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Premium Assistance

Background

Many nonprofit organizations around the country offer premium assistance for patients with chronic and expensive disorders. High quality insurance with adequate networks and formularies is necessary to preserve access to hemophilia treatment centers and specialized hematologists, a wide variety of clotting factor, and the services necessary to properly manage a bleeding disorder. Without affordable access to treatment and care, managing a bleeding disorder becomes nearly impossible. The types of plans necessary to adequately cover the cost of a chronic condition often come with a high premium. It is essential to the bleeding disorders community that charities willing to assist our community in affording high quality insurance are able to do so.

Many of these organizations also help patients afford their premiums during times of economic or family crisis such as the loss of a job or primary earner, or while patients transition from their parent’s plans onto their own.

Issue

In March of 2014, the Centers for Medicaid and Medicare Services (CMS) issued an interim rule (which has the force of law) that listed 3 entities that insurance companies MUST accept premium assistance from:

  1. Ryan White HIV/AIDS Programs
  2. Indian tribes and tribal organizations
  3. Federal and State Entities

CMS did not include nonprofit organizations on this list of entities that companies must accept premium assistance from. Many insurers are using that omission to stop accepting payments from 3rd party nonprofit organizations.

Patients around the country with chronic and expensive conditions can no longer receive the help they need to afford their insurance premiums. HFA supports legislation that adds nonprofits to the list of entities that insurance companies on the Marketplace must accept premium assistance payments from.

Additional Resources

pgr_hr3742_1pg_2016 HFA Premium Assistance Talking Points and Timeline of Events
HR3742 Copy of H.R. 3742 – Access to Marketplace Insurance Act
ADV_Map_PatientAssistance_2015-06-09-01 Map of states where third party premium assistance is not accepted.

Assisting and Advocating for the Bleeding Disorders Community