11/6/2017 by Share Your Story

Migraine Patients: How to Pick Health Insurance during Open Enrollment

Here are some tips to help migraine patients select the right health insurance plan during open enrollment.


Every patient struggles to pick the right health insurance plan during open enrollment. But, that task is even more challenging for patients living with the debilitating pain of migraine headaches.

Just because you get insurance doesn’t mean you’ll have access to the care, treatments and medications that help you manage your migraine pain. Health insurance companies frequently force migraine patients into one-size, fits-all policies that restrict care and block access to the treatments prescribed by your doctor.

You need the treatment that works best for you. Period.

How to Pick the Right Insurance Policy

Patients Rising has some tips and advice to help migraine patients select the right health insurance plan during open enrollment.

1. Shop Around: Compare Insurance Plans

Always take the time to compare health insurance plans. Even if your current plan is available for renewal, it’s still important to do your homework on your current plan. Last year’s plan might not be the same as the plan offered in 2018. For example, your current plan could have major changes to its formularies and other benefits. Pharmacy benefit managers for many insurance companies can change medications from year-to-year.

2. Research Plan Benefits

Not all health insurance plans are the same. Health insurance plans with similar monthly premiums could have very different benefits and co-pays. Migraine patients need to make sure that they thoroughly research plan benefits to see if their treatment is covered, and what it will cost to access that treatment. Make sure to identify what it will actually cost you instead of just looking at the monthly premium.

3. Spot Potential Barriers to Access

Many health insurance plans block migraine patients from accessing treatments when they need it. Medical decisions made by a patient with their doctor are being overruled by insurance companies. Beware these common insurance barriers to access — step therapy, prior authorization and value frameworks — all of which can stop you from getting the right treatment.

Insurance Barrier: Step Therapy

Patients refer to step therapy as fail first. That’s because under step therapy, health insurance companies force migraine patients to try less effective treatments first — even if that treatment contradicts their doctor’s recommendation. When the first treatment fails, the patient then must fight to gain access to another treatment. Step therapy has real harms for migraine patients because the fail first cycle can go on for months as your condition worsens.

Beware: Health insurance companies often require patients to go through step therapy even if they have already failed under a different insurance policy.

Have You Been Denied?Insurance Barrier: Prior Authorization

Under prior authorization, an insurance company gets the power to veto the treatment prescribed by your doctor. Patients are forced to get permission from the insurance company before insurance will cover the cost. And insurance prior authorization requirements make it inconvenient for a doctor’s office to provide the proof. In some cases, they require a prescribing physician to speak on the phone with the insurer’s medical liaison. That additional hurdle can discourage doctors and patients, who’ve already spent hours completing paperwork.

Check Out Peggy’s story for a better understanding of the difficulties with prior authorization.

Insurance Barrier: Value Frameworks

Value frameworks impose complicated mathematical formulas on patients, rigid price controls on advanced medications and, ultimately, limit the kind of treatments that patients can access. Like a three-card monte street hustle, no matter how the data gets shuffled, the result is always the same: widespread patient treatment is too expensive and it’s time to cut people off.

Read Patients Rising’s piece on value frameworks published at the Washington Times.

4. Beat the Deadline: December 15, 2017

Most patients need to enroll by December 15, 2017. If you get health coverage through your employer, be sure to double check your own open enrollment deadline.

This year, the Open Enrollment period for plans purchased through the Health Insurance Marketplace is shorter than in previous years. According to HealthCare.gov, the federal government’s official website for the Affordable Care Act, “If you don’t act by December 15, you can’t get 2018 coverage unless you qualify for a Special Enrollment Period.” Here are the key dates to remember:

  • November 1, 2017: First day to enroll, re-enroll, or change a 2018 insurance plan through the Health Insurance Marketplace.
  • December 15, 2017: Last day to enroll in or change plans for 2018 coverage. After this date, you can enroll or change plans only if you qualify for a Special Enrollment Period.
  • January 1, 2018: 2018 coverage begins, if premium paid

Are You a Migraine Patient that Needs Help? Our Patient Advocates Can Help

Patients living with migraines often experience unique challenges to accessing the right treatment. If you’re struggling to get the care that you need to manage your migraine pain, our patient advocates can help. Tell us your story.

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