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Open Enrollment begins for 2021 insurance plans

Open Enrollment is a time frame each year when health insurance plans are required by law to accept applications from new plan enrollees regardless of their health history. This also is the time when you can choose to stay with your existing health plan if it is the right one for you. Open enrollment dates vary, depending on the state you live in and whether you get your coverage from your employer, an ACA Marketplace, or another source – but for many people, open enrollment takes place annually in the fall. Here are some key dates to keep in mind:

  • Every year, open enrollment for Medicare plans runs from Oct. 15 through Dec. 7.
  • Open enrollment in coverage through the ACA Marketplaces runs from (at least) Nov. 1 through Dec. 15; however,
  • If you get insurance through your job, check with your human resources department to find out when your company’s open enrollment period begins and ends.
  • Enrollment in Medicaid is available 365 days per year, based on need, income, and other state-specific eligibility criteria.

This year’s open enrollment period may be a little more confusing than normal, due to the COVID-19 pandemic, noise around the ongoing elections, and the proliferation of substandard “skinny” plans that can trap unwary purchasers. There is confusion, too, arising from a pending Supreme Court case that concerns the constitutionality of the Affordable Care Act. Please be assured that the ACA still remains the law of the land. Use your opportunity during this year’s open enrollment period to select a plan that meets ACA standards for coverage and financial protection, and don’t fall for misleading sales pitches. Make sure you get the health coverage you need for next year!

HFA offers a variety of resources that can help you navigate this process, including an Open Enrollment Guide and (in our Dear Addy Corner) further information about Marketplace issues for 2021. NHF’s website includes a Personal Health Insurance toolkit that may be helpful to you. Your treatment center social worker may be able to advise you with respect to some of the specific insurance plans offered in your area. Likewise, navigators and assisters may be able to guide you through the Marketplace options available to you.

Please be an active participant as you consider your insurance options for 2021! And whether you choose to keep your current health insurance or to enroll in a new plan, READ YOUR POLICY. This is critical because the health insurance plan you choose will be yours for 12 months unless you have a qualifying life event that allows you to switch plans.

 

Quick Hits:

  • HFA joined with 32 other patient groups to release a blueprint listing top health care priorities for the next Administration. The report elevates the collective voices of patients and urges elected officials to ensure that all people living in the U.S., including those with pre-existing conditions, have access to adequate and affordable health coverage. The nonpartisan organizations have shared the blueprint with the campaigns of both President Trump and Vice President Biden, as well as among state and federal legislators.
  • The Supreme Court heard oral argument in a lawsuit (Rutledge v. PCMA) concerning states’ ability to regulate pharmacy benefit managers. At issue in the lawsuit: did Arkansas exceed its authority when it passed a law prohibiting PBMs from underpaying independent pharmacies. Almost every state in the country has sided with Arkansas in the lawsuit. The PBM trade association, on the other hand, argues that Arkansas’s law is preempted by ERISA, the federal statute that governs pensions and self-funded health plans. The Court’s ruling (not expected before spring 2021) could have wide impact since some 40 states have enacted various laws regulating PBMs.
  • The federal Centers for Medicare and Medicaid Services approved Medicaid waiver applications from Georgia and Nebraska. CMS allowed Georgia to go forward with a very limited expansion of its Medicaid program, coupled with premiums and a work reporting requirement. Georgia’s limited expansion will cover only a small fraction of the low income individuals who would have been covered had the state opted for a full ACA expansion. In separate action, CMS approved a Nebraska plan to allow Medicaid expansion beneficiaries to earn extra benefits by satisfying work and wellness requirements. Nebraska argues that because its work requirements are “voluntary,” they stand apart from other state programs that have been struck down in the courts.
  • The Governor of Puerto Rico signed into law a bill protecting patients against accumulator adjuster provisions that limit the value of drug copay assistance programs. Puerto Rico becomes the sixth U.S. jurisdiction to enact such protections.
  • CMS announced that average premiums for 2021 will decrease for plans offered in the 36 remaining federally-facilitated Marketplaces.  For “benchmark” silver plans in which most consumers enroll, monthly average premiums will fall by two percent for a 27-year-old (to $369), while consumers selecting the lowest-cost gold plans will see a six percent decrease ($402 for the same individual).  Lower premiums are due largely to increased competition as 22 additional insurers will be participating in 2021.  As a result, only nine percent of counties will have just one insurer offering ACA coverage, down from 50 percent of counties as recently as 2018.
  • United Healthcare announced that it will be rolling out accumulator adjusters across its health plans, affecting manufacturer copay assistance program for specialty drugs billed under the major medical benefit. Previously, accumulator adjuster protocols typically applied only to drugs covered under the pharmacy benefit. HFA is working in coalition with other patient groups to oppose this and other applications of accumulator adjusters; these insurance company strategies cause financial hardship for patients by limiting the value of manufacturer copay assistance.
  • The Trump Administration extended the coronavirus public health emergency for an additional 90 days beyond its previously-scheduled October 23rd expiration.  The move means that states remain prohibited from making any changes to Medicaid eligibility until at least Jan. 22 of next year.
  • CMS released a final rule that will require health plans to inform enrollees about drug prices and patient out-of-pocket drug costs (including whether accumulator adjusters apply). The rule will also require insurers to disclose prices for certain services from doctors, hospitals, and other providers. The changes will not take effect for some time (different parts of the rule have effective dates between Jan. 1, 2022, and Jan. 1, 2024).

 

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