Category Archives: Insurance

Topics in ABA: Experience Trumps Credentials

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Over the past 10 years the number of BCBA’s has grown from approximately 2,500 in 2005, to close to 20,000 in 2015.  This growth is partially due to the increase in availability of certification programs in the field of behavior analysis. Although there is a growing need for behavior analysts, many students have been entering degree programs with little or no experience working in the field of ABA and a limited knowledge of what a behavior analyst actually does.

As professionals who have supervised and taught in certification programs our experience has been that the most successful students are those that have a background in ABA and have had the opportunity to demonstrate those principles in the natural environment (for our sake, with kids with autism). We have unfortunately witnessed unsuccessful students and a common denominator is typically jumping into a certification program without truly understanding the roles and responsibilities of a BCBA.

As a behavior analyst you have the ability to change behavior! We can make a huge difference in the life of a child with autism and their family; this is something that should not be taken lightly. This is why we are dedicated to not hire or promote individuals because of their credentials, but instead due to their experience and proven ability to be effective at what they do.

Chrissy Barosky M.Ed BCBA, & Danielle Pelz, MS BCBA

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Can the ACA help my family?

HealthINFO

The period for open enrollment is drawing to a close.  The last day for open enrollment is March 31, 2014.  After this period, an individual (or family) wanting medical benefits must wait for a qualifying event (marriage, childbirth, loss of employment, etc.) or wait until the next open enrollment period to sign up for benefits.
Individuals or families wanting benefits to begin on March 1, 2014, must complete registration by February 15, 2014, to guarantee coverage.

Healthcare.gov is the federal website (often referred to as an exchange or marketplace).  Indiana elected to use this website so a family who qualifies for the premium subsidy must go through this website in order to qualify for the reduced rates.

The government has restrictions for who qualifies for the subsidy.  Below is a grid which shows the household size and maximum household income allowed.

Household Size    Maximum Household Income

1                              $45,960

2                              $62,040

3                              $78,120

4                              $94,200

5                              $110,280

6                              $126,360

7                              $142,440

8                              $158,520

If you meet these qualifications and are interested in purchasing a policy through the exchange, please know that there are other qualifications, too.  For more information, please call Eric at (317) 815-5501, ext. 2

Restrictions on Policies Available to Purchase

The policies available through the exchange are typically not available if the patient is already covered by Medicare, Medicaid, or Tricare.

For more information on this topic, please explore our previous Newsletters about the ACA Health Care Exchanges. 

Autism Specific ACA information
Information about how the ACA specifically will affect families with children on the Autism Spectrum.

General Information regarding ACA laws
Information compiled by our Insurance guru to help you to navigate the ACA myths and laws, especially how those may impact ABA coverage.

If an individual or family needs additional coverage beyond what is provided by Medicaid, Medicare, or Tricare please call Eric at (317) 815-5501, ext. 2, to discuss other options.

Affordable Care Act (ACA) – implications for our families

A lot of our families have asked us questions about the new Affordable Care Act.  Some of you have received letters in the mail from your insurance provider giving you a deadline if you wish to keep your existing plan.

Here are a few pointers that we’ve gathered together that might help.

Disclaimer:  Please note that most people out there including the experts are still trying to piece together the effects of this new legislation.  We are by no means close to being experts on insurance law… these are just pointers based on what we’ve gathered along the way and should only be used to supplement your own research and/ or advice from professionals.  

Is the government now providing health insurance?

  •   A common misunderstanding is that health insurance is now purchased through the government.  This isn’t true.
  •    The government has created online exchanges (healthcare.gov) for Indiana through which you can shop, compare and purchase insurance plans.  The plans themselves are still administered by insurance companies (Anthem and PHP are the major providers for Indiana)
  •    All plans must comply with new federal wide guidelines – such as not getting denied for pre-existing conditions, deductible levels etc.

What are the major changes in how this affects my child’s insurance?

