Tag Archives: access to care

short term health plans

TAKE CARE: Advocacy Blog Series

Short-Term Health Plans

We are continuing our advocacy blog series meant to help you take care when it comes to important arthritis health care and coverage issues. If you’re now just tuning into this series, check out previous advocacy blog posts here. Our last take care blog kicked off a focus on health insurance benefits and open enrollment. Today we explore short-term health plans, a type of insurance that has been on the market for some time but is receiving attention due to new actions taken by the administration. Read on to learn about these plans and why they are an unsatisfactory option for people with arthritis.

What are short-term health plans?

Short-term health plans are not new. As the name suggests, these plans are meant to fill in temporary gaps in health coverage. For example, if an individual is in between jobs or needs coverage outside of the traditional open enrollment period, short-term plans are available to purchase for up to three months from insurers and brokers.

Why are short-term plans in the news?

Earlier this month, the federal Departments of Labor, Treasury, and Health and Human Services finalized a regulation that loosens and expands the availability of short-term plans. Despite over 98 percent of health care stakeholders strongly opposing this action, the administration decided to move forward with its proposal.

What is changing with short-term health plans?

Beginning in October, the new regulation permits short-term plans to be sold for 12 months and renewed by an individual for up to 3 years. This is a change from current rules, which do not allow short-term plans to be a substitute for comprehensive coverage. Today, they are limited to a duration of 3 months and are not renewable health policies.

Are short-term health plans different than individual market health plans?

Yes, short-term health plans are separate from plans offered on the health insurance exchanges because they do not need to comply with important patient protections enacted under the Affordable Care Act. You will not find these plans on healthcare.gov, for example. Since short-term plans are not considered comprehensive coverage, the new regulation means insurers and brokers can more widely sell short-term plans that:

  • Deny enrollment based on age, gender, health status, or other factors that might suggest an individual’s future use of health care services
  • Exclude coverage for pre-existing conditions
  • Exclude any or all of the essential health benefits like prescription drug coverage, emergency care, or other provider services
  • Apply annual or lifetime dollar limits on coverage
  • Increase patient out-of-pocket maximums above limits imposed by current law
  • Impose more stringent network adequacy requirements

What kind of issues would someone with arthritis face if they enrolled in a short-term health plan?

Short-term plans are not ideal for people with arthritis since they can deny coverage for people with pre-existing conditions. The plans are also medically underwritten, meaning you would be asked to fill out a medical history; in turn, this is used to approve or deny your enrollment. The Affordable Care Act prohibited this behavior for plans offered on the individual market. However, because short-term plans are not considered comprehensive health coverage, they do not need to comply with this rule.

Do short-term policies need to disclose anything specific to consumers?

Yes, they must include clear language stating these plans may not work best for people with pre-existing conditions like arthritis. Be on the lookout for disclosure language that:

  • Urges you to carefully check the policy for exclusions or limitations regarding coverage of pre-existing conditions, or specific health benefits like prescription drugs
  • Warns a loss of short-term plan coverage means you may have to wait until the next open enrollment period before enrolling in health insurance again

For any health plan, it is always good practice to carefully review the terms and conditions to understand the scope of benefits and potential out-of-pocket costs you may incur. 

Is there anything else I should be aware of about short-term health plans during open enrollment?

Short-term health plans often misrepresent health coverage and benefits; these plans also have a history of fraud. In addition, you should know that since these health plans are temporary and do not offer comprehensive coverage, premiums are significantly cheaper than insurance found on healthcare.gov. While lower premiums might sound attractive, if you are unexpectedly diagnosed with a chronic disease like arthritis, your plan may not offer coverage for services like prescription drugs or emergency room visits to help you manage your health – and failure to disclose a medical condition up front could also result in an insurer rescinding the insurance policy, leaving you without any health care coverage at all.

What resources are available from the Arthritis Foundation?

In the coming months the Arthritis Foundation will be raising awareness about the open enrollment period, but you can get started with our Your Coverage, Your Care toolkit. It’s a great resource to help you understand your insurance options, the claims process, and tips to overcome barriers. Additionally, if you have any questions about your health care, we have licensed clinical social workers on staff that can talk with you 24 hours a day for your convenience. You can reach the Arthritis Foundation Helpline at 1-844-HELP (4357).

If you’d like to stay informed of federal and state-based health care issues, consider signing up to be an Advocate. Becoming a part of our Advocacy grassroots network is an easy way to get involved and stay informed.

