Just days before our patient-advocates arrived for AKF’s Advocacy Day on the Hill, CMS said, in its Final 2017 Notice of Benefit and Payment Parameters (NBPP), it would defer clarifying its guidance directing health insurers to accept third-party premium payments from nonprofit organizations for Marketplace plans.

CMS’s guidance, outlined in its March 2014 Interim Final Rule (IFR), does not prevent insurers from accepting premium payments from third parties such as nonprofits, but it does not require them to do so.  The 2017 NBPP was made final on February 29.

Together with other nonprofit organizations that assist low-income patients, we worked behind the scenes and submitted public comment letters imploring CMS to clarify the rule to protect patients. CMS wanted to include a “guardrail,” or provision, which would only require insurance carriers to accept third-party payments only for individuals who are not eligible for any minimal essential coverage. Medicare is considered minimal essential coverage. Since almost all ESRD patients on dialysis are eligible for Medicare, this guardrail could exclude them.

Our comment letter to CMS stressed that the proposed guardrail could result in these individuals losing their choice to stay on their current insurance. Individuals on dialysis are legally entitled to retain private insurance for 30 months before being required to use Medicare as their primary insurer. Therefore, low-income ESRD patients are legally eligible to participate in a Marketplace QHP for 30 months, and they should be able to receive assistance from charitable organizations such as AKF.

AKF will continue to work to include nonprofit organizations as an organization from whom insurers must accept third party premium assistance. We will continue to update you on this important issue.