Washington Wire: October 2019

Open Enrollment begins for 2020 insurance plans.

The Open Enrollment Period 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. Opportunities to enroll in insurance outside of the open enrollment period are typically very narrow, so it is important to take action during this time frame!
For many types of coverage, open enrollment generally occurs over the next several weeks.  The exact dates vary depending on whether you get your insurance coverage from your workplace, an Affordable Care Act (ACA) Marketplace, or another source. Here are some key dates to keep in mind:

• Every year, open enrollment for Medicare plans runs from October 15 through December 7.
• Open enrollment in coverage through the ACA Marketplaces runs from (at least) November 1 through December 15; however,

  • six states and the District of Columbia operate extended open enrollment periods.

• 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.

Regardless of where you get your insurance coverage, it is important to take an active role in considering your options for 2020! When reviewing potential health plans (and when considering whether to renew your existing plan), read all plan provisions carefully. Pay close attention to the “general provisions” (length of policy, types of providers you can see, term definitions), the “drug provision” (is your factor product, and any other drugs you need, covered by the plan), and the provisions that describe claims and the payment of claims.
Finding appropriate and affordable health care coverage is no easy task – but it’s crucially important. Where can you get help navigating your insurance choices? HFA offers a variety of resources on our website, including an Open Enrollment Guide, and (in our Dear Addy Corner) further information about Medicare and Marketplace issues for 2020. NHF’s website includes a Personal Health Insurance toolkit that may be helpful to you. Finally, your treatment center social worker may be able to advise you with respect to some of the specific insurance plans offered in your area.
Quick Hits:

• Over the course of October, the bleeding disorders community received news of additional product safety issues. Genentech reported that it had detected particulate matter in vials of Hemlibra, and CSL Behring issued a notification regarding a printing misalignment on boxes of Humate-P. Taken together with Bayer’s July 2019 announcement regarding its distribution of mislabeled and expired clotting factor, these developments are deeply concerning. HFA and NHF are working together to address the critical topic of product safety via a Safety Summit and via the establishment of a shared online forum where community members can register their thoughts, concerns, and questions about product safety. Please stay tuned as this collaborative work between the national patient organizations moves forward.
• Seventeen community members participated in HFA’s Young Adult Advocacy Summit from October 19^th through the 22^nd. Participants took part in rap sessions, an improv activity, a social media takeover, and more. They capped off the event with a visit to Capitol Hill to advocate for surprise billing protections and for the Advancing Youth Enrollment Act – legislation that aims to make insurance more affordable for young adults. Thank you to all who participated!
• A federal appeals court appears likely to uphold a lower court ruling blocking the implementation of Medicaid work reporting requirements for Arkansas and Kentucky. At oral argument on October 11, judges on the panel raised concerns about the massive coverage losses among Arkansans during the four months that the state’s work reporting requirements were in effect. Also in October, Arizona announced that it would pause implementation of its work reporting requirements until the appellate court issues its ruling.
• President Trump issued an October 3rd executive order that directs the US Department of Health and Human Services to find innovative ways to expand consumer choices for Medicare Advantage plans – for example, reducing barriers to bundling Advantage plans with a medical savings account. Some Medicare advocates fear that the executive order is one step in a larger effort to “voucherize” or privatize Medicare. The order, by itself, does not make any changes to the Medicare program; further action from HHS would be required in order to implement any of the changes outlined in the order.
• HFA, along with NHF and the Tennessee Hemophilia & Bleeding Disorders Foundation, submitted comments opposing a proposal to radically restructure the Tennessee Medicaid program (TennCare). As previously reported, Tennessee has asked the federal government to provide TennCare with an up-front, lump sum amount of federal funding, in place of the existing system of open-ended matching payments called for by the federal Medicaid statute. Patient advocates, including HFA, NHF, and THBDF, have voiced deep concern over the proposal’s impact on coverage and care for individuals with chronic health conditions, and over TennCare’s request to limit drug coverage for TennCare beneficiaries.
• On September 30, 2019, CMS released an informational bulletin announcing an opportunity for up to 10 states to apply to participate in a “wellness program demonstration project” for individual insurance plans sold in their ACA Marketplaces. Participating states can allow insurers to charge lower premiums to people who take part in “health-contingent” wellness programs. Patient advocates fear that these programs could disadvantage people with pre-existing conditions, since individuals who are unable to participate in the “wellness programs” would end up with higher premiums. As of this writing, it is not clear how many states will apply for this authority.