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H H S Department of Health and Human Services
U.S. Department of Health and Human Services
Health Resources and Services Administration

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Affordable Care Act and HRSA Programs

Provider Marketplace Toolkit

Getting Answers is EasyA primary goal of the Affordable Care Act is to help uninsured Americans gain access to quality, affordable health care. Central to this goal is the creation of the Health Insurance Marketplace. Through the Marketplace, eligible Americans will be able to enroll in an affordable health plan to get coverage that starts as early as January 2014.

Now is the time to raise awareness of the Marketplace to maximize the number of Americans who enroll during the first open enrollment period beginning October 1, 2013.

What is the Marketplace?

The Marketplace is a new way for consumers to find health coverage that fits their budget and meets their needs. At the Marketplace, consumers will be able to compare insurance options based on price, benefits, quality and other factors with a clear picture of premiums and cost-sharing amounts to help them choose the insurance that works best for them. Financial help to lower costs is available for people who qualify. Consumers may be eligible for a free or low cost plan, or savings that lower monthly premiums right away.

How can you help?

Start by viewing the provider toolkit below.  This toolkit includes a range of resources and materials that clinicians and health care administrators can use to learn more about the Marketplace and educate patients about their new health care options, how insurance works, and the benefits of having insurance. It also includes materials for providers to learn more about the Small Business Health Options Program (SHOP).

 

Affordable Care Act Basics
Includes: Overview of the Affordable Care Act and Health Insurance Marketplace; State-specific information; Marketplace enrollment timeline; Consumer assistance information
Target Audience: Providers; Administrators; Staff

Overview of the Health Insurance Marketplace

Health Insurance Marketplace: 10 Things Providers Need to Know (PDF - 173 KB)
Fact sheet that outlines key elements about the Health Insurance Marketplace from a provider perspective.

How the Health Care Law Benefits You
Webpage that provides facts and figures on the opportunity that the health care law offers to individuals and small businesses.  It also directs individuals to where they can go to learn more about what is happening around the health care law in their state.

State-Specific Resources

Affordable Care Act State Fact Sheets
Fact sheets that describe how the Affordable Care Act is making a difference for individuals in each state.

State Marketplaces (PDF - 273 KB)
Webpage that includes information on the type of Marketplace in each state, and where to go to apply for coverage, compare plans, and enroll.

Enrollment Timeline

Key Dates for the Health Insurance Marketplace Enrollment (PDF - 354 KB)
Fact sheet that provides individuals with information on what they can do to get ready for enrollment, and upcoming key dates they should mark on their calendar.

Consumer Assistance

Resources to Help Consumers Apply and Enroll through the Marketplace (PDF - 503 KB)
Fact sheet that provides an overview of the different types of consumer assistance (i.e., Navigators, non-Navigator assistance personnel, certified application counselors, and agents and brokers) that will be available through the Marketplace.

Patient Handouts and Education
Includes: Eligibility information; Consumer assistance resources; Information directing patients where they can go to enroll and find out more about new coverage options.
Target Audience: Patients

Health Insurance Marketplace: 10 Things to Tell Your Patients (PDF - 173 KB)
Fact sheet for providers to use to educate their patients about the Health Insurance Marketplace.

About the Health Insurance Marketplace (PDF – 2 MB)
Brochure for consumers, provides overview of the Health Insurance Marketplace.

Things to Think About when Choosing a Plan (PDF – 698 KB)
Fact sheet for consumers, provides information they should know as they shop for health plans.

Get Ready to Enroll in the Marketplace (PDF – 661 KB)
Fact sheet that provides information to let consumers explore their options, prepare to apply and sign up for Marketplace updates before open enrollment begins.

Need Affordable Health Insurance? (PDF – 773 KB)
Poster that encourages people to sign up at HealthCare.gov to get e-mail and text updates about the Marketplace.

Business Operations
Includes: Information about the Small Business Health Options Program (SHOP); the health care law; and business operations.
Target Audience: Administrators; Providers

SHOP Overview

Overview of the SHOP Marketplace
Presentation that gives a general overview of the Small Business Health Options program.

