. So thank you very much for that. >> Okay, well, we don't have any other questions at this time. So if you want to continue on, Karl, take it away. >> Thanks a lot. One of the things when I'm making my presentation about the things that navigators need to think about when helping with health insurance questions and understanding what it is they need to have is I like to refer to it as jeopardy. We have on this slide, for those of you know, the game show jeopardy, we have the logo on this specific slide. If you're familiar with that game show, you know that in that game, you've got to ask the right question. That's the correct response is the right question, not the right answer. That's really the issue when you're looking at health insurance, you've got to be asking the right questions. If you're not asking the right questions, you're never going to get the answers you need to begin with. I like to say it is not about the answer, it is about asking the right questions. On this slide, we also have a link to our YouTube channel, where we have a series of these. Lots of times, I'm not going to do it today, I go through a jeopardy presentation, you know, sort of mocking the game show, and it sort of shows some of the issues I'm going to talk about in the next few slides. It really underscore these issues that comes up and some of the consumers that these folks might be needing and the questions they need to think about when answering, or excuse me, when reviewing their options for health insurance. But we do want to take a look at some of the specific things that consumers need to consider when choosing a health plan. There is a lot of different things that folks need to think about. They need to think about their providers they go see. Their pharmacy benefits, the drugs they take. Any particular therapies that they use. And any potential equipment that they use. So these are really four areas they really need to think about, and I'm going to go through all of these to provide a basic background on some of the  some of the things that really need to be considered by these folks so that they are making sure that they're looking at all the possible issues that could come up with health insurance coverage. Because when you make this decision, when you enroll in this plan, you are going to be in that plan for the next year and you can't make changes in that year, so you want to make sure you don't end up in a plan that won't immediate your needs. Let's go ahead and take a look at some of the things you need to think about when you're looking at health insurance plan as it relates to your providers. The first question you need to look at is whether a doctor is in the qualified health plan's network, refer to these qualified health plans as QHP. As I said earlier, the Affordable Care Act requires everyone to have coverage under  or if they face a tax penalty. Not just any kind of coverage. They need a qualified health plan, and there is a very specific definition for what is a qualified health plan. All you need to know is this  any plan offered through healthcare.gov or statebased marketplaces does qualify as a qualified health plan. It is not allowed to be sold if it is not. So in terms of these QHPs though, it is important that we're taking a look at some of these specific issues that they have. So is there a current  is your current doctor in the QHP's network? There is a lot of these networks, insurance companies as a way to save money, they try to narrow the networks and make it so they  it sort of reduces some of the administrative things they have, dealing with a few doctors, and they believe, therefore, it is a way to save money for  in terms of what they pay if they limit their networks. But what that does is sometimes doctors will not go  will not be in a network. And some of the stuff changes year to year. So just because a doctor was in a network one year doesn't mean they won't be in it next year. That's important to check to see if your doctor that you already see is in the plan's network. Another thing you need to think about is are other specialists that you will be seeing in your network. So not just maybe your primary care doctor, but also some of the specialists that you need. Maybe specialists that you don't see now, but you know you will need to see in the future. You need to be checking out to make sure there are other specialists that will be available. And if they  if they do have this network of providers, you really need to ask the question, what are the network of providers is sufficient. So for instance, if you have a specific issue you know you're going to need seek treatment for in the coming year and maybe you don't have that provider now, but you will need to see that doctor in the near future, you need to look at what the network of providers are for that particular specialist and whether or not that network of providers is sufficient. Maybe even going as far as to look at the network and the directory of physicians and calling around to them and asking are you accepting new patients, and if I am a new patient, how long do I have to wait for a new appointment. Some of those doctors have very long waiting lists or not even accepting new patients. Just because they are listed under directory doesn't mean they will be a doctor available to you if you are not already being seen by that particular practice. So it is something that's important to make sure network of providers is sufficient. That's especially true for the next few questions for the slide, which relates to mental health treatment and substance use disorder treatment. These are areas where sometimes they narrow the networks in terms of the providers that they do contract with. So if you are going to be seeking treatment for mental health or seeking treatment for substance a use disorder, then you really need to look at those