  •    You can now put your dependent/ child on his or her own policy.  This is quite a big change in that now the child can have his or her own policy.  Depending on your individual circumstances, this could actually lower your out of pocket expenses.  This is a big benefit of ACA.
  •    There are no lifetime maximum limits to coverage; there are also caps on out of pocket maximum spend for covered individuals/ families.

How does the exchange work and why use it?

  •    Currently, it only works sometimes!  You have to log in and create an account and then get quotes.
  •    Depending on your individual circumstances (income, # dependents etc), you might be eligible for credits and tax subsidies.
  •    Individuals and families whose income falls at or below 250% FPL ($28,725 for an individual, $58,875 for a family of four) will be eligible for cost-sharing reductions.  http://www.cbpp.org/cms/index.cfm?fa=view&id=3190
  •    Those eligible for this subsidy can take advantage of it by purchasing a silver-rated (or higher) plan (there are different tiers of insurance available – platinum, silver, bronze.  Platinum pays for 90% of expenses, silver 80% and bronze 70%)
  •    If you intend to purchase insurance through the Exchange, you must do so during the open enrollment (ending March 2014)https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/
  •    Coverage starts Jan 1st, 2014

Do I have to use the exchange?

  •    If you expect to get a subsidy (based on income level) then generally you must use the exchange to purchase insurance
  •    You can buy insurance on or off the exchange (more on this below)
  •    If your employer provides coverage currently that qualifies under the ACA act then you are automatically disqualified for a subsidy

What other options exist?

  •    If you don’t expect to get a subsidy – either because of income level OR if you get insurance through your employer, then you can shop for insurance on private exchanges or directly through insurance companies
  •    One private marketplace is http://www.ehealthinsurance.com
  •    In Indiana – the major insurance companies you can go to directly are Anthem and PHP

So, what should I do?

  •    Regardless of your circumstances, we believe you should research and compare all your options.  Even if you receive employer provided coverage, you might still want to research the new options that have been created out there
  •    One of the carriers available in Indiana is PHP.  We are in network with PHP and generally they are easier to deal with than anyone else.  Also, they have not been known to automatically send all children getting 20hours or above to medical review.  We highly encourage you to check out PHP as an option – some of our families have got highly competitive quotes from PHP including quick responses from customer service.  o   .  Caveat: PHP is not available in certain zip codes. 
  •    If you think you are eligible for a subsidy (see table at:http://www.cbpp.org/cms/index.cfm?fa=view&id=3190); then create an account at healthcare.gov and shop around for rates; You can also call 800-318-2596

 

  •    If you are not going to qualify for a subsidy – check rates at http://www.ehealthinsurance.com
  • Sample comparative from ehealthinsurance.com
  •    Assess if it is cheaper to put your dependent on their own separate policy
  •    Make sure whatever you pick is an Indiana based plan (so the mandate applies).   Generally it should be – but doesn’t hurt to make sure!
  •    Before you sign up for anything – please get all the important policy information!  Make sure you look at not only the monthly premium but also the deductibles and out of pocket maximum on the policies you compare.
  •    Generally speaking policies with an office visit co-pay will be prohibitively expensive in the long run (since you incur a deductible as well as an office visit co-pay every day the child is getting service)
  •    If you are eligible for a cost-sharing subsidy, you need to pick a silver plan or above
  •    Finally – if you’ve received a letter from your insurance company about grand-fathering your existing plan, you definitely still want to evaluate the policy options available.  Many families are actually finding savings through these new plans (keeping in mind, that now you can put a dependent on their own policy).

Please feel free to call us with any questions (317-815-5501 ext- 2)
We intend to evolve the above guide as we get new information.

Additional recommended reading can be found at the links below:

Information from Autism Companion, a local publication.

http://www.autismcompanion.com/a-guide-to-purchasing-insurance-for-children-with-special-health-care-needs/

http://www.npr.org/2013/10/11/230916150/faq-all-about-health-insurance-exchanges-and-how-to-shop-for-coverage

https://www.healthcare.gov/get-covered-a-1-page-guide-to-the-health-insurance-marketplace/

https://www.ehealthinsurance.com/affordable-care-act/faqs?fromRetail=true

Thanks for sticking with us!