Sweeping insurance and policy changes are poised to reshape how patients access and maintain coverage across Medicare, the Marketplace, Medicaid, and the Supplemental Nutrition Assistance Program (SNAP). At the Association of Cancer Care Centers Winter 2025 Virtual Oncology Reimbursement Meeting, Aimee Hoch, MSW, LSW, OSW-C, FACCC, an oncology financial advocate at St. Luke’s Cancer Institute, outlined how financial advocates and care teams can proactively help patients navigate enrollment windows and anticipate disruptions driven by recent legislation.
“Each year, open enrollment is an important opportunity for financial advocates and providers to help our patients optimize their insurance,” Ms Hoch said, emphasizing that coverage transitions are common throughout the cancer continuum. “Our goal is to ensure that we can proactively navigate coverage changes so patients avoid interruptions in care.”
Enrollment Windows as Critical Intervention Points
Ms Hoch framed open enrollment as only one part of a broader set of enrollment opportunities that arise throughout the year.
“Our patient space covers transitions from employer plans to COBRA, Marketplace, Medicaid, and Medicare,” she said. “Upcoming changes can affect eligibility, costs, and renewal processes; our role is to understand impacts and opportunities, navigate them proactively, educate patients and caregivers, and prevent gaps in coverage that delay treatment.”
In evaluating plan options, she urged advocates to consider total cost of care—not just premiums—including deductibles, coinsurance, copays, out-of-pocket maximums, provider networks, formularies, and the patient’s anticipated treatment plan.
Medicare: Enrollment Pathways and Policy Shifts
Ms Hoch reviewed Medicare coverage pathways, stressing the importance of tracking patients approaching age 65 and educating them during the 7-month initial eligibility window. She also highlighted the general enrollment period for those who miss initial sign-up, as well as special enrollment periods tied to coverage loss or participation in certain assistance programs.
“Rolling onto Medicare can be very stressful,” she said. “This is an important time to help navigate patients so they get the most coverage possible.”
She underscored the value of screening all Medicare beneficiaries for the Medicare Savings Programs and the Low-Income Subsidy (Extra Help), both of which can reduce premiums, cost sharing, and late enrollment penalties. State Health Insurance Assistance Program counselors, she noted, remain a critical unbiased resource for Medicare decision-making.
Ms Hoch outlined projected Medicare cost increases, including higher Part A deductibles and Part B premiums and deductibles. She also reviewed changes tied to the Inflation Reduction Act, including the prescription drug out-of-pocket cap and smoothing options.
A significant policy shift under H.R. 1 affects Medicare eligibility for immigrants. As of July 4, 2025, only 3 immigration categories are eligible for new Medicare enrollment. Current beneficiaries who no longer meet eligibility criteria will be notified in 2026, with benefit terminations beginning in 2027.
“Planning now is important to avoid abrupt care interruptions,” she stressed.
Marketplace Coverage: Higher Barriers Ahead
Ms Hoch warned that Marketplace coverage will become more difficult to access and maintain over the next several years, particularly if enhanced premium tax credits expire.
“Here’s what patients will feel,” she said. “Increased premiums, increased paperwork, increased barriers to the application process, and an increase in uninsured individuals or those with less coverage.”
Beginning in 2026 and extending through 2028, changes include shorter open enrollment periods, expanded documentation requirements for special enrollment, elimination of auto-renewals, removal of caps on premium tax credit repayment, and restrictions on immigrant eligibility for subsidies.
Ms Hoch emphasized the importance of accurate income reporting, as repayment caps are set to disappear. “Review options during open enrollment,” she said, calling it a critical opportunity to reassess coverage before changes take effect.
Medicaid: Work Requirements and Eligibility Restrictions
Although no immediate Medicaid changes were in effect at the time of her presentation, she cautioned that major shifts are scheduled for late 2026 and 2027, including new work requirements, more frequent renewals, and reduced retroactive coverage.
“These are big changes,” she said, noting that adults aged 19 to 64 years in Medicaid expansion categories will be subject to work or community engagement requirements beginning in 2027, with limited exemptions.
Failure to meet requirements could have cascading consequences. “Patients will not be eligible for Medicaid, and they will not have access to Marketplace subsidies,” Ms Hoch said, describing the potential for dual coverage loss.
She encouraged teams to begin preparing now by ensuring patients’ contact information and documentation—particularly immigration status—are up-to-date, and by building screening processes to identify exemptions.
SNAP: Immediate Impacts on Food Security
Ms Hoch also addressed changes to SNAP that are already underway, highlighting their relevance to oncology programs managing food insecurity and financial toxicity.
“SNAP changes intersect with oncology through nutrition, financial distress, and treatment adherence,” she said.
Recent policy shifts expanded work requirements, raised age thresholds, eliminated certain exemptions, and narrowed immigrant eligibility. Patients who fail to meet requirements may be limited to 3 months of benefits over a 3-year period, making exemption screening and timely documentation critical.
She emphasized that advocates should be prepared to assist with appeals, noting that administrative errors are likely as workloads increase at county assistance offices.
Action Steps for Oncology Teams
Throughout the session, Ms Hoch returned to the importance of preparation, education, and proactive navigation. Key strategies include tracking enrollment timelines, screening for assistance programs and exemptions, maintaining accurate documentation, and connecting patients with reliable resources.
“I know there’s a lot of information,” she said, encouraging teams to focus on planning ahead. “But understanding these changes now gives us the opportunity to protect our patients’ access to care.”