networks, and decide if those networks are sufficient. Because lots of times, that becomes a problem for these particular plans, is they aren't necessarily always the  they aren't always the most robust in terms of how large the networks are. Some plans are better than others. Lots of times if you're looking at those options, then, that could be the difference between making a decision between one plan and another, and it might mean just paying a couple of bucks more am premiums, but if you know it is a bigger access, lots of times that peace of mind is worth it. In terms of some of the pharmacy benefits, there are some important questions that you want to consider. For instance, take a look at the drugs that you currently take and compare that with the plan's formulary. Make sure those drugs are included on the formulary and look to see where they are included. Because the next question here is also a very important one. That is looking at some of the tiered benefits that these plans have. Some of these prescription medication benefits does have some of these tiered benefits as a result, they have, you know, most people are familiar with generic and main brand tiers, whereas you try generic or a name brand drug, you're going to pay more for it. There is usually a third tier sometimes a fourth tier that deals with specialty drugs. The reason these tiers are important is because usually the copays for these different tiers are very, very different. And as you go up to the next tier, the copay usually goes up. So what you're paying out of your pocket to receive that drug is usually higher in those instances. So if your drug is on one of these higher tiers, either a name brand or even a specialty tier, then you're going to want to make some comparisons as it relates to what you will spend the year for that particular drug. You're going to want to take a look at things like deductibles and copays associated with these and decide if moving up to a more expensive plan may be beneficial to you. It is important to note that some of these pharmacy designs really do unfortunately end up sort of discriminating against people with disabilities the way they design the pharmaceuticals. For instance, the national multiple sclerosis society, and they are keenly aware of this issue, and they are always telling me about the fact that the drugs that are used to  the primary drugs used to treat multiple sclerosis are on specialty tiers, and as a result of that, their outofpocket costs for a lot of these individuals can get very high. Now, some of these organizations do have and some even drug companies do have plans where you can get some assistance with this stuff, but nothing directly through other than what the insurance covers that is available through the marketplace. The only thing available on the marketplace for this kind of thing is the specifically what would be built into the plan in terms of copay and what the insurance pays and then things that we'll get into cost share reductions that we'll get into later. For the most part, there is really limited in the marketplace what can help these folks cover some of these more expensive drugs. So lots of times, thinking about what the person is paying a month in their drugs, sometimes it does benefit to move up to a higher coverage and a higher premium amount than what they're paying every month, because the savings they'll make in outofpocket costs far outweigh what they will pay the extra amount in premiums. It is important that you're looking at all of these pieces when looking at a plan. The other thing you need to ask about is whether the plan requires preauthorization for medications, and what I mean by that is especially if you're new to a plan, a plan may want a doctor to get authority from them before they are able to cover it, and that's one of those things that you're going to want to make sure that if there is preauthorization required, that you have an adequate amount that that preauthorization isn't going to delay you in having  and then forcing to you have a gap where you're out of meds. So if for instance, you're going to be running out of that medication soon and you are on a new plan, you really need to think about whether or not you need to be seeking that preauthorization before you get too close to when you're going to run out of the drug. It could require or it could result in a delay, and talk to your doctor about submitting that for the health insurance company so you get preauthorized so the pharmacy could fill it in a timely way, it is really important. The other thing that sort of goes right along these lines is whether or not plans require a patient to try a generic drug first, commonly known as step therapy. What a health insurance will say if there are two drugs that could really treat a condition, and one of them is a generic drug and the other is name brand, they may require you to try the generic one first. If you you've done that before, and you tried the generic before and you know it doesn't work, you may want to look at whether or not the qualified health plan requires these types of things, because if there is that type of requirement for step therapy, then that's something you're going to want to really try and  it may be a plan that you don't want to work  you don't want to sign up for, or if you do, you may want to be talking to them immediately about the fact that you have tried this before, so there is not delays when you do try to get that drug refilled. Some other things that people with disabilities lots of times use, a lot of different therapies they use, so this is also important. We talk about the preauthorization for drugs. This is important for rehabilitation and habilitation therapies. Making sure there is not a delayin getting the therapy done, and being able to maintain that you're able to still have that therapy and there is not