For over 20 years, our federally approved Health Insurance Premium Program (HIPP) has supported dialysis patients in all 50 states, consistent with the guidance provided in Advisory Opinion 97-1 (AO 97-1) from the U.S. Department of Health and Human Service (HHS) Office of Inspector General (OIG). In 2019, AKF’s HIPP program assisted more than 73,000 patients in maintaining the health insurance they selected. Our program is needs-based; to receive help from AKF, patients must demonstrate that without our assistance, they would be unable to afford their coverage.
About 68 percent of our HIPP grants support patients with Medicare Part B, Medigap, and Medicare Advantage premiums. The remaining HIPP grants assist patients with COBRA, employer group health plans and commercial premiums, including about 8 percent of our grants that helped patients access the Affordable Care Act’s (ACA) Qualified Health Plans (QHPs) in the individual insurance market for the 2019 plan year (both on and off-exchange).
Working to ensure that insurance carriers accept charitable payments on behalf of ESRD patients
In March 2014, the Centers for Medicare and Medicaid Services (CMS) released an Interim Final Rule (IFR), entitled the Patient Protection and Affordable Care Act: Third Party Payments of Qualified Health Plans Premiums. CMS stated that insurance carriers must accept charitable premium payments from state and federal organizations, tribal organizations, and the Ryan White HIV/AIDs organizations for the payment of premiums for QHPs. Since the IFR does not specifically state that insurance companies must accept charitable premium payments from not-for-profit organizations, many insurance carriers are refusing third party payments from AKF on behalf of patients with ESRD who are on dialysis and those who have received a transplant.
Unfortunately, many insurers across the country have extended this practice to other types of insurance coverage beyond ACA Qualified Health Plans, including to Medigap. Several of the plans stipulate that coverage will be terminated if the individual accepts any direct or indirect contribution or reimbursement by or on behalf of any charitable organization, except for the entities mandated by CMS as third-party payers in their 2014 IFR.
AKF is fighting these discriminatory practices and we are advocating for HHS to clarify their position on third-party payments, so insurance companies must accept premium payments made on behalf of individuals with kidney disease. We are also actively communicating with state legislators and insurance commissioners and their staff members about AKF and our HIPP program with the goal of encouraging state insurance departments to direct insurance companies to accept AKF’s charitable assistance payments via formal bulletins, or in the alternative, via directives.
Legislatively, AKF supports the passage of the federal Access to Marketplace Insurance Act, which was introduced in the previous congress and is expected to be reintroduced in the current congress. The legislation would protect patient access to coverage by requiring insurance companies to accept payments from nonprofit charitable organizations like AKF. On the state level, AKF will advocate against state legislation that seeks to limit our ability to provide financial assistance to HIPP grant recipients.
Protecting ESRD patients from insurance carriers pushing them off private insurance
Individuals on dialysis are legally entitled to stay on their group health plan private insurance for 30 months prior to being required to move to Medicare. Many dialysis patients prefer to be on private insurance for as long as legally allowed, and it is their choice. More importantly, staying on employer-based and other commercial insurance is often the only way that ESRD patients can access the specific benefits that they need, including family coverage. Insurance carriers have employed tactics to encourage patients on dialysis to move to Medicare early by offering to pay for the patient’s Medicare Part B premium. Some insurance carriers have told beneficiaries that they must move to Medicare prior to the legal date. AKF is working with state regulators to address these practices.