Help Your Patients Enroll in Health Insurance Marketplaces
One of the principal ways that the Affordable Care Act (ACA) will expand coverage to millions of uninsured persons is through state-by-state health insurance marketplaces. These marketplaces will help eligible patients buy individual health insurance plans that they can afford. They will provide a web-based platform that will enable patients to effectively comparison shop and select the best plan for them and their families. Eligible persons will also be able to get tax subsidies to help them afford the plans offered by the marketplaces.
Open enrollment for 2014 is now closed; however, your patients may qualify for a special enrollment period if they experience a qualifying life event (i.e. birth of a child, marriage, divorce, or employment change) or were unable to enroll in the marketplace due to certain complex situations. Open enrollment for 2015 begins on November 15, 2014. To help you help your patients determine health insurance choices, as well as to answer questions that you might have, the American College of Physicians has put together a series of documents to address questions about the changes in healthcare coverage brought about by the new marketplaces.
On July 22, two federal appellate courts issued conflicting rulings regarding the legality of financial subsidies available to qualified consumers through federally-run health insurance exchanges. One court overturned the subsidies for federally-run exchanges in a 2-1 decision, while another 3 judge panel unanimously upheld the current law providing for subsidies in state- and federally-run exchanges. The administration has requested a review of the ruling against the subsidies by the full appeals court. Should the courts remain split, the issue may be taken up by the Supreme Court. In the meantime, the ruling does not affect current subsidies and they remain in effect in ALL states and for ALL currently eligible persons in state- and federally-run marketplaces.
ACP supports the subsidies as a critical component to the expansion of health insurance coverage under the ACA as intended by Congress. The College is hopeful the courts will uphold the availability of these subsidies in all health insurance exchanges.
The following documents include general information on resources that are available to you and your patients, and answers to frequently asked questions about insurance enrollment. In addition, ACP has also assembled state-specific resources to tell you more about what is happening in your area and help you provide your patients with accurate contact information.
Affordable Care Act Issues Physicians Need to Know: This document provides practical information to physicians and their patients regarding provider network adequacy issues, the health insurance appeals process, information about cost sharing, and how physicians can help their patients acquire non-covered drugs.
ACPís State-by-state Guides to Helping Patients Enroll
Find information about how the insurance marketplace will operate in your state and a resource guide you can give to your patients to help them find the appropriate people to answer their questions about health insurance.
Questions and Answers about Health Insurance Marketplaces and the Affordable Care Act
- ACPís Frequently Asked Questions about Patient Enrollment in Health Insurance Marketplaces
- ACPís Questions & Answers About Physician Concerns on the ACA
ACP Health Insurance Enrollment Comment Center
Have questions or comments about ACA health insurance marketplaces and enrollment? Contact ACP staff at firstname.lastname@example.org to share your thoughts.
- From ACP: An Internistís Practical Guide to Understanding Health System Reform
- From Coverage to Care: From Coverage to Care is an initiative designed to help people understand how health insurance works and find the physician or health care professional that's right for them. Resources include videos and educational brochures and poster. Materials are available in English or Spanish.
- HHS Info about Marketplaces: For Professionals | For Patients (English) | For Patients (Spanish)
- HHS State-by-State Fact Sheets
- Web MD: Health Insurance Checklist
- AARP Health Law Answers Tool, Health Care Reform Guide
- Kaiser Family Foundation
- Consumers Union
- Health Insurance Marketplace
- National Partnership for Women and Families
- Internal Revenue Service: Information on Reporting Income Changes for Premium Tax Credit
- Additional resources available at healthcare.gov
ACP Policies and Recommendations
This library is a collection of ACP's Clinical Guidelines, Ethical Guidelines, Policy Statements, and copies of testimony and letters to government and non-government officials.
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