The Health Insurance Marketplace: What you need to know

In the September 2013 issue of The Record, we published an article titled “The Health Insurance Marketplace: A new way to shop and purchase health insurance.” We’ve recently received requests from health care providers to republish the article and provide updates as necessary. Here’s an overview of what you need to know about the products purchased on the Health Insurance Marketplace.

As part of the Affordable Care Act, consumers were able to purchase health care coverage from the Health Insurance Marketplace for coverage effective Jan. 1, 2014.

Each state had an opportunity to create its own Marketplace, either run by the state in partnership with the U.S. Department of Health and Human Services or independently, according to federal and state laws governing health care. Michigan’s Health Insurance Marketplace represents a partnership between the state and the federal government.

When open enrollment launched in October 2013, the Marketplace enabled consumers to compare prices and coverage among eligible insurance plans. The Marketplace allows consumers to select the plan that best meets their budget and health care needs. Consumers can still purchase health insurance coverage directly from health plans, such as Blue Cross Blue Shield of Michigan and Blue Care Network.

As a health care provider, your patients may have treated you as their primary source of information about health care reform, especially the Marketplace. We gave you information to help you answer some basic questions.

The Marketplace in a nutshell
The Health Insurance Marketplace is essentially a website that allows consumers to compare prices and coverage from different health plans that meet certain government requirements during open enrollment periods. Once a health plan is selected, consumers can either purchase through the Marketplace or directly from health plans.

There are two different Marketplaces, one for individuals and one for small groups:

• Individual Marketplace — For consumers purchasing coverage on their own
• Small Business Health Options Program, also known as SHOP — For businesses with 50 or fewer full-time-equivalent employees

Keep the following in mind:

• Open enrollment on the Marketplace for coverage that was effective Jan. 1, 2014, began Oct. 1, 2013.
• Open enrollment for 2014 coverage is over. Your patients can enroll on the Marketplace only if they are experiencing certain life events that qualify them for a special enrollment period. For more information, visit healthcare.gov**.
• Open enrollment for 2015 coverage will begin in November. We’ll provide further details in a future issue of The Record.

Products purchased on the Marketplace
As a reminder, health care providers sign contracts to perform services within certain networks, such as our PPO or HMO. Keep in mind that providers are required to accept new members within the network they are contracted with, whether a product was purchased on or off the Marketplace. The only exception is if a practice has been closed to new patients. If you have any questions about the contracting or reimbursement process, please contact your provