by Lauren Dunn, MSW | VCU Hemophilia Social Worker

For many, the fall season offers the opportunity to review and make changes in healthcare coverage for 2021. Even if you’re happy with your current health insurance coverage, it’s a good idea to review your options each year during open enrollment to be aware of any changes coming for your current coverage or if there are new options available to you. Keep reading for more information on changes coming with Medicare and ACA plans in 2021.

Medicare Open Enrollment- Oct 15- Dec 7, 2020
This year there is a big change for people who are under age 65 and who qualify for Medicare due to disability. Beginning January 1, 2021, Medicare enrollees in Virginia who fall into this category will now be able to purchase Medigap supplemental policies. These kinds of policies help “fill in the gaps” to pay for services that are not fully covered by Medicare. Factor products are paid for through the Medicare part B benefit, which covers 80% of the cost, leaving the other 20% to the enrollee, a cost that is not affordable without additional supplemental coverage. In the past, insurance companies were not required to sell Medigap policies to people under 65 and finding affordable coverage or patient assistance programs to help with Medicare coinsurance coverage has been very challenging. We are still learning about the details of what options will be available but consider contacting your HTC social worker during open enrollment to discuss new options that may be available for you.

Affordable Care Act (ACA) Open Enrollment- Nov 1- Dec 15, 2020
In 2021, there will be 9 plans offering ACA health insurance plans in Virginia: CareFirst, Cigna, Group Hospitalization and Medical Services, Anthem Healthkeepers, Kaiser, Optima, Piedmont, Oscar Health, and Optimum Choice (new in 2021). The good news in that insurers have proposed an average rate decrease of 6.9% for 2021, meaning many enrollees may see lower premiums. Virginia also approved legislation to transition to a fully state-run exchange by 2023 and will begin this transition with this year’s open enrollment season. It’s a good idea to check in with your HTC and other medical care providers to be sure your plan choice for 2021 is in network and provides coverage for the services you need.

Supreme Court Hearing
The U.S. Supreme Court will begin hearing arguments on the constitutionality of the Affordable Care Act (ACA) on November 10, 2020. The Supreme Court will consider whether the ACA was made unconstitutional when the individual mandate penalty provision was eliminated and, if so, if the ACA should be overturned. The ACA provides a number of important protections including: mandating coverage for pre-existing conditions, continuing dependent coverage until age 26 for children on a parent plan, the elimination of annual and lifetime caps, coverage for essential health benefits and the expansion of Medicaid to cover adults. HTCs and chapters, among many others, will all be monitoring the Supreme Court decision and any impact on the bleeding disorders community.