Updated Resources for Open Enrollment

The next season of Marketplace Open Enrollment is about to start on November 1, 2024 on Healthcare.gov! People who want to sign up for comprehensive health coverage have until January 15, 2025 at midnight to complete the sign-up process. Those who enroll by December 15^th will be able to start using their insurance on January 1, 2025. Later enrollees can begin using their coverage on February 1, 2025. Outside of this window, consumers may also qualify for a Special Enrollment Period  with qualifying life events, like a change in household or residence, or the loss of other health coverage. For those that qualify, Medicaid enrollment happens year-round.

For Navigators and other enrollment specialists, AAHD is proud to offer updated resources that support people with disabilities to get the healthcare they need. This fall, AAHD updated our catalog of enrollment guides with the National Disability Navigator Resource Collaborative (NDNRC). These 21 fact sheets have been updated and are available for Navigators supporting people with disabilities with common insurance questions:

• Factsheet 1 – Comparing Health Plans’ Benefits and Coverage Summaries
  • What is the “Summary of Benefits and Coverage? How much will I pay out of pocket for the care, equipment, and services I need? This fact sheet reviews common questions about benefits and coverage available through the Health Insurance Marketplace.

• Factsheet 2 – Getting and Using Health Plan Evidence of Coverage
  • An Evidence of Coverage document details the benefits in a health insurance plan. This fact sheet reviews how to access and use these documents when considering which Marketplace health insurance plan to buy.

• Factsheet 3 – Using Health Plan Customer Services to Learn Scope of Coverage
  • This fact sheet answers questions about the role Marketplace health plan customer services can play when using your coverage.

• Factsheet 4 – Rehabilitation and Habilitation Services and Devices
  • What kinds of services qualify as rehabilitative or habilitative care? Will my Durable Medical Equipment be included in my device coverage?  Are there limits to what my plan will cover? This fact sheet answers questions about rehabilitation and habilitation services and device benefits available through the Marketplace.
• Factsheet 5 – Prescription Medication Benefits
  • Will my plan cover the prescription drugs I need? Is my current pharmacy in-network with this plan? How do the tiered benefits work in pharmacy benefit plans, and how does this affect how I access the medications I need? This fact sheet answers questions about prescription medication benefits available through the Marketplace
• Factsheet 6 – Supporting Collaborations between Navigators, Connectors and Assisters, and Local Disability and Affinity Organizations
  • This fact sheet reviews the importance of identifying and building relationships with local disability and affinity organizations to support people with disabilities in accessing other relevant benefits. Learn more about the ways you can collaborate with local organizations to support enrollment, with a summary of key organizations by type.
• Factsheet 7 – Mental Health and Substance Use Disorder Parity
  • What mental health and substance use disorder benefits are available through the Marketplace? Learn about the mental health parity law and the benefits required for all plans serving people with mental health and substance use.
• Factsheet 8 – Medically Frail Status as an Exemption to Receiving Medicaid Alternative Benefit Plan with Essential Health Benefits
  • How does qualifying for a “medically frail” status help someone access the right coverage? This fact sheet answers questions consumers might have if their exchange application indicates that they potentially qualify for enrollment in their state’s Medicaid expansion.  These individuals may have health conditions that qualify them as “medically frail” or another category that is exempt from enrollment in the Alternative Benefit Plans (ABP) with essential health benefits that will be provided to individuals in the Medicaid expansion population.  Fitting within an exemption category could be very important for some people with disabilities who would benefit from a potentially different array of services and treatments available under traditional Medicaid, and who may have not qualified for Medicaid before under traditional eligibility rules.  If you are in a state that has chosen not to expand its Medicaid program, the information here may still be useful to callers with disabilities who did not realize they are eligible for traditional Medicaid in their state.
• Factsheet 9 – Streamlined Marketplace Application Process
  • What is the application process like for enrolling in Marketplace coverage? What kinds of accommodations and supports are available to navigate the process with a disability? This fact sheet answers questions about the application process.
• Factsheet 10 – Medical Supplies Benefits
  • Which medical supplies are available through Marketplace plans beyond what’s covered by rehabilitative and habilitative care and device coverage for Durable Medical Equipment? Learn about common questions people might have around benefits for their medical supply needs.
• Factsheet 11 – Civil Rights of People with Disabilities under the Americans with Disabilities Act and Section 504 and Section 508 of the Rehabilitation Act
  • This fact sheet reviews key disability rights laws that impact the enrollment process for people with disabilities. Many participants in the Marketplace need reasonable accommodations or policy modifications from Navigators, Assistors and Certified Application Counselors. This practical guide will help Navigators evaluate how to best help consumers with various disabilities to participate fully, privately and independently in all aspects of the Marketplace, including federally funded consumer assistance programs and activities.
• Factsheet 12 – Process for Medicaid Eligibility
  • How do I qualify for Medicaid? What is Medicaid expansion, and is that available in my state? If I qualify for Medicaid, when should I enroll in a Marketplace plan instead? This fact sheet answers common questions that consumers might have about their Medicaid eligibility when enrolling in coverage.
• Factsheet 13 – Referral and Resource Lists
  • What other resources are available for people with disabilities making decisions about their healthcare coverage? This fact sheet offers some additional community supports and considerations for assisting people.
• Factsheet 14 – Medicaid Home and Community-Based Services Waiver Waiting Lists
  • What is a HCBS Waiver? This fact sheet is intended to provide Navigators, Assisters and Certified Application Counselors with information about people with disabilities who are on the Medicaid Home and Community-Based Services (HCBS) Waiver waiting list.  HCBS waiver recipients and their families can seek health insurance through the Marketplace or through Medicaid expansion if that is occurring in their state. Many will have concerns about continuity of care and other issues that are common to many people with disabilities, as well as a few issues that are unique to potential HCBS waiver recipients