Related Resources:

Open Enrollment

TAKE CARE: Advocacy Blog Series

It’s Never Too Early to Think About Open Enrollment

We are continuing our advocacy blog series meant to help you take care when it comes to important arthritis health care and coverage issues. If you are just now tuning into this series, check out our previous blog posts on accumulator adjustment programs, pharmacist gag orders, President Trump’s drug pricing blueprint, drug rebates, premium increases, and an update on the Affordable Care Act.

Continue reading TAKE CARE: Advocacy Blog Series

drug rebates header

TAKE CARE: Advocacy Blog Series

Drug Rebates 

We’re excited to continue our advocacy blog series meant to help you take care when it comes to important arthritis health care and coverage issues. If you are just now tuning into this series, check out our previous blog posts on accumulator adjustment programs, pharmacist gag orders, and President Trump’s drug pricing blueprint.

This week we dig in to the world of drug rebates, which are often negotiated between pharmaceutical manufacturers and pharmacy benefit managers (PBMs). Read on to learn more about how drug rebates play a role in the drug supply chain and impact access to medications.

Continue reading TAKE CARE: Advocacy Blog Series

president trump drug pricing blueprint

TAKE CARE: Advocacy Blog Series

President Trump’s Drug Pricing Blueprint

We’re excited to continue our advocacy blog series meant to help you take care when it comes to important arthritis health care and coverage issues. If you are just now tuning into this series, check out our previous blog posts on accumulator adjustment programs and pharmacist gag orders.

This week, read on to learn more about President Trump’s drug pricing blueprint and the different policy areas that the plan addresses.

Why did the Administration decide to release a drug pricing blueprint?

On Friday, May 11 the Administration released its long-awaited plan, “Putting Patients First,” intended to help lower drug prices and reduce out-of-pocket costs for patients. President Trump has spoken at length about the need to tackle prescription drug prices, and the blueprint released last week was an effort to follow through on that promise.

In response to the blueprint, the Arthritis Foundation released a brief statement on social media, expressing cautious optimism, but urging thoughtful development of proposals going forward.

Continue reading TAKE CARE: Advocacy Blog Series

arthritis foundation advocacy clawbacks

TAKE CARE: Advocacy Blog Series

Pharmacy Benefit Manager Gag Orders and Clawbacks

We’re excited to present our second blog in a series meant to help you take care when it comes to important arthritis health care and coverage issues. This week we’ll tell you about a practice some pharmacy benefit managers have been using called clawbacks, which affect the price of medications you pay at the pharmacy counter. Read on to learn more and see how the Arthritis Foundation is addressing the issue.

What are clawbacks?

A person who fills his or her prescription at the pharmacy may pay more for a prescription drug with insurance than if he or she had filled it without insurance. This can occur due to a “clawback,” a term used to describe the difference between the cash cost of a drug (purchasing a drug without insurance) and the copayment required by your health plan. That difference, the clawback, is often passed by the pharmacy back to the pharmacy benefit manager (PBM) as a profit. Unfortunately, this often occurs without the patient ever knowing they could avoid the higher copay by paying without insurance. A provision in the contract between the pharmacist and the PBM, known as a “gag order,” prohibits the pharmacist from disclosing cost information related to payment options.

Continue reading TAKE CARE: Advocacy Blog Series

accumulator adjustment programs

TAKE CARE: Advocacy Blog Series

Accumulator Adjustment Programs

We’re excited to present a new advocacy blog series meant to help you take care when it comes to important arthritis health care and coverage issues. Over the next two months, we’ll post a blog every other week to help patients like you know what access issues we are watching and what you can do about them. This week we’ll tell you about a new policy many pharmacy benefit managers (PBMs) are using called accumulator adjustment programs, which could especially impact people in high deductible health plans. Read on to learn more about these programs and why they are being implemented. Continue reading TAKE CARE: Advocacy Blog Series

Arthritis 101 Congressional Briefing

Arthritis 101 and Prescription for Access – Making Sure Your Voice is Heard!

Arthritis knows no political affiliation. It affects more than 50 million adults and an estimated 300,000 kids in the U.S., regardless of where they live or for whom they voted. We want to assure you that your voice is being heard by both Republicans and Democrats, especially as lawmakers consider changes to our healthcare system.
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barriers arthritis care

Arthritis Advocate Gives Patient Perspective on Access to Care at Congressional Briefing

For 14 years, Elizabeth Krempley has lived with rheumatoid arthritis (RA). She has also lived with the difficulty of affording the high cost of her medications and the burden of getting her medications covered by insurers. She has not always been able to take her drugs as a result of those difficulties, resulting in adverse health consequences.
Continue reading Arthritis Advocate Gives Patient Perspective on Access to Care at Congressional Briefing