NEW Provider Marketplace Toolkit, a one-stop shop for providers to learn more about the Marketplace and inform their patients and community about their new health care options.
WEBCAST Ready, Set, Go: ACA Basics and Outreach & Education Opportunities, Thursday, November 21, 2 to 3:30 pm ET
Overview of the two major pathways to health care coverage for maternal and child populations and strategies/resources for HRSA maternal and child health grantees to help educate families and others about the new insurance options.
The Affordable Care Act increases access to health insurance coverage and health services for all Americans. Everyone involved in health care in the U.S. has a role to play, including HRSA, our grantees and those we serve.
Starting this fall, there will be a new way for individuals, families, and small businesses to buy health insurance: the Health Insurance Marketplace (also called an Exchange). The Marketplace is designed to help people find health insurance that fits their budget, with less hassle. Every health insurance plan in the new Marketplace will offer comprehensive coverage, and consumers can compare all their insurance options based on price, benefits, quality, and other features.
In addition, individuals with incomes between 100 and 400 percent of the federal poverty level (FPL) may be eligible for federal premium tax credits to help pay for private health insurance through the Marketplace. Individuals with incomes between 100 and 250 percent of the federal poverty level may also be eligible for additional cost-sharing reductions to help lower their out-of-pocket expenses (e.g., co-pays and deductibles).
The Affordable Care Act allows states to establish Medicaid eligibility for low-income adults between 19-64 years of age with income at or below 133 percent of the Federal Poverty Level (FPL).
People who obtain insurance through non-grandfathered plans inside or outside Health Insurance Marketplaces or through a Medicaid Alternative Benefit Plan will be ensured coverage of essential health benefits, including items and services within at least the following ten categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment, prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services (including oral and vision care). Within these ten categories, the specific benefits to be covered will vary by State.
The Affordable Care Act includes a number of private health insurance market reforms that will benefit the individuals you serve:
Most reforms will be effective on January 1, 2014, although some provisions have been effective since 2010. Learn more about status of ACA implementation at the HealthCare.gov timeline.
Insurance plans offered through the Marketplace – known as Qualified Health Plans, or QHPs – are required to include a sufficient number and distribution of Essential Community Providers (ECPs) in their provider networks. As defined in statute and regulation, ECPs include providers that service predominantly low-income, medically-underserved individuals as described in section 340B of the Public Health Service act and section 1927(c)(1)(D)(i)(IV) of the Social Security Act. CMS published a letter to issuers (PDF - 430 KB) in which it operationalized this provision for plan year 2014. CMS has posted a list of specific providers who qualify as ECPs (PDF - 35 KB) under the statutory definition. The six major ECP categories are:
Note that this is not an exhaustive list of all provider types who could qualify as ECPs.
For millions of consumers, the application will be the single point of entry to see their health coverage options and tax credits that will help pay for premiums. The application can be submitted when open enrollment starts October 1.
Marketplace Consumer Application