By recognizing the activity limitations that flow from certain impairments, Navigators will be able to identify some of the types of accommodations people with disabilities require so they can participate in an informed manner in the process of making healthcare insurance selections. Navigators will also be better equipped to help people with disabilities select appropriate insurance coverage that meets their individual requirements.
Here are some examples of activity limitations that might be associated with specific impairments and conditions:
- Someone with a chronic condition such as arthritis may experience activity limitations such as difficulty walking, bending, or lifting. Why is this information important to Navigators?
- The person may require physical accessibility in order to access the building where the navigator is located
- The person may be receiving regular physical therapy or visiting a specialty provider such as a rheumatologist. She or he therefore will require insurance coverage that includes either current providers or comparable, equivalent providers within the same specialty, and affordable, ongoing access to physical therapy services
- The person may require a mobility device such as a walker or wheelchair, so she or he will need access to a durable medical equipment supplier that can provide the appropriate device as well as follow-on services that may be needed to maintain it
- Someone with a chronic condition such as diabetes or multiple sclerosis may have activity limitations related to seeing or mobility. Why is this information important to Navigators?
- The person may require physical accessibility in order to access the building where the navigator is located. She or he might also require printed materials in alternative, accessible formats such as digital or large print in order to gain access to and compare summaries of benefits and coverage for various plans and to determine if his or her preferred providers participate in any of the networks being offered.
- Someone with a cognitive impairment or an intellectual disability may experience activity limitations that affect understanding, remembering, and/or communicating. Why is this information important to Navigators?
- Navigators are required to ensure that information about health insurance options are presented in a manner that the person can understand.
- Navigators might need to spend additional time with this applicant in order to ensure that communication is clear and that the person has had sufficient time to ask questions or to process the information that has been provided.
- Navigator should be aware that the information might need to be presented in more than one format to be fully understood.
- Navigators should consider ways they could help memorialize the conversation for the person’s future reference, such as suggesting places where a person could take notes or offering to send an email with major discussion topics after the meeting, but only after having obtained the express consent of the person receiving the communication to use her or his email address,
- If a consumer with a cognitive impairment or developmental disability is accompanied by an authorized person who is facilitating communication, it might also be appropriate for the Navigator to provide that person with information regarding the major discussion topics, but only if they have obtained express permission to use her or his contact information.
- People with chronic conditions are likely to require periodic or ongoing treatment by multiple providers as well as care coordination. These providers likely have long-standing familiarity with this individual’s specific disability, therefore it will be important to determine if they participate in the networks of the plans she or he is considering. If this individual is eligible for Medicaid, the Navigator should assist her or him to understand how to evaluate the choices that may be available under the Medicaid program. (See “How is Medicaid eligibility being determined for people with disabilities?”)
- Someone with a neuro-degenerative condition such as muscular dystrophy or multiple sclerosis may have activity limitations related to walking, self-care, and/or communication. Why is this information important to Navigators?
- This person might use a mobility device such as a walker or wheelchair and therefore will require physical accessibility in the location where he or she will be meeting with the Navigator.
- She or he will likely need to consider insurance options that provide for access to suppliers who specialize in mobility equipment such as motorized wheelchairs, specialists such as neurologists, radiologists, and rehabilitation therapists for physical, occupational, and speech therapy. It will be important therefore to highlight and compare overall costs for the services, equipment, and medications in relation to premiums, co-pays, and deductibles.
- Some Benchmark plans, which states have chosen to guide the benefits available from insurance plans that are offered through the Marketplace, may not include benefits such as habilitation, even though habilitation is an essential health benefit required by the ACA. They might also include, for example, annual benefit limits on durable medical equipment such as wheelchairs or ventilators even though the ACA bars such lifetime and annual limits. Navigators should be aware that these discrepancies might be replicated in plans available through the Marketplace and be prepared to advise consumers to carefully review and compare the type and scope of benefits being offered by plans they are considering.
- If this individual lives in a state that is participating in the Medicaid expansion and she or he is eligible for Medicaid, the Navigator should assist her or him to understand how to evaluate the choices that may be available under the Medicaid program. (See “How is Medicaid eligibility being determined for people with disabilities?” for a discussion of Medicaid eligibility and options.)
- Someone with a mental health condition or cognitive impairment may have difficulty concentrating or following detailed instructions. Why is this information important to Navigators?
- It will be important for Navigators to spend the time required to ensure that this individual understands her or his coverage options and is able to make an informed decision.
- This person either may be taking prescription medications or require such medications at some point in the future. Therefore it will be important that needed medications be included on the formularies of the various plans being considered, and that the person is made aware of the right to request an exemption if a future prescribed medication is not on the formulary.
- She or he may also require mental health counseling, which plans are required to provide. It may also be important to this person to preserve ongoing relationships with one or more trusted healthcare professionals for both mental and physical health services, so the Navigator should help the consumer understand how to determine if these providers participate in the networks of the plans she or he is considering.
- Someone who is deaf will not be able to understand verbal communications. Why is this information important to Navigators?
- In order for most people who are deaf to participate meaningfully in face-to-face discussions with a Navigator about insurance options available through the Marketplace, a Sign Language Interpreter likely will be required. Navigators should arrange for this accommodation when the person requests it for effective communication. This accommodation is especially important because of the complexity of the insurance choices that are available and to ensure that the person who is deaf has meaningful access to the information required in order to make an informed purchase decision. People who are deaf have varying levels of familiarity and proficiency with written English and other languages. Therefore, Navigators should provide standard written materials, but not assume that the discussion can skip important information that would typically be discussed verbally just because those same topics are covered in the written materials.
- Someone with a substance use disorder may have cognitive or decision-making difficulties. Why is this information important to Navigators?
- The person may require treatment services, therefore it is important that Navigators assist the person to understand whether or not those services are included in the benefits package that she or he is considering.