some sort of preauthorization that's going to hold that up. So if there is something like that you want to make sure you're doing that well in advance so there are not delays in getting the therapies you need. Then you also want to ask the question whether the qualified health plan treats rehabilitation and habilitation. Lots of people understand the different between rehab and hab, but those who are not fab with those two different things, lots of times it is  I like to talk about it with rehabilitation and habilitation, you are talking about the same kind of service, but it is when you need it. Rehabilitation is acquiring a skill that you lost, you had at one point, you lost it. Habilitation is trying to gain the skill that you never had. So for instance, for a child who has had trouble walking in the past, getting physical therapy and helping them learn how to walk if they're behind developmentally in these areas and need special physical therapy to help them learn this, that would be habilitation. Versus that same therapy could be given to someone that's older in life and maybe they have a stroke, and they shall  so they lose their ability to walk they had before, that same, even though it is the same provider, providing the same service, that instance, it is rehabilitation as opposed to habilitation. So when you have those differences, lots of times, even though it is the same provider, providing the same services, the insurance companies look at them differently and they are unfortunately lots of times much more willing to pay for rehabilitation than they are habilitation, and it is unfortunate that that's the case, but lots of times, that is the case. So if you are in a situation where you're going to need habilitation therapies or maybe the person you are assisting has a child that's going to need habilitation therapy, really understanding how that qualified health plan deals with those types of issues is very important and understanding how they're going to deal with it is going to be very important. The next question is really important for these benefits as well, and that's whether or not the qualified health plan puts limits on these visits. And there is important distinction, the Affordable Care Act, people are familiar with the fact that they did away with monetary caps on health insurance plans. So as a result, health insurance companies are no longer able to limit the amount of money they spend on an individual in terms was their care. But that's important. It is a monetary cap. Not a service cap. They are still allowed to cap services. So they can limit the number of visits, for instance, that you get for rehabilitation. So as a result, lots of times these things are even based on some of the things that are going to happen to the average person. So for instance, if someone breaks their leg and needs to go to physical therapy and regain the use of that, that physical therapy is going to have sort of a pretty much everyone knows about how long  obviously it is different for every individual, but they have a basic individual of how long it will take in terms of physical therapy and the rehab visits, a number of rehab visited that will be needed. That's not always the case with people with disabilities, who sometimes need these services for basic maintenance of what they're doing. People that have ability limitations that really need to go to physical therapy to maintain the use of their legs that they do have, that's sometimes a very important and lots of times they can't have a limit on that, because if they do, it defeats the purpose. They need to be able to continue to go to that for it to have any lasting effect. And therefore, some of those limits could be problematic. Understanding those limits is very important. You really need to be thinking about that as it relates to those individuals. And obviously that applies for rehab and habilitation, because a lot of those are going to be very identical in terms of, you know, understanding what the person is going to really need and whether or not a limit could be problematic for that person. One of the qualified health plan covers other therapies, maybe nontraditional therapies, some people need medical massage for conditions, pain they have. Some people need acupuncture for pain they have. Other conditions they have. Some of these nontraditional therapies, you're going to want to make sure the qualified health plan covers these and how they cover them and if they're covered differently than they are for other therapies. Understanding all of the needs the individual has, whether the qualified health plan covers them, and if they do, how they cover them, as it relates to outofpocket expenses is very important. Whether the qualified health plan covers other supports, whether it is transportation or anything like that in terms of getting to and from appointments. I could tell you that the vast majority of these health plans aren't going to cover stuff like that. And to this date, Medicaid is still probably the best in terms of covering a lot of those types of areas and those types of things. So it is important to know that for the purposes of the  when you're helping those individuals and sometimes if they can qualify for Medicaid, then, they're better off with the Medicaid plan because of the extra services and supports it will provide in those areas. But some, finding out if an insurance company would cover something like that could be very important, because a person that needs to get to an appointment but has a transportation issue, if there is no other sort of transportation possibilities for that individual, qualified health plan may cover it, unlikely, but they may, and it is something you can look into it. Let's talk about the next area, which is equipment, and really what gets covered by a health plan as it relates to equipment. So for