Access to Care & Treatments
Healthcare Reform and You
In March 2010, the President of the United States signed into law the Patient Protection and Affordable Care Act (ACA). This legislation introduced major reforms to the US health care system aimed at expanding coverage and increasing affordability for uninsured and underinsured Americans. Key features of the ACA include:
- No pre-existing condition denials for children and adults
- Health Insurance Marketplaces, also known as exchanges, where individuals and small business can shop for health plans that must cover essential health benefits
- Insurance tax credits for individuals with incomes between 100 and 400 percent of the Federal Poverty Level to help pay for health care premiums
- Federal funding to encourage states to expand Medicaid coverage to childless adults with incomes up to 133 percent of the Federal Poverty Level
- Coverage for young adults on their parent's plans up to the age of 26
- Reduced cost-sharing for prescription drugs in Medicare Part D's "Donut Hole"
- Penalties for individuals who fail to obtain and maintain health insurance coverage
People living with epilepsy who've had a hard time securing affordable health insurance because of pre-existing conditions can now purchase health plans through the health insurance marketplaces, and may even qualify for government assistance to cover the cost of premiums. Read more about the ACA here.
Getting Started in the Marketplace
What is the Health Insurance Marketplace?
Health Insurance Marketplaces offer a choice of different health plans for individuals and families can shop for coverage if they need to buy health insurance on their own. Premium and cost sharing subsidies are available for low income individuals and families. Individuals and families with very low incomes will also be able to find out at the marketplace if they are eligible for coverage through Medicaid and CHIP. Small businesses can also buy coverage for their employees through the Small Business Health Options Program (SHOP) Marketplace.
How do I Access my State's Health Insurance Marketplace?
Everyone can access their state's Health Insurance Marketplace, whether it is run by the federal government or by their state, at www.healthcare.gov. Some marketplaces are operated by the state and have a special state name, while in other states which chose not to set up and operate their own marketplace, the federal government is running the marketplace.
How do I Compare and Select a Plan?
The Epilepsy Foundation has designed a checklist to help individualsevaluate their health care needs and compare plans offered on the marketplace. When choosing a plan, individuals should be looking not just at premiums but also at other factors like the formulary and cost sharing requirements, which will impact access to care and total costs. Click here to view the checklist.
Who Can Help Me Navigate the Enrollment Process?
There are Navigators and other groups and individuals certified to help with enrollment questions in every state. If you have questions about the marketplace you can reach out to your state's Navigators. These organizations have staff who can provide one-on-one help to individuals navigating the new health insurance marketplaces. There are other community groups who can help you, including In-Person Assistors, Certified Application Counselors and insurance brokers. Click here to view the list of Navigators in your state.
Frequently Asked Questions
The Kaiser Family Foundation has put together a list of questions and answers to help you understand how the ACA impacts you, From basic questions about what is the marketplace to more complex questions about eligibility and coverage, these FAQs cover all aspects of the ACA.
Health Reform and You: A User's Guide to Health Insurance Marketplaces
The National Patient Advocate Foundation has published a guide intended to help individuals understand the new Health Insurance Marketplaces and determine what coverage is right for them and their family. View the publication, which includes an introduction to health insurance and the marketplaces; and information on enrollment, affordability, plan options and more.
Find your Marketplace In Your State
Healthcare.gov has designed a site that will help navigate you to the right marketplace website for your state.
Prescription Drug Coverage
This is a set of fact sheets for 19 states and the District of Columbia detailing their prescription drug coverage across the new marketplace plans. If you live in one of these covered areas these sheets will help you get an in depth look at the prescription plans. If not, you can use these sheets to get an idea of what drug coverage looks like throughout the country and know what to look for in your own state.
Epilepsy Foundation Comments on ACA
Patient Protection and Affordable Care Act
On Friday, December 21, 2012 the Epilepsy Foundation submitted official written comments to Secretary of Health and Human Services Kathleen Sebelius on the Standards Related to Essential Health Benefits, Acutarial Value, and Accreditation encouraging her to improve federal oversight with the benchmark plans. By doing so Secretary Sebelius would be able to ensure that those living with epilepsy are able to access the appropriate level of care without an undue burden.The Foundation also provided comments on the Health Insurance Market Rules; Rate Review to encourage the Department of Health and Human Services to eliminate financial disincentives that could make it more difficult for someone with a disability to acquire insurance.
Epilepsy Foundation Comments
We look forward to the expanded care and benefits that will be provided through the ACA for the millions living with epilepsy, and the Foundation urges HHS to research and clearly address, in policy, the numerous hurdles and restrictions that come with chronic disorders like epilepsy within health care insurance systems.
Epilepsy Foundation comments to the Deputy Administrator and Director of the Center for Consumer Information and Insurance Oversight on essential health benefits under the ACA. We encouraged him to make the guidelines more thorough so we can ensure there will be adequate coverage under the new plans.
Epilepsy Foundation Writes to the Department of Labor and Department of Health and Human Services
Epilepsy Foundation comments to the Secretary of Labor and Secretary of Health and Human Services on clinical trials under the ACA. We asked the Secretaries to issue regulations regarding clinical trials so that we can ensure new health insurance plans will cover medical expenses for those participating in the trials.
Non-discrimination in Workplace Wellness Plans
On January 25, 2013, the Epilepsy Foundation joined 21 national disability groups on comments to the Department of Labor on proposed rules implementing the Affordable Care Act's (ACA) provision concerning non-discrimination in workplace wellness programs. While the proposed rules included some protections for consumers, the groups called for clear requirements that wellness programs must comply with the Americans with Disabilities Act. The groups recognize the potential of wellness programs to discriminate against individuals with disabilities, particularly with the use of financial incentives and penalties tied to health status that jeopardize employee's access to affordable, quality health care. Read the letter here.
Epilepsy Foundation Letters on the ACA
Essential Prescription Drug Coverage
On Tuesday, October 2, 2012, the Epilepsy Foundation joined a diverse group of 57 patient advocate organizations to deliver a letter to Secretary of Health and Human Services Kathleen Sebelius, urging the federal government to establish strong prescription drug requirements as part of any regulation that will define essential health benefits unde the Affordable Care Act (ACA). We also ask that the patient protections described in ACA that prevent plans from discriminating against patients, including those with disabilities, be published soon. Read the letter here.
The Epilepsy Foundation, American Academy of Neurology, and the American Epilepsy Society sent a joint disease organization letter to HHS Secretary Sebelius. The organizations urged the Department in its work on a Notice of Proposed Rulemaking (NPRM) on Essential Health Benefits (EHB) for state-based insurance exchanges under the Affordable Care Act, to at minimum adopt a structure similar to that of the Medicare Part D program in offering access to "all or substantially all" medications in six therapeutic classes affecting conditions such as cancer, HIV/AIDS, kidney disease, mental illness and epilepsy. Read the letter here
ACA in the Judiciary
The Supreme Court and the ACA
Epilepsy Foundation Advocacy on the ACA & Court Hearings
In the States: Find out more about what is going on with health insurance reform in your state.
www.healthcare.gov – Federal Web page for resources on health reform and health insurance needs
www.consumerreports.org/health/insurance/health-insurance.htm -- Online guide from Consumers Union on major marketplace reforms under the new health reform law
http://healthreform.kff.org/ -- Kaiser Family Foundation Health Reform Source online publication
The following link offers state specific information on health insurance laws, coverage, programs, and consumer issues: http://healthinsuranceinfo.net/getinsured/ -- Georgetown University Guide on Health Insurance