GIRS has been tracking payer trends for the past 19 years to assist with the market uptake of client Products. CMS has announced that they will be making $80 million in grants to the Navigators in Federal Marketplaces for the 2022 plan year. Navigators are a network of trained individuals that help consumers review their health coverage options as well as complete eligibility and enrollment forms. As open enrollment has been extended to August 15th, 2021, this change will allow for an increase in patients to spend lower premiums and obtain health coverage through the Federal Marketplace.
Funding for Navigators is critical becausethey provide patients with greater information on their options for healthcare. “Navigators play a key role in helping us educate consumers about health plan options,” stated Secretary Becerra. “This eight-fold increase in Navigator funding will help consumers decide whether to enroll or continue their health care coverage through HealthCare.gov during the Open Enrollment period this fall.”
This expansion is occurring primarily in the Federal Marketplace, among the uninsured and other vulnerable communities, where the education by the Navigators is necessary to assist in an increase in enrollment. This initiative could result in an increase in overall plan selection for those in communities that have historically experienced lower access to health coverage and greater disparities in health outcomes to health coverage.
This funding will allow for an increase in enrollment in overall plan selection and an increase in the number of returning participants continuing their coverage relative to new participants in a marketplace plan. As of April 21st, 2021, overall enrollment across the nation was up 5% compared to the same timeframe in 2020. Specifically, this is an increase from 11.41 million in 2020 to 12.0 million enrollees in 2021. Additionally, of those enrolled in 2021, 79% were returning participants from the previous year.
What is the Implication of ACA Expansion for You? The implication of the increase in enrollment in the ACA marketplace is the potential expansion of this marketplace for your drugs, medical devices, biologics, diagnostics, and other products that will be utilized by these patients. It is important to plan and strategize and track this expansion, to reap the benefits. If your accounts are currently experiencing non coverage or inappropriate reimbursement in this marketplace, please contact us for reimbursement assistance.
Disclaimer: The information in this blog is based on payer information which is dynamic. It is accurate at the time of posting but should not be construed to be reimbursement or legal advice. CPT® is the trademark of the American Medical Association (AMA).
Sources:
- HHS Announces the Largest Ever Funding Allocation for Navigators and Releases Final Numbers for 2021 Marketplace Open Enrollment | CMS
- Marketplace Enrollment Tops 12 Million For 2021; Largest-Ever Funding For Navigators | Health Affairs
About GIRS
For more than 19 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, email us at info@girsinc.com or call us at 901-834-9119.