instance, does the qualified health plan cover durable medical equipment? Disposable medical supplies, prosthetics, all these three areas are obviously very different, and the Affordable Care Act does require every qualified health plan to cover ten essential health benefits in these ten essential health benefits are medical devices. Medical devices has never been a defined term by the federal government. Some states have defined it, but some states haven't. In some instances, what a med device is will vary from state to state and in some states, it may vary from plan to plan. Understanding how your state defines the medical device and what it covers is going to be very important, because obviously durable medical equipment is very different than medical supplies, and prosthetics and the way all those are covered are very different. So understanding exactly what it is that is covered by those plans for these individuals is something that you are going want to make sure you understand, and also what costs are associated to the person and the person that is signing up for the coverage, because once again, the outofpocket costs could become very problematic for an individual if they're signing up for coverage, and they need to do power wheelchair and if they've got a high deductible, they may pay thousands of dollars to help get the chair that they're not prepared to pay out. So that's also a very important part, a very component to understand how all that plays into it. Then as it relates to stuff like, you know, power wheelchairs and those types of things, does it cover durable medical equipment and repair. Does it cover that? You have a power wheelchair, if something breaks, does it cover that. If it breaks down beyond repair, will it cover the replacement of that? All these things are important in understanding what limitations are in some of these plans is important. I mentioned on this slide prosthetics, you know, whether there is limits problems stet particulars and how many it covers. You've heard some of strange, you know, plans where there is instances where it covers one limb per lifetime. That's very problematic for a lot of different reasons. Number one, if someone loses both their legs, it is problematic, but only if one leg is lost, what happens when they need a replacement or if it is a child and they're growing out it. Understand what it is you're purchasing and making sure it will cover the needs is very important. Let's talk about some other  some other considerations that people need to think about when choosing their health plan. If they are already covered by a health plan on the health exchange, then you really need to ask about reenrollment. Automatic, a lot of people will opt into automatic reenrollment, so they're automatically reenrolled and if the plan they had before is working for them, and it is going to be offered again in the coming year, then really, you don't have to worry about anything. It will be reenrolled and you don't have do anything and they're going to be enrolled in the new plan. But you have to make sure they were signed up for that and if they are going to be reenrolled. There is really nothing else that needs to be done. If  but if they are going to be automatically reenrolled and in a plan they don't like, then you really need to make sure you're taking action before December 15th because if you don't, then there is going to be automatically reenrolled in the plan and have to live with it for another year. Or if the individual is in a plan that's being discontinued, a lot of these  most of the states will have a situation where the person could be automatically reenrolled in a similar plan. Well, a similar plan will talk about premiums versus deductibles and those things. They may not look at the specific issues that I've been talking about for the last bit on this Webinar. So if you're trying to make sure that the  all of these issues that you need to be taking care of are taken care of, if they were on the old plan but getting moved to a different company, you might want to look at that plan and make sure it will cover everything, because if it is not, you may not want to be automatically reenrolled in the plans. Other things to think about are co-occurring conditions. Most people with disabilities don't just have one condition. They may have multiple conditions, and you don't want to get too focused on one and forget about the other. You want to make sure you're balancing out the needs of the individual, whether it is maybe physical needs as well as some maybe mental health or intellectual disability needs, and making sure you're covering all needs as it relates to healthcare coverage. Then you also have continuity of care issues in terms of changing plans, if that will affect the doctors that they're seeing, and that can sometimes create some problems in terms of going to see new providers and other things that go into that. So making sure that you're looking at those continuity of care issues and thinking about it, because if you deal  another reason why enrolling early sometimes is good because if you know will be a change, if you're enrolling early, you will know if a change is coming on January 1st, if you know that plan  that change is coming, you can start to do the legwork ahead of a time and make sure you get an appointment with the doctor early on in January so you can get on that doctor's radar so you can get your prescriptions written, get your drugs filled, whatever it is you need, and make sure there is no break in that continuity of care. The other issue is the treatment of mental versus physical health. And you know, there is an act was passed in 2008 mental health parity act, required all large group plans to deal with physical and mental health on par. So if they put limits on physical health, in other words, physical therapy, rehab, something like