Help Your Patients Enroll in Health Insurance Marketplaces
One of the major ways that the Affordable Care Act (ACA) expands health coverage to millions of uninsured persons is through state-by-state health insurance marketplaces. Since opening in 2013, the marketplaces have helped eligible patients buy individual health insurance plans that they can afford. They provide a web-based platform that enables patients to effectively comparison shop and select the best plan for them and their families. Eligible persons are also able to get tax subsidies to help them afford the plans offered by the marketplaces.
The ACA has helped to reduce the number of uninsured and made health insurance more affordable and accessible for millions of people, but millions remain without coverage. The remaining uninsured will be harder to reach. The penalty for failing to enroll in adequate coverage is higher in 2016: 2.5% of annual household income or $695, whichever is higher. Those currently enrolled in marketplace-based coverage may find a better deal by shopping around and enrolling in another plan.
Open enrollment begins on November 1, 2015 and ends on January 31, 2016. Physicians and their staffs can help get the word out about enrollment opportunities and educate their patients about community-based health insurance enrollment assistance. To help you help your patients make informed 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 marketplaces.
The open enrollment period for the 2016 plan year has ended. However, special enrollment periods are available under certain circumstances such as a change in family status (including marriage or birth of a child), residence or income. Health insurance shoppers can visit www.healthcare.gov or call 1-800-315-2596 to see if they qualify for a special enrollment period. Medicaid enrollment is open throughout the year.
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)
- ACA Pocket Guide for Providers: a handy pocket-sized guide with information on enrollment resources, important dates, essential health benefits, and a list of preventive services covered for free when provided by an in-network physician or other health care professional.
- 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.
The ACP Advocate Blog
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the State of the Union
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Reporting Requirements in '16, Legislative Wins from '15, and A Look at
the Budget Deal
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Improving Meaningful Use, Insurance Network Guidelines, and the AMA
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