Fall 2013, Volume 21, Number 4
The Affordable Care Act is about to move into high gear.
Starting October 1, 2013, Americans who are uninsured or who buy their own health insurance coverage will have a new, hassle-free way to shop for insurance: the Health Insurance Marketplace. The site provides easy-to-understand information about all coverage options for consumers.
To prepare for the Marketplace's opening, the Federal Government has revamped its HealthCare.gov website. (A Spanish version is available at CuidadoDeSalud.gov.) The government has also launched a new consumer call center: 800-318-2596.
"The new website and toll-free number have a simple mission: to make sure every American who needs health coverage has the information they need to make choices that are right for themselves and their families—or their businesses," said U.S. Health and Human Services Secretary Kathleen Sebelius.
The website has information about benefits and key deadlines, and describes how the new Marketplace will work. There are also new resources, videos, and checklists.
"Consumers can get a head start by beginning to explore their options now," said Suzanne C. Fields, M.S.W., L.I.C.S.W., SAMHSA's Senior Advisor to the Administrator for Health Care Financing.
All plans offered on the Marketplace must cover a comprehensive set of benefits, including physician visits, preventive care, hospital stays, prescriptions, and mental and substance use disorder services. The plans must also treat everyone fairly, meaning that discrimination against pre-existing conditions—such as mental and/or substance use disorders—will be banned.
The private companies offering coverage through the Marketplace offer a range of plans to suit consumers' budgets and meet their needs.
The Marketplace simplifies the search for health coverage by gathering all available options together in one place. Consumers can find out what they're eligible for by filling out a single application.
The application results will let consumers know if they can get lower costs on monthly premiums or lower out-of-pocket costs for private insurance plans. The application results will also tell consumers if they qualify for free or low-cost coverage through Medicaid or the Children's Health Insurance Program. Because they'll have a clear picture of what they'll pay and what benefits and protections they'll receive, consumers can then easily do "apples-to-apples" comparisons of their options based on price, benefits, quality, and other features.
Some states will be running their own Marketplace, where consumers can apply for coverage, compare plans, and enroll in coverage directly through their state's site.
Although the application process is designed to be very user-friendly, help is available to those who need it.
With the opening of the new toll-free call center (800-318-2596), consumers can now talk to trained customer service representatives 24 hours a day, seven days a week. Representatives will be able to provide information in both English and Spanish, and a language line can assist callers in more than 150 additional languages.
Consumers who need extra help exploring their options or completing the application can take advantage of several other types of assistance (see "How do I get help enrolling in the Marketplace?").
While enrollment begins in October, actual coverage begins as early as January 1, 2014.
Because of the Affordable Care Act, millions of Americans who are currently uninsured will soon have access to health coverage. "A lot of people are going to be eligible for the first time," said Kevin J. Malone, a public health analyst in SAMHSA's Office of Policy, Planning, and Innovation. Lack of familiarity with health insurance is just one potential challenge to understanding the new options and enrolling. Some people may also have language barriers, behavioral health issues, or other concerns that may make obtaining coverage challenging.
"Fortunately," said Mr. Malone, "the U.S. Department of Health and Human Services is doing everything it can to ensure that everyone understands the options and enrolls easily."
The new Health Insurance Marketplace, for example, offers one-stop-shopping that helps consumers determine what coverage they're eligible for, easily compare their options, and enroll in a plan with an easy-to-use application. "Navigators," "assisters," and other helpers will be available, and the Marketplace also includes a "live chat" feature to have questions answered immediately. Plus, the U.S. Centers for Medicare and Medicaid Services (CMS) created a broad range of materials for behavioral health treatment and service providers and other professionals to help those they serve. These resources are available on a new CMS Health Insurance Marketplace site.
Everyone in the behavioral health field can help in the effort to enroll people, said Kevin J. Malone, a public health analyst in SAMHSA's Office of Policy, Planning, and Innovation. "We want everyone to find a way to participate. There is a huge range of ways that people can be involved in spreading the word."
For providers, the new CMS Health Insurance Marketplace makes it easy. At the most basic level, you can help build awareness about the new coverage options and enrollment's opening on October 1. The site also offers an English or Spanish "widget" to link to the Marketplace for consumers, which can be embedded in websites, blogs, or social media postings. The site also has sample brochures, fact sheets, articles, and videos about the value of health insurance, the Marketplace, and more, which can be distributed or used in newsletters or on websites. There are also logos and graphics that can be used in your own materials.
You can also help people to enroll. If you are a mental and/or substance use disorder treatment and service provider, for example, you could encourage your intake staff to guide clients to the Health Insurance Marketplace, review their options, and start the application process.
People aren't on their own when it comes to enrollment, however. Consumers will have access to several different kinds of help:
In some states, agents and brokers can also help consumers explore options and get enrolled.
Organizations may serve as navigators and, although the first round of federal navigator grants has already been awarded, Mr. Malone predicts that there will be another round of funding.
In the meantime, the CMS website created for providers offers training materials that can help ensure staff knowledge of the ins and outs of health reform, the application process, and more.
SAMHSA is also helping its constituents help consumers. With its Enrollment Coalitions Initiative, for example, five coalitions have come together to promote effective dissemination of CMS materials: consumer, family, peer, and recovery community organizations; mental and/or substance use disorder treatment and service providers, criminal justice organizations; housing support and homeless service organizations; and community-based prevention organizations. (See "Providing Education on New Health Care Options" in the summer 2013 issue of SAMHSA News for more information.)
"Getting involved at whatever level you can will make a big difference," said Mr. Malone. "We want to make sure that people and organizations know that anything they do to help will be important."
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