As someone who worked towards, supports, and deeply cares about the ACA, it is somewhat astounding how many facts, details, and rules about it that I didn’t know about before todays Web Forum. In case you don’t have a chance to listen to the whole Web Forum, here are a few relevant points:
- Did you know you can change plans or enroll in coverage outside of the open enrollment period, if you have a qualifying event? That will put you in a Special Enrollment Period (SEP), which has different governing rules. You can learn more about those rules here, or check your eligibility here.
- There are certain decisions made by the Qualifying Health Provider (QHP) that can be appealed, including decisions regarding:
- Termination of coverage
- Denial of payment for a medical service
- Accepting or rejecting prior authorizations
- Coverage of prescription drugs
- Denial of coverage of urgent care
- The ACA marketplace QHPs must not discriminate against people based on race or color, national origin, sex, sexual orientation, gender identity, age, disability, or health condition. This means their plan design can’t discourage enrollment by people with significant health needs. To use an example relevant to the Web Forum, Marketplace plans cannot decide to withhold coverage for all diabetes drugs, or design their plans so that diabetes coverage is inferior to coverage of other conditions.