Open enrollment season is approaching, and now is the time to start preparing for any upcoming changes to your health insurance coverage.
For many individuals, Medicare Annual Enrollment runs from October 15 through December 7, while Marketplace (ACA) Open Enrollment begins November 1. Insurance changes made during these enrollment periods often take effect on January 1.
Tell HOC About Insurance Changes Early
If you expect any changes to your insurance coverage, please notify the HOC Business Office as soon as possible. Advance notice allows our team to:
- Verify your new insurance benefits
- Obtain prior authorizations for specialty medications
- Identify specialty pharmacy requirements
- Resolve potential coverage issues before they affect your care
Early planning can help prevent treatment delays, medication interruptions, and avoidable claim denials.
Specialty Pharmacy Requirements
HOC believes patients should have a choice in where they receive their specialty medications. Unfortunately, some health plans require members to use a specific specialty pharmacy as a condition of coverage. While these requirements are determined by your insurance plan, our insurance navigation team is available to help you understand your benefits, navigate plan requirements, and advocate for your care needs whenever possible.
Medicaid Members: Consider Appointing HOC as Your Authorized Representative
If you have Wisconsin Medicaid, you may choose to appoint HOC as your Authorized Representative. This designation allows HOC to receive copies of certain Medicaid eligibility and benefit notices, including renewal requests and other important communications. Wisconsin Medicaid specifically allows members to appoint an organization to serve in this role and to receive copies of eligibility-related correspondence.
As Medicaid renewal and eligibility requirements continue to evolve, having HOC involved can help our team identify potential issues early, assist with required documentation, and reduce the risk of an unexpected loss of coverage that could impact access to medications and care. If you are interested in learning more about this option, please contact the HOC Business Office.
Planning for Medicare?
If you will be turning 65 or transitioning to Medicare in the next 12 months, we encourage you to speak with your HOC team early. Medicare plan decisions can affect provider access, medication coverage, out-of-pocket costs, and specialty pharmacy requirements.
HOC has developed educational resources and planning tools specifically for individuals with bleeding disorders who are exploring Medicare options. Our goal is to help you become an informed consumer and understand your choices before making enrollment decisions.
The earlier we know about an upcoming insurance change, the better we can help ensure a smooth transition and uninterrupted access to care. If your insurance is changing, or if you have questions about Medicaid, Medicare, or open enrollment, please contact the HOC Business Office. We’re here to help.
