In order to help people with disabilities make informed decisions about their health care insurance, Navigators should understand how to assist consumers examine health plan options to determine if they will provide the required coverage and when consumers may be eligible for marketplace insurance subsidies. Moreover, Navigators should also understand when consumers are potentially eligible for traditional Medicaid, the Medicaid expansion, or other government healthcare coverage programs such as the Children’s Health Insurance Program (CHIP), and be able to explain those possibilities to consumers.
This determination is important because people with certain impairments will likely also have very specific healthcare services needs. Meeting these needs will depend upon a number of factors including cost and availability of specific benefits and services. For example, some people depend on a network of specialty providers such as rheumatologists, neurologists, endocrinologists, physiatrists (doctors who specialize in rehabilitative medicine), mental health and substance use providers, physical, occupational, and speech therapists, and equipment suppliers who specialize in mobility devices such as motorized wheelchairs or respiratory equipment such as ventilators.
Because people with disabilities often have long-standing relationships with providers who are familiar with their complex medical needs, it is particularly important that Navigators help consumers determine if these providers participate in the provider networks of any of the health plans that individuals are considering. In other cases, people with disabilities who do not have insurance but hope to obtain coverage through the Marketplace, may also require access to specific specialty providers, therapies, pharmacies, and suppliers. It will be important therefore to determine if such providers are available under the Marketplace plans being considered. Navigators should also urge people with disabilities who are eligible for Medicaid to contact their state Medicaid office to inquire if these providers accept Medicaid or are available through the contracted Medicaid health plans.
