While we talk to patients about insurance coverage and answer their related questions throughout the year, the health insurance Marketplace and Medicare open enrollment seasons provide the best opportunity to educate patients about their insurance options. The enrollment season is just around the corner, giving us a great opportunity to help patients optimize their insurance coverage. To best serve your patients, it’s important to be prepared. 

The most important thing to convey are the enrollment dates for 2022 coverage. Medicare open enrollment starts Oct. 15 and ends Dec. 7. The health insurance Marketplace open enrollment begins Nov. 1 and ends on January 15 for most states. To have coverage that is effective Jan. 1, 2022, patients must be enrolled in a plan by Dec. 15, 2021. Ten states have adopted their own open enrollment timelines:

• Idaho: Nov. 1 – Dec 15, 2021
• Massachusetts: Nov. 1 – Jan. 23, 2022
• New Jersey: Nov. 1 – Jan. 31, 2022
• Rhode Island: Nov. 1 Dec. 15, 2021
• Vermont: Nov. 1 – Dec. 15, 2021
• Washington: Nov. 1 – Dec. 15, 2021
• Washington, DC: Nov. 1 – Jan. 31, 2022
• California: Nov. 1 – Jan. 31, 2022
• Maryland: Nov. 1 – Dec. 15, 2021
• New York: Nov. 1 – Jan. 31, 2022

Medicare

During open enrollment, patients receive many telephone calls and mailings advertising the different plans available to them. While it’s always good for patients to know the options they have, it’s also good to tell them to be cautious about the information they receive. Remind patients that if they are happy with the coverage they currently have, there is no reason to change it. Far too often, patients end up making changes to their coverage that they do not fully understand.

Triagecancer.org and Medicare.gov are great resources for assistance with Medicare open enrollment. You may also be able to form a trusting relationship with a local agency that specializes in Medicare plans to which you can refer patients. Green Bay Oncology financial counselors use Informed Choice, an insurance agency that specializes in Medicare products. Another great resource is your state’s Aging and Disability Resource Center, which provides more detailed information on Medicare and offers trained state health insurance assistance program counselors who are available to help.

Marketplace

Before enrolling patients, you must be familiar with the health insurance Marketplace plans that are available in your area. They can not only differ from state to state, but also from county to county. This could mean that a patient who lives in a different county than your facility may not have an option available that allows them to be seen by your program or practice. It's important to educate patients about what to look for in a plan and how to determine which is the least expensive option for them.

If your facility is not a certified application counselor designated organization (CDO) for the health insurance Marketplace, be sure to have reputable resources available for patients who are unable to navigate the enrollment process on their own. You can use Healthcare.gov to search for this help. Two functions on the website—“Search for a local agent/broker or assister” and “Get contacted by a local agent/broker”—can help you find the best person to assist your patients with Marketplace enrollment.  

Starting with Patients

Finally, identify the specific patients with whom you need to discuss open enrollment. If possible, use your EMR to identify your uninsured and underinsured patients. Plan to meet with these patients at an upcoming appointment or reach out to them by phone to discuss open enrollment and help them understand the plans that may be available to them. Remind patients to verify that their current providers are in network with any plans they may be considering. Don’t forget to follow up with them after your initial contact to make sure all their questions are being answered. If you’re uncomfortable discussing insurance coverage with patients, try practicing with a colleague, friend, or family member first. While these conversations may be somewhat uncomfortable, you will become more at ease with them in time.

For more tips on helping patients optimize their insurance coverage and how you can prepare for open enrollment, please make sure to join us on Oct. 29 for the next virtual ACCC 2021 Oncology Reimbursement Meeting, “Navigating Health Insurance and Open Enrollment.” You can register today and watch from anywhere.

Jordan Karwedsky is a financial counselor at Green Bay Oncology in Green Bay, Wis., and she is a member of the Network Task Force in the ACCC Financial Advocacy Network.