that, if they put limits on that, they could put the same kind of limitations on their mental health therapy treatments. But if they didn't have any caps on those services, then they couldn't put caps on mental health services. So that was very important for the large group plans that were offered then. If you do have  if you don't have that  if you don't have that kind of coverage, you weren't protected under that act. The Affordable Care Act expanded it to the small group market, as well as the individual market. So plans that are now offered on the exchange do have to have these same kind of parity where they deal with physical health and mental health at the same level. So any caps that they put on one have to be the same as the other. Also, figuring out what a plan covers. Plan transparency is an important area I talked a lot about issues here and talk about covering this, and obviously, you know, finding out how the plan  whether the plan covers it will be very important and understanding that. That's why I really highlighted the first three fact sheets earlier on. Because those really will help you get answers to the questions. But I always like to give my own explanation of this. Because I use the power wheelchair so that when the Affordable Care Act first started being implemented in 2013, I went on the Maryland exchange where I live and I decided to see if I could find out if a different plans on there would cover, you know, durable medical equipment and specifically, my chair and if I need today have it repaired, replaced, what would happen with that. And in looking through all of that, I had a hard time finding the answers to those questions. Now, if I knew to ask those questions, and I had a hard time getting the answers to those questions, imagine how much more in the dark someone will be if they don't know they need to ask the questions in the first place. Make an educated decision about this, and really trying to figure out what is covered in this area. There have been advancements that have been made in the area of planned transparency as a result of the first few years, so we are a little better off than we were when it first started in 2013 and some states have put some specific guidelines in place in terms of what has to be covered, and what has to be disclosed ahead of time. Really, sometimes finding those answers isn't as easy as you think. Thinking about Medicaid as an option for an individual, and whether or not that is going to be something that that individual can apply for is always important. I've been talking throughout this Webinar about the whole concept of premiums versus outofpocket costs. Really understanding the difference of those and trying to figure out exactly what is covered in those areas, and whether or not an individual is better off sort of paying a little bit more in a monthly premium so their outofpocket costs are less. That sometimes is very important to these individuals, and understanding exactly what their needs are and understanding what those outofpocket costs could be is important. There is lots of calculators on the internet, Kaiser family foundation has one, where you could go there and input some basic data in terms of what  what your medical needs are in terms of how times you see a doctor, what your drugs are and it gives you a better idea what your total monthly costs will be so you have an idea whether you are in that group that should be thinking about paying a higher premium. So trying to see what you can do to find those resources that are available and they could be very helpful to really trying to help individuals make those kind of decisions. Then we also talk about individuals that are transitioning to Medicare, both in terms of if they're older, maybe retired early and trying to bridge themselves into Medicare or for folks that maybe have qualified for Social Security disability and looking for something that will bridge them in that 24month waiting period they have, if they have some of those months that they've got to cover, what can that individual do to sort of work transition to Medicare. Those are other things that those folks that really need to think about as well. Now, let's talk a little bit about some of the financial assistance that's available to the individuals that are shopping for coverage on the marketplace. These are what we refer to as the advanced premium tax credits or AP it. C. Premiums are paid directly by the government to the insurance company. So when you are receiving a tax credit, it is actually dollars that you never see. It is paid directly by the IRS to the insurance company. If you go on healthcare.gov, put in all your information in, and they say congratulations, you get X dollars per month. That's not money you will see. That's money that the government will pay directly to the insurance company you choose for the plan you enroll in. So that's paid directly to them. It is based on your income. And it is also based on some gee graphic considerations, because so if you hear about someone that is making the same amount as you, live in a different part of the state that you do, lots of times it will be different, because it is based on the amount of premiums that someone has to pay for a silver plan in that area. So an individual is looking at different plans, it is going to  those tax credits are going to be based on the amount of those premiums. So that's why it might, the tax credits available might differ from state to state, even if the person is making the same amount of money. That's why the special enrollment period becomes important if you move to a different part of the state, because sometimes you qualify for coverage if it is more expensive, that results in premium tax credits going up. 100% to 400% to the federal poverty level and you cannot claim the advanced premium tax credit if coverage is available through