Things to Think about when Choosing a Plan for your Business (PDF –292 KB)
Fact sheet that provides employers with information they should know as they review health plans.

Health Care Changes Wizard
Tool that helps businesses understand what they need to know about new insurance options and other health care changes, as well as finding health care related resources.

Billing Capacity

Engaging Safety Net Providers in Expanded Coverage: Tips on Enhancing Billing Capacities go to exit disclaimer (PDF – 375 KB)
Fact sheet that identifies key steps that payers may be able to assist with or that safety net providers can take to prepare for third-party reimbursement.

Building Safety Net Billing Capacity: State Support for a Solid Foundation go to exit disclaimer
Webinar facilitated by the National Academy for State Health Policy (NASHP) that discusses concrete ways that states can facilitate safety net provider participation in Medicaid and QHPs in order to serve newly insured and remaining uninsured populations. Speakers from Maryland and Texas also share examples of their work.

Essential Community Providers

Essential Community Providers: Tips to Connect with Marketplace Plans (PDF – 289 KB)
Fact sheet that provides information on essential community provider designation and network requirements.

Training and Education
Includes:  Sample slides, webinars and other materials that can be shared with health professionals.
Target Audience: Administrators; Providers; Staff

Potential Impacts of the Affordable Care Act on Safety Net Providers in 2014
HRSA presentation that provides information about how the Affordable Care Act will impact safety net providers.

Overview of the Health Insurance Marketplace
Centers for Medicare and Medicaid Services (CMS) presentation that provides an overview of the Health Insurance Marketplace, identifies who will benefit, defines who is eligible, and explains the enrollment process.

The Health Insurance Marketplace 101
CMS presentation that provides an overview of many benefits of the Affordable Care Act already in place and a basic introduction to the Marketplace.

Getting Ready for the Health Insurance Marketplace Toolkit for Behavioral Health Providers
30-minute, interactive presentation that includes fact sheets, brochures and other resources to help providers explain the Affordable Care Act and encourage uninsured individuals to apply for coverage. Also see toolkits for community-based prevention organizations, consumer, family, peer & recovery community organizations, housing support and homeless services organizations, criminal justice organizations, and mental health and substance abuse treatment provider organizations.

Preventive Services for Women: New and Important Changes in Covered Services go to exit disclaimer
Information about preventative services available to women under the Affordable Care Act. 

Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence
Information about women’s preventative health services that are covered by the Affordable Care Act, and providers’ role in screening and counseling for interpersonal and domestic violence.  

Preventive Services for Adults: Are Your Patients Taking Advantage of These Benefits? go to exit disclaimer
Information about the provision in the Affordable Care Act that requires many health plans to offer preventative services with no copay.

Preventive Care, Private Health Plans, and Your Practice go to exit disclaimer
Information for providers how they can standardize and streamline their practice in light of the Affordable Care Act requirement that many health plans offer preventative services with no copay. 

Preventive Services for Children: Getting the Message to Parents and Caregivers go to exit disclaimer
Information about the provision of the Affordable Care Act that expands children’s access to vaccinations and other routine preventative services with no copay. 

What Does the Affordable Care Act Mean for Your Patients This Year and Beyond? go to exit disclaimer
An interactive feature from 2011 that provides information for providers about provisions of the Affordable Care Act they need to know.

Talking with Patients about the Affordable Care Act -- Part 1: Why Insurance Matters go to exit disclaimer
Information for health care providers about how to discuss aspects of the Affordable Care Act and the importance of health insurance with patients. CME/CE credit available.

Helping Your Patients Navigate the Health Insurance Marketplace go to exit disclaimer
Information about the Health Insurance Marketplace so that physicians, nurses, and pharmacists can discuss the Marketplace with their patients. CME/CE credit available.

ACA and CHIP: What Providers and Patients Need to Know go to exit disclaimer
Information about the intersection of the Children's Health Insurance Program (CHIP) and Medicaid in offering healthcare coverage to children in lower-income families. CME/CE credit available.

 

Learn More about Health Insurance Market Place