Disease Information & Support


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You may. Subsidies are a key component in the Affordable Care Act's approach to making insurance premiums more affordable for low- and middle-income Americans. Right now, subsidies based on your income are available in all 51 marketplaces across the country, and they can be used to help offset the cost of any plan sold in the marketplace. 

Still working its way through the judicial system is the question of whether subsidies will continue to be offered to consumers purchasing health insurance coverage through the 34 federally-facilitated marketplaces. For now, officials have indicated that theses marketplaces will continue approving subsidies for those who meet the eligibility criteria.

Whether you are deciding which type of coverage is most appropriate or whether you are in the middle of the plan year and have concerns about your coverage, providing feedback to The Leukemia & Lymphoma Society and to state and federal health officials is very important.

Governments at both the state and federal levels will be looking for ongoing consumer complaints, questions and feedback. Consumer feedback is absolutely essential to improving the law because implementation and improvements will continue for years.

LLS will continue to be a resource to patients and their families through our Information Resource Center (IRC) as well as local patient support staff. You can reach our information resource center by calling 1-800-955-4572, Monday to Friday, 9 a.m. to 9 p.m. ET.

Provider networks are set by insurance companies. All insurance marketplaces are required to provide a list of in-network providers to consumers. It is important to double check with both the insurance company company and your healthcare providers that they are included in the network of the plan you choose.

If you sign up for a plan and find out later that your provider is not covered as promised, you can speak with an information specialist at our Information Resource Center (IRC) for additional support at: 1 (800) 955-4572. You can also contact the insurance commission in your state for further assistance. Find your insurance commission here: www.naic.org/state_web_map.

Many insurance plans within the insurance marketplace may not cover National Cancer Institute-designated cancer treatment centers. When you are looking for coverage through your state or federal insurance marketplace, there is a required website link that will take you to that insurance company's website where you can find a listing of providers, hospitals and cancer centers. The web link on the site may be titled "Network Coverage" or "Provider Directory."

We encourage anyone looking for coverage to contact both the insurer and the cancer treatment center to confirm that the insurance plan you chose includes your treatment center in its network and to ask how much the visits would cost you.

In 2015, health plans in the small group and individual markets must comply with a total annual out-of-pocket (OOP) maximum of $6,600 for in-network expenses for an individual and $13,200 for a family. This means your total OOP or payment for healthcare services is limited to these amounts annually.

However, cancer patients should be mindful that only in-network services and treatments count toward the annual OOP maximum. Also, it's important to know that your monthly premium does not count toward your OOP maximum. So it is imperative that patients check with their plan to confirm that their drugs are covered and that their physician, hospital and specialty cancer center are in-network. Otherwise, patients risk paying higher costs for those benefits and services.

State parity laws are pieces of legislation that require insurance companies to apply the same cost-sharing rules to both intravenous and oral forms of cancer treatment. These laws, already in existence in more than 30 states plus the District of Columbia, are not impacted by the ACA.

For states without a parity law, the ACA offers limited protection for patients who must cover thousands of dollars in prescription drug cost-sharing each month. While health plans in the small group and individual market must comply with a total annual out-of-pocket maximum ($6,600 in 2015, for in-network expenses), this does not protect patients from high deductibles and/or high co-insurances for drugs or services in their health plan. LLS continues to advocate for changes in the insurance market that would give patients broader, more affordable access to the treatment they need.

No. These rules - usually referred to as "utilization management" - are not specifically addressed in the ACA. Generally, this means insurers can continue applying these rules however they see fit, except in states that have passed their own laws addressing utilization management techniques. For example, some states have a law requiring insurers to respond within 72 hours to a request for prior authorization. Insurers operating in those states would have to abide by that timeframe, even though it's not specified in the ACA.

The ACA was designed to phase out the coverage gap found in most Medicare drug plans. Usually called the "donut hole," this gap refers to instances where Medicare enrollees - after having spent a certain amount of money on their prescription drugs - would become temporarily responsible for covering an increased share of their drug costs. Under the ACA, this gap will be phased out gradually between now and 2020. This is an important change for blood cancer patients on Medicare whose treatment involves high-cost drugs. Click here to visit the Medicare website where you can learn more about the impact to your specific type of plan.

To be considered "grandfathered," a health insurance plan must have been in existence prior to the ACA being signed into law on March 23, 2010. To retain that status moving forward, a grandfathered plan cannot be changed in certain ways: consumers may not be forced to take on a larger share of their health care costs, and covered benefits may not be cut.

Grandfathered health plans do not have to comply with certain patient protections included in the ACA. For example, the ACA requires insurers to cover 100% of the cost of certain preventive services but grandfathered health plans are not subject to this requirement. Some grandfathered plans do not have to cover pre-existing conditions.

There are two types of grandfathered plans: group plans sponsored by an employer and individual plans. The second kind refers to plans you buy on your own, as an individual. The ACA allowed the first kind - grandfathered plans that are job-based - to continue enrolling people after March 23, 2010 and still be considered a grandfathered plan. So, if your health insurance is provided through your employer, you may want to ask your employer or your insurance company if your plan is grandfathered, even if you enrolled after March 23, 2010. Having this information will help you better understand what benefits the ACA requires your plan to cover.

last updated on Monday, March 02, 2015

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