other means as long as it is affordable. So for instance, if your employer offers insurance that is considered affordable you cannot claim the advanced premium tax credit and get credit on the marketplace. There are instances where some of the employer based insurance is not considered affordable, because of the income that you've made and then you would be eligible for it. So just because you have that offered to you doesn't necessarily mean you're automatically disqualified from the premium tax credits, but if it is considered affordable, that has to do with how much of the percentage of your income it takes. There is an exact amount, but roughly 10% of your income, if what your employer requires you to pay exceeds 10%, it is considered not affordable and you could be eligible to receive the premium tax credits that are available under the Affordable Care Act. Let's talk about some of those out of pocket costs and some of the things that they are different to pay for especially for lower income folks. So cost sharing reductions are something else you may have heard a lot about in the news lately. They are designed to help low income individuals pay without of pocket costs, such as deductibles and copays, they are paid by the government to the insurance company. The person that receives the benefit is never actually seeing those dollars. Once again, it is based on your inspecting. It is available to people that are between 100% and 250% of federal poverty level. So not everyone that receives it is available. It is only the folks on the lower end of the spectrum that do. If you are on the lower end of that spectrum, you must be enrolled in a silver plan or higher that is eligible for cost sharing reduction. If you enroll in a bronze plan and you would qualify for cost sharing reductions, you can't receive them if you're on a bronze plan. And that has to do with the outofpocket costs you have to spend. Bronze is cheaper, but out of pocket is higher. So when you go on to the silver plan, the premiums do go up a little bit, but the outofpocket costs go way down. And then the government will even help pay for some of the cost sharing reductions if you do fall into this window for it. So that's very important. Now, it is important to note that these are written into the Affordable Care Act, but they have been subject to the politics of the ACA I'll call it. And obviously, I don't want to get too much in the politics of the Affordable Care Act and who has done what, but there was an issue in the Obama administration with paying for these cost sharing reductions, because congress hadn't appropriated funds for it. And the Obama administration continued to pay for it, with other Obamacare funds. And congress basically filed a lawsuit to stop those, and now the Trump administration is in place, this he have been paying the CSRs for the first few months, but if you heard recently, the beginning of the October, the president announced they were going to discontinue payment of the cost sharing reductions, and there is a lot of maneuvering going on around this particular issue, a lot of the talk you heard by partisan bill that came out between senators Alexander and Murray. One of the main things it deals with funding these cost sharing reductions. So if I were going to make my best guess, I think the CSRs will continue to be available, but you should know they will be subject to the politics of the Affordable Care Act and therefore could be a benefit that would go away if that is not something that gets resolved. Some other changes that are coming up for the affordable  for the affordable care act and coverage for 2018 and beyond. Some things that didn't exist before in 2018 and beyond, insurance companies are going to be denied coverage if you have an outstanding balance on premiums from a prior year, or probably a better way to say it is this. If you have an outstanding balance, what you think is your first payment for your 2018 coverage, it is actually going to get applied to your 2017 coverage. Therefore, if you don't make your first payment for 2018, that's the thing that is the final step you need to effectuate your enrollment and it will not go toward that coverage and that coverage will never go into place. If you have an outstanding balance, that's something you want to check on to make sure. Now, there are some rules that will be very unlikely to happen this year, because of the way that all the  this is new that the new administration has put into place, the prior administration did not do. So the insurance companies are going to have to let you know they're going to do that, not knowing if that was an option, they probably didn't. This is probably not going to apply until 2018 into 2019, but it could be something that would become problematic. If do you have back balance on a premium that you have to an insurance company, you wants to check to see if you're making that first payment, it really is going toward your 2018 coverage, because if it is not, then that could mean that your 2018 coverage does not get put in place. Understanding that's very important. Another change that's in place already, some of the things that are approved for eligibility for special enrollment. Different requirements of different proof in terms of what you have to do to show that you're eligible for a special enrollment period, making sure you've got that documentation. Also, when you're enrolling in an SEP, you are no longer be able to change metal levels, a special enrollment comes about, you get married and you want to add your spouse, you cannot now change levels of metal coverage because of that. You've got to stay on the prior plan. The prior metal level. You can change plans within the metal level, but you cannot change to a higher metal level. There is also going to potentially be an allowance for association health plans, which