Momentum - Winter 2012

Matters
Health coverage:
What’s next

by Marcella Durand

Many provisions of the Affordable Care Act will kick in Jan. 1, 2014, but others take effect earlier. This means you should expect some changes in your health insurance plan as you enroll or re-enroll this fall. Here are a few to look for.

Making coverage understandable

For people who are covered through an employer’s plan, the most noticeable change affecting open enrollment is the new Summary of Benefits and Coverage.

The summary, which went into effect Sept. 23, provides standardized information about what a particular plan covers and how it will work, making it simpler to compare plans and understand coverage options better. “Whatever choices you are making will be much clearer,” says Kimberly Calder, the Society’s director of Federal Health Affairs and Insurance Policy.

The summary includes a glossary (see “Defining the terms,” pg. 53), a chart illustrating what the plan covers and excludes, plus coverage examples of common medical conditions. Perhaps most important, the summary provides

all this in understandable language with no fine print.

Red flags

Even though the summary goes a long way toward helping people understand their coverage better, Kris Erickson, senior health insurance manager for the Society, recommends that people with multiple sclerosis be very careful as they enroll or re-enroll. “Make sure you take the time to review your options,” she cautions.

Watch out for:
•;Caps;on;prescription;drug
coverage
•;No;coverage;of;injectable
medicine
•;Co-insurance;instead;of
copayments
“Instead of people paying $30
at a pharmacy as a copayment,
they may be required to pay 20
to 30 percent of a medication
instead, if the plan stipulates
co-insurance,” says Erickson.
“This happens with medications
in specialty tiers, such as
disease-modifying therapies, a
lot.” Therefore, if you have the
choice, consider choosing direct
co-pay. Also examine the plan’s
formulary, which lists which
drugs are covered and for
how much.

Getting credit

The Summary of Benefits is now included in all private individual and group plans. However, employers aren’t required to offer health insurance. While larger employers have received tax advantages for some time for offering health coverage, and have generally been more likely to offer health insurance, there are some options if yours doesn’t.