Aetna CEO Mark Bertolini told CNBC earlier this month that "what we're finding is third parties, who have to either provide coupons or discounts, or these drugs for free, are signing up people to the exchanges, through the enrollment system and paying the bills for them — whatever their out of pocket costs are — and moving the costs of those drugs from their own programs to ours."
CMS said Thursday it is is looking into is whether health providers, in addition to steering people to Obamacare plans, are also offering to pay those people's premiums and out-of-pocket health costs in an effort to get the higher insurance reimbursements from the plans.
Such payments, CMS said, "are discouraged" by the agency as of now. But CMS added that it is also considering whether to take steps that would ban or limit premium and out-of-pocket assistance from providers to patients, according to the agency.
And CMS said it is eyeing possibly imposing "civil monetary penalties on health-care providers when their actions result in late enrollment penalties for Medicare-eligible individuals who are steered to an individual market plan and, as a result, are delayed in enrolling in Medicare.
Dr. Joseph Vassalotti, chief medical officer of the National Kidney Foundation, said the group "is concerned about allegations of dialysis patients potentially being steered into health insurance options that primarily benefit the provider; but may not necessarily be in the best interests of the patient."
However, he added, that while most patients with end-stage renal disease "choose to enroll in Medicare, there are some patients for whom Medicare may not meet their health and financial needs. As a result patients should retain the option to choose private health insurance coverage."
"Over the past few years insurance companies have developed policies, including refusal to accept third-party premium assistance, to avoid having to cover dialysis patients because of the high costs associated with their care," Vassalotti said. "The Affordable Care Act was intended to protect patients with pre-existing conditions and offer them the option to maintain or enroll in private health coverage regardless of their health status. NKF supports extending this same protection to individuals with kidney failure.
The National Kidney Foundation does not pay premiums for patients.
The president of the American Kidney Foundation, which does have a premium-assistance program, defended it Thursday, and said the group will be giving CMS comments explaining why it is necessary.
"Let's not lose sight of the critical fact that end-stage renal disease .... patients have as much right under the law as anyone to access ACA plans," AKF's LaVarne Burton said in statement to CNBC.
"For some, these plans may provide more comprehensive coverage for the full range of medical care they need, including dialysis. For others, Medicare (with Medigap if available to them) or Medicaid may indeed be the best choice," Burton said.
"What's important is that the patient has the choice. Insurers are actively working to take this choice away from low-income patients with chronic illnesses who need charitable assistance to pay their premium."