Have you or your patients struggled to find or maintain health insurance? Job losses resulting in uncovered individuals and families, along with increasing health insurance costs, have prompted recent changes in the federal government that allow for additional avenues to obtain or retain health insurance.
Marketplace health insurance plans
The Health and Human Services Organization made it possible for the 36 states offering health insurance marketplace plans to provide a Special Enrollment Period, which took place from February 15, 2021, to May 15, 2021, on healthcare.gov. In addition, several states that operate their own marketplace platforms will also offer new enrollments outside the standard open enrollment period. This special enrollment period allows members to sign up without a qualifying event.
The American Rescue Plan Act
The American Rescue Plan Act of 2021 (ARP) was developed to help individuals eligible for COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation coverage. It was signed into law by President Biden on March 11, 2021. COBRA health insurance allows an individual who is no longer eligible for group health insurance due to job loss or reduced work hours to continue coverage under the group plan for a fee. Individuals who were covered for ABA group health insurance would also fall under this coverage.
The ARP also supports some beneficiaries seeking premium assistance, such as individual health insurance for ABA therapy. For Assistance Eligible Individuals, the premium is paid directly to the employer. The premium assistance program was offered from April 1, 2021, to September 30, 2021. Some individuals who previously declined or canceled COBRA coverage may be eligible to apply for this program. Refer to the Department of Labor (DOL) overview for full details.
How to qualify for health insurance with the special enrollment periods
Aside from commercial insurance coverage, many individuals and families may be eligible for Medicaid coverage due to either disability or income status. Most states are also expanding the availability of Medicaid programs. In most cases, Medicaid covers services at or near 100% with little or no out-of-pocket cost for the beneficiary with deductibles, copays, coinsurance, or even premium costs. Understanding what is a deductible in health insurance is crucial, as deductibles are part of the health insurance cost that beneficiaries must consider when selecting a plan. You can also check for ABA therapy insurance coverage with COBRA.
What the future holds
As of April 1, 2023, states will begin the Medicaid redetermination process, which forms part of the public health emergency unwinding. To stay ahead of any changes, it is recommended that individuals check if autism-related ABA therapy insurance coverage will be affected.
Get the best ABA billing and consulting at Missing Piece
Does insurance seem mind-boggling? Do you struggle with differentiating the facts and misconceptions behind ABA therapy billing? Understanding ABA health insurance plans and coverage can be stressful. Let Missing Piece help you with your revenue cycle management so that you can focus on ABA treatment plans and patient care. We offer a free consultation and unique solutions tailored to your company.
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References:
Department of Labor
Continuation of Health Coverage (COBRA)
FAQs on COBRA Continuation Health Coverage for Employers and Advisers
Healthcare.gov
Medicaid expansion & what it means for you
National Conference of State Legislatures: