I am shopping for a private insurance plan in the new health insurance Exchange (also known as “marketplace”). What are the top three things I should consider as I shop for a plan?
My child is overweight and I’m not sure where to go. Should I take him to the pediatrician or should we go see a specialist?
Official response from
Health care exchanges (or the “health insurance marketplace”) were created by the Affordable Care Act and allow those people who don't get insurance through an employer or government program to purchase health coverage. Coverage options vary by state; some states have exchanges run entirely by the federal government, and others will create their own exchanges. (Learn more about individual state exchanges here. You can also visit HealthCare.gov to see coverage and price options.)
Those seeking to purchase insurance have until March 31 to make a choice. Those who do not have insurance by that date face a penalty of one percent of yearly income or $95 per person, whichever is higher. (The penalty increases each year through 2016.)
All available insurance plans will offer “essential health benefits” (EHB) that cover things like emergency services, maternity, neonatal and pediatric care, and preventative services. Unfortunately, the federal government did not include a comprehensive definition of what pediatric benefits must be included in each
Official response from
1) In a nutshell, waivers allow medical services that are typically not covered through the state Medicaid plan to be covered. Services covered by Medicaid waivers vary by state, but there is virtually no limit to the services that can be sought through the program. Obtaining a waiver takes some time and a few steps but can increase your child’s well-being.
a. You must be enrolled in your state’s Medicaid program. Click here to learn more about Medicaid (and other programs in your state).
b. You must meet certain eligibility requirements; specifically you must qualify medically and meet income guidelines.
c. You must obtain a waiver application through your state Medicaid office (find it here, or use the number listed on the back of your Medicaid card). Many state websites have downloadable forms.
d. Complete the waiver application, and provide information about the home and community-based services in which are you interested. The form should also have instructions on where and how to submit it.
e. Make sure to follow up on your application. Eventually your state Medicaid office will work with you to schedule an interview with an evaluator (though you can contact them to schedule an interview once your application has been submitted). The evaluator will determine your eligibility for home-based services – they may approve you or add your name to a waiting list.
What information can we provide to increase your children's health literacy?