could take people out of the marketplace, and potentially create some instability in the marketplace which could cause premiums to go up and allowance for shortterm policies which could potentially do the same thing I want to stay out of the politics of that, but it is important to know that all of those things could be in place because as you are going forward, if you do see some premiums really going up, it could be tied to one of these potential issues. And then something else that I didn't include on this for purpose of as I'm thinking about, what Richard brought up earlier, enrolling often, they are going to be times that the administration has already announced that healthcare.gov will not be available. It will not be available for a period of time, mostly it is going to on overnight hours, but it will be basically for 12 hours on Sunday. It is not going to be available. That's for pretty much every Sunday of open enrollment. I think except for the last one. And they're saying that's for maintenance it will be down for the 12 hours, but just know that. As you're trying to enroll, if you're doing that, there could be outages on a Sunday overnight if you don't have that. There is information out there on our Website, some of the news items that we've put out there if you want more specific information on that. But that is something else that could potentially cause delays for individuals, and that's why once again, it is important that people are make sure they enroll in the coverage early, and not wait because as it gets closer and closer, some of those outages may cause backup and that could cause problems for Website. The last thing I do want to point out is some other resources you can check out. We have two new contracts that we just started on that we're working with, we're working with community catalyst on a project that is really aimed at helping with outreach enrollment efforts, and really trying to promote outreach for those individuals that are going to be working to, you know, get people to enroll in health insurance. So we've got a lot of information that we're putting out. We're working with the center on budget and priorities, understanding what it is they need to know to help people for people with disabilities enroll. Center budget, beyond the basics Webinar series they've done, where they've dealt with a lot of different topics, but they've dealt with a lot of different topics, a lot of it is technical issues relates to immigration status, so if any of those are of interest to you and you want to learn more about it, check that out. If you are going to be helping people navigate the health insurance marketplace and you want to have some sort of handy guide of a how to and sort of a very Q & A thing that will help you get quick answers to questions, I would encourage you to check out the Georgetown university center on health insurance reforms navigator. The other one, get America covered, making sure people are aware what's available to them. So that's another project that has a lot of resources available as well. At this point, I think we are going to open it up for more questions. And I think we can also, at this point, Carol, you can correct me if I'm wrong, we can ask them about doing the survey as well. >> That's right. We do have one question, an open question. If anybody else would like to, feel free to open up that Q & A tab and submit your question. Yes, I've also posted the evaluation survey into the chat. We have a question that is how do you apply for advance premium tax credits? >> The tax credits are applied through the marketplace. You have to go on the healthcare.gov or if it is statebased exchange, and as part of the application process, it asks you information about income and it will ask you, you know, if you've  you obviously give proof of that income and there are ways to do data matching. If you give them permission, it can check with the IRS database as it relates to your income level. It will tell you as you're going through that process, congratulations, you qualify for advance premium tax credit at that amounts to, and it might be say $150 a month or something like that. And that will tell you, and then when you're looking at plans, it will show you what the premium is and what the premium you'll pay after your premium tax credit is applied to it. >> We don't have any questions right now. Anybody is thinking for a lastminute question. We'll give you another moment. While we're waiting to see if we have any more questions, we do appreciate your taking the time today to go to our link here that is on the screen, and also, the link is pasted in the chat that will take you to our evaluation survey. We do, really do take it seriously. We like your feedback in order to improve our programs. So please do that, if you would. Okay, any more questions? I don't see anymore. Okay. Any other comments, Richard, Karl, before we go? >> The only thing I'll say is on the very  the title slide of this, my email address was there, if anyone has questions, by all means, please reach out to me and feel free to send me an email, if you have any questions I'm happy to help you out. If I don't know the answer, I'll refer you to someone that will. If you've got questions as you're going through open enrollment, we're here to help, and we're happy to answer any questions you may have that maybe you think about after the fact. >> Wonderful. >> Karl, thank you. And it has been a great Webinar. We appreciate you doing this. Carol, thank you. Certainly, as Karl said, reach out directly to him. You can also reach out to us at the CHRIL.org Website. We can answer questions there. So we would be happy to hear from you. Thanks to CILS for the work you're doing and helping people to get registered for this open enrollment period for this coming year. Karl, thanks again. >> Thanks, everybody. Bye.