• Factsheet 15 – Medicaid Buy-In

• • What is the Medicaid Buy-In program, and how does it support people with employment? This fact sheet answers questions about Medicaid Buy-In as a coverage option for people with disabilities. The Buy-In program is an optional Medicaid coverage group for working individuals with disabilities.
• Factsheet 16 – Moving from Coverage-to-Care for People with Disabilities
  • What is the Coverage to Care Initiative? What are the steps recommended to prepare to access care with your insurance? This fact sheet reviews the ways that coverage can be used through the Coverage to Care model.
• Factsheet 17 – Disability Etiquette
  • What should a navigator know about interacting with people who have a range of disabilities? This fact sheet provides an overview of tips for communicating more effectively with people with disabilities as they complete ACA enrollment.
• Factsheet 18 – Renewals and Redeterminations
  • How does the annual renewal process work for a Marketplace plan? Will I still be eligible for premium tax credits? This fact sheet reviews some common questions that come up during the renewal and redetermination process, with a focus on renewal considerations that an assister needs to know to support consumers with disabilities.
• Factsheet 19 – End of the Medicaid Continuous Coverage Requirement
  • This fact sheet reviews key information that people with disabilities need to know about the end of the Medicaid Continuous Coverage Requirement, which had been in effect since the start of the COVID-19 pandemic and ended in 2023.
• Factsheet 20 – Assisting Consumers with Communication Needs
  • Consumers with communication-related needs might require sign language interpreters, large print materials, captioning, or other assistive devices during their enrollment meetings. This fact sheet reviews best practices in supporting people with communication-related disabilities.
• Factsheet 21 – Special Enrollment Periods
  • Does acquiring a disability qualify as a special enrollment period for a Marketplace plan? This fact sheet reviews common questions about the circumstances that allow someone to sign up for coverage outside of the annual Open Enrollment period.

*The American Association on Health and Disability would like to acknowledge the Robert Wood Johnson Foundation for initially funding the NDNRC project and the Center on Budget and Policy Priorities for providing the resources to help us update and re-release these fact sheets.