Member and Community Relations Update

The Importance of Knowing Your Patients’ Type of Insurance
by Jennifer Borrillo, Senior Vice President of Member and Community Relations

Open Enrollment for most health insurance plans will soon be in full swing. Open enrollment dates and the process your patients must follow will vary by the type of health insurance and employer. Now is the ideal time to begin preparing and contacting your patients about their 2025 health insurance to determine if there will be changes that may impact the clinical and pharmacy services they require, and your HTC provides.

Open Enrollment Periods

• ACA Marketplace open enrollment is usually November 1st to January 15th. The end date can be as early as December 15th in some states that run their own exchanges.
• Traditional Medicare annual open enrollment is usually October 15th to December 7th, while the annual open enrollment period for Medicare Advantage is January 1st to March 31st.
• Employer provided open enrollment periods vary by employer, so it is important to stay on top of deadlines and learn about the coverage options offered by employers. If an employer’s health plan is self-insured, it is especially critical to find out if an “alternative funding program” has been implemented by the employer. Alternative funding programs can significantly limit or completely exclude patient access to specialty medications or include time-consuming obstacles causing critical delays.
• There is no limited enrollment period for Medicaid or the Children’s Health Insurance Program (CHIP).

If patients miss open enrollment, they may have to wait until the next open enrollment period to gain access to coverage unless they have a qualifying life event that qualifies them for a Special Enrollment Period (SEP) or if their household income is below 150% of the federal poverty level (FPL) they can still enroll or change their Health Insurance Marketplace plan. Please go to Healthcare.gov for complete details.

While there remains a lot of uncertainty in the health insurance market, Congress has enacted some important policies during the last few years that will lower premiums and out-of-pocket costs for many people seeking insurance on the ACA marketplaces. For many patients, it pays to shop around. Given the time frame to enroll and premium changes, we encourage you to contact your patients enrolled in ACA plans to be sure that they re-enroll in coverage before the deadline in your state.

Some additional items to consider in assisting your patients:

• Do you have a solid process in place to track your patients’ insurance?
• Do you know if their insurance is a fully insured or self-insured plan?
• Do you know if your Pharmacy Program can dispense clotting factor?
• Do you need the support or assistance from the Hemophilia Alliance to enhance your Pharmacy Program and Insurance Contracting efforts?

Remember, the Hemophilia Alliance Member and Community Relations (MCR) Team is here to help. We have developed a Patient Insurance Tracking Spreadsheet and Insurance Questionnaire to assist in your efforts. Please contact your assigned MCR Team Member to discuss how we can assist you in your Payer Relations and Insurance Contracting efforts and always remember – We Work for You!