Before Enrolling in a New Health Plan, Make Sure Your Pharmacy & Other Providers Are “In-Network”

CF COMMUNITY BLOG

Get Covered: Preparing for the 2017 Open Enrollment Period

 By Hajin Moon October 12, 2016

Some of you may have received a notification from your current health insurance company about the changes expected in 2017 — and it probably did not sound very pleasant.

Earlier this year, a few insurance companies publicly announced that they were leaving the Health Insurance Marketplace due to losses in revenues in 2014 and 2015. All existing enrollees of those companies’ plans will receive a notification stating that their current plans are no longer being offered as of 2017. The plans designed by Medicare-approved private insurance companies, such as the Medicare Advantage plan, may also send a notification of change each year.

In 2017, monthly premiums are expected to spike — especially for the plans offered through the Health Insurance Marketplace. This may result in your monthly premium increasing by as much as 40 percent. Fortunately, health insurance companies are obligated to notify customers of any expected changes in advance.

In some states, the available health insurance plan choices will be very limited in 2017. Some states may have only one insurance company participating in the Health Insurance Marketplace, while even multiple companies may offer a very limited choice of health care providers and facilities by having only HMO network options available. This means that before enrolling in a new plan it is of the utmost importance to make sure that your CF care center and providers are considered in-network.

In addition, prescription coverage varies greatly based on your plan choice, so it’s important to review the plan’s drug formulary and how the plan is covering each of your medications. Each year, an increasing number of insurance companies are requiring prior authorizations for expensive medications and treatments, such as those for cystic fibrosis.

There is a limited time period in which people can enroll in a new health insurance plan or make changes on an existing plan, referred to as the Open Enrollment Period. State insurance plans, such as Medicaid or the Children’s Health Insurance Plan (CHIP), are not subject to the Open Enrollment Period and anyone can enroll in a plan throughout the year. For employer group plans, there is a specific period set by your employer, and your plan administrator (such as your human resources department) can provide you with the dates. The Open Enrollment Period also applies to federally funded insurance plans such as Medicare, as well as private plans offered through the Health Insurance Marketplace or directly through an insurance company.

Watch the video “Health Insurance Marketplace 2017 Open Enrollment Preview” from the Alliance for Health Reform to learn more about these upcoming changes.

Here are the important dates to remember.

For Medicare plans:

  • October 15-December 7: Annual Medicare Open Enrollment Period for electing Part D prescription plans or Medicare Advantage plans
  • January 1, 2017: Date that any changes to an existing plan or new enrollment during open enrollment become effective

For private insurance plans, including plans offered in the Health Insurance Marketplace:

  • November 1, 2016: Open Enrollment Period starts
  • December 15, 2016: Last day to enroll in or change plans for coverage to start January 1, 2017
  • January 1, 2017: Date that any changes to an existing plan or new enrollment during open enrollment become effective
  • January 31, 2017: Last day to enroll in or change a 2017 health plan. After this date, you can enroll in or change plans only if you qualify for a Special Enrollment Period.

CF is a challenging, time-consuming disease. We understand that there are many moving parts, and that understanding health insurance coverage requires extensive research and hours on the phone. CF Foundation Compasss dedicated and knowledgeable case managers can do the legwork for you and help you explore and compare options. Contact Compass at 844-COMPASS (844-266-7277) or by email at compass@cff.org with your open enrollment questions.

Full article at: https://www.cff.org/CF-Community-Blog/Posts/2016/Get-Covered-Preparing-for-the-2017-Open-Enrollment-Period/

NOTE: You may also contact us at Cystic Fibrosis & Freedom Pharmacies for assistance at 1-888-307-4427 or 407-898-4427.

Special thanks to the Cystic Fibrosis Foundation® for this helpful blog.

 

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