Payer Update, September 2020

Payer Update

Know Your Patients and Their Insurance
By Jeff Blake

Health Insurance Open Enrollment season has begun. Now is a great time to begin preparing and contacting your patients about their 2021 health insurance to determine if there will be changes that may impact the clinical and pharmacy services you provide.

Sunday November 1st kicks off the open enrollment period for the ACA marketplace plans, which goes until Tuesday December 15th. Given all the uncertainty in the health insurance market, some plans’ premiums are increasing. Despite that, people may be able to enroll in more generous or less expensive coverage than last year depending on their state and individual financial situation. It will pay to shop around. Given the time frame to enroll and the premium changes, we encourage you to contact your patients enrolled on ACA plans to be sure that they reenroll in coverage before December 15.

Some additional items to consider about the ACA for your patients:

  1. Even though the ACA Open Enrollment Period is over for 2020, your patient can still enroll in or change a Health Insurance Marketplace plan if they have a life event that qualifies them for a Special Enrollment Period. Please see for complete details.
  2. If your patient qualifies for Medicaid or the Children’s Health Insurance Program (CHIP), they can apply anytime.

Some additional items to consider for your HTC include:

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

The Alliance Team is here to help. We have developed a Patient Insurance Tracking Spreadsheet and Insurance Questionnaire to assist in your efforts. Please contact one of the Alliance Team Members to discuss how we can assist you in your Payer Relations and Insurance Contracting efforts and always remember We Work for You!

Also in this Issue…

Notes from Joe
· Continued Opportunities and Threats Facing HTCs

Legal Update
· 340B Program Developments: The Latest

Alliance Update
· Alliance Seeking Board Nominations
· Join Our Growing Hemophilia Alliance Team
· 2021 Meeting Schedule

Notes from the Community
· CDC Awards Cooperative Agreements to Bleeding Disorders Organizations
· Hemophilia Alliance Foundation Poster at NHF’s BDC Shows Impact of Grants
· NHF Seeks Input for Blue Sky Strategic Plan