Physicians, nurses, social workers, healthcare centers, insurers and others who provide or perform healthcare services are the connecting link between health reform and patients. In addition to delivering care, healthcare providers are often in a position to help patients navigate an increasingly complex healthcare system during a time of need.
Q: What does the ACA’s grace period mean for me as a provider?
Marketplace consumers receiving advance premium tax credits can keep their insurance for a 90-day “grace period” if they fail to pay one month’s premium. To qualify for the grace period, consumers must have also previously paid at least one premium during the coverage year. For the first month of the grace period, insurers must continue paying their share of costs for medical services. The insurer may hold off payments during the second and third months of the grace period. Consumers will lose coverage if they don’t pay their premium at anytime during the 90 days. Providers can then seek payment directly from the consumer. This brief
from Health Affairs explains more on the grace period.
Q: Does Medicaid Cover Dental?
Now, as of July 1, 2014 Medicaid covers restorative dental services like x-rays, crowns, and fillings for adults. Dental coverage is comprehensive for children on AllKids and includes services like twice-a-year exams. See a detailed description of dental services offered under Medicaid
Managed Long Term Services and Supports
Starting July, 2016 managed care organizations will be responsible for coordinating long-term services and supports for people who live in a nursing facility or receive home and community-based services through a Medicaid waiver program. This April 2016 fact sheet from Health & Disability Advocates informs consumers about the change.
New Observation Status Rules
Starting August 2016, hospitals are required to let people know if they are an outpatient on observation status. This April 2016 fact sheet from Health & Disability Advocates prepares patients for the changes.
Network Adequacy Analysis
This December 2015 report from the Aids Foundation of Chicago analyzes Illinois silver-level Marketplace plans’ coverage of HIV and the Hepatitis C Virus treatment. The trend has been for Marketplace plans to limit coverage of necessary treatments for this population.