During this season of open enrollment, the Arthritis Foundation is here to help you make an informed decision in selecting the best health coverage for your unique needs. Open enrollment is the time of year when individuals elect health care benefits through their employer, Medicare, Medicaid, or the federal and state health exchanges created through the Affordable Care Act. Open enrollment periods vary based on the type of insurance you have, but generally occur in the late fall.
As part of our commitment, the Arthritis Foundation hosted awebinar last monthto provide a general overview of open enrollment and the tools and resources you need to secure the best health care for you and your family. In addition, we hosted our very first Twitter chat on November 9th devoted to this year’s open enrollment. Thousands of you engaged with us on Twitter to#AsktheAFand we rounded up your questions in one location.
继续读下去，了解更多关于开放注册的信息，以及你在Twitter聊天中提出的问题。如果您有进一步的问题，关节炎基金会也有执业临床社会工作者可以与您讨论这些选择或任何其他问题，您可能有关于您的护理。Call toll-free at 1-844-571-HELP.
Federal Exchanges
What is the time frame for enrolling in a federal exchange plan?
Federal exchange enrollment is currently open and runs from November 1 to December 15. Visithealthcare.govto learn about your options.
What types of questions should I ask when considering my health plan options?
Several questions that you should consider asking when selecting a health plan include:
- Can I use co-payment cards as a part of my insurance? Will my co-payment card apply to the deductible?
- Is my specialty care doctor on the list of network providers?
- Are my prescriptions covered under the major medical or pharmacy benefit?
- 我的处方属于哪一级?
- Do I have a choice of more than one pharmacy provider?
- What services require prior authorization?
Are plans based on age?
Under the Affordable Care Act, protections exist to ensure that higher risk, older enrollees are charged no more than 3 times as much as a healthy young adult.
如果你所有的医生都不在保险计划之内，你有什么建议吗?
Ensure you weigh the cost of in-network & out-of-network provider benefits. Identifying the plan that covers as many of your current providers as possible will help ensure your out-of-network costs are as low as possible. If you are in an employer-sponsored plan, consider discussing the plan’s network with someone in your HR department to help inform future benefit design.
What if you and your spouse have enrollment dates that are different? Can you change your election before December 15?
最好是和有执照的社会工作者谈谈，这样你就可以讨论适合你家庭特定需求的最佳选择。你可以拨打我们的服务热线844-571-HELP，向有执照的社会工作者寻求帮助。
State Exchanges
How do state exchanges work?
State exchanges work very similarly to federal exchanges, but they are run by your local state government. If you visitlocalhelp.healthcare.gov你应该能找到帮手。所有州和联邦交易所都遵守一定的规定，尽管州交易所在许多领域有一定的自由度。请记住，适用于联邦医保交换计划的患者保护也适用于州医保交换计划。Open enrollment is currently open for all state exchanges, but the deadlines vary.
Can I have a state and a federal exchange plan at the same time?
No, depending on the state you live in, you’ll be eligible for one or the other. You can visitlocalhelp.healthcare.gov找出你适合的保险计划。
有些州的医保交换计划不包括既存状况，是真的吗?
《平价医疗法案》(Affordable Care Act)仍然是美国的法律，已经存在的疾病也受到保护。今年早些时候，有人提议立法取消这些重要的保护措施，但这些法案没有获得通过。
Costs and Access
How much should we expect to pay for a plan?
对于联邦交换计划，取决于你选择的计划——铜、银、金或白金——你将为你的护理每年支付一定比例的费用。你们的保险公司会支付余下的费用。To understand how you and your plan would split costs on the federal exchange, check outhealthcare.gov. To learn about the basic costs for enrollment in Medicare, visitmedicare.gov.
我应该从哪里去了解一个计划提供的处方药覆盖范围?
阅读您的健康计划所提供的处方，以确认您的药物在该计划的范围内。You can refer toour toolkitto understand your formularies and the impact on your out of pocket costs, especially regarding biologics.
如果我的计划说它支付一定比例的药品费用，我怎么计算我的实际支出是多少，特别是昂贵的生物制剂?
You can refer toour toolkit, which will help you understand your out of pocket costs, especially regarding biologics.
What should I do if I encounter access issues once the plan year starts?
如果您在获得医疗护理或治疗方面遇到问题，我们鼓励您与您的福利经理、人力资源部或联系您的保险专员。The Arthritis Foundation has a resource online for you to learn about common reasons for claim denials and how to manage the appeal process in our toolkit,Your Coverage, Your Care.
Medicare
Do you recommend traditional Medicare or one of the Medicare HMO/PPO plans?
You may find better value with Medicare Advantage (HMO/PPO) over traditional Medicare, depending on your health needs. At a minimum, the plans offered through Medicare Advantage must offer coverage comparable to original Medicare. However, Medicare Advantage can limit the choice of providers. Check out detailed Medicare cost information onmedicare.gov. For Medicare Part D, the prescription drug benefit, review the open enrollment guide available on the Arthritis Foundation’swebsite.
Employer-Sponsored Insurance
Do you recommend having double coverage and selecting different plans for your spouse and personal employer?
It depends. You should review both you and your spouse’s unique medical needs and coverage benefits of the plans. Reach out to your employer’s HR department for guidance about group coverage. In addition, you may contact a licensed social worker so you can discuss the best options for your family’s specific needs. You can call our helpline at 844-571-HELP to speak to a licensed social worker who can help.
High-Deductible Health Plans
What is a high-deductible health plan (HDHP)?
据healthcare.gov网站报道，HDHP计划比传统保险计划有更高的免赔额。每月的保险费通常较低，但在保险公司开始支付它的份额(你的免赔额)之前，你自己支付更多的医疗费用。HDHP可以与健康储蓄账户(HSA)相结合，允许你支付某些医疗费用，而不用缴纳联邦税。越来越多的病人使用hdhp，有时是他们自己的选择，有时是因为这是他们通过雇主提供的唯一选择。
How does a health savings account (HSA) factor into an HDHP?
An HSA is a type of savings account that allows you to set aside money on a pre-tax basis to pay for qualified medical expenses. A Health Savings Account can be used only if you have an HDHP.
What do HDHPs mean for me and my chronic disease?
For patients with a chronic disease such as arthritis, treatment is ongoing, and out-of-pocket costs can often put medications out of reach. Many drug companies offer programs to help relieve the cost of arthritis-related medications, covering co-payments at the pharmacy (e.g., co-payment cards). However, this type of co-payment assistance is not unlimited and often has monthly or yearly limits.
Will co-payment assistance vary from plan to plan or manufacturer to manufacturer?
Check out ourwebsite了解更多与关节炎相关的药物制造商提供的共同支付援助。每个HDHP计划都是不同的，所以一定要联系你的保险公司，了解他们如何对待HDHP下的共同支付援助。
What do I need to know about co-payment assistance with my HDHP?
If you have an HDHP, a health plan’s benefit design may only credit you with the amount of money you spent out of your own pocket, rather than permitting the value of co-payment assistance to be applied to your deductible or out-of-pocket maximum. We recommend going right to the source and asking your health insurer how co-payment assistance is applied. If you have health insurance through your employer, speak with your HR Department to understand your health coverage options and whether the health plans available utilize programs that would place limits on co-payment assistance.
如果我在选择医疗保险计划方面有其他问题怎么办?
The Arthritis Foundation has created a toolkit,Your Coverage, Your Care, to help you better understand health coverage options, determine how your current plan meets your arthritis care needs, and guide you through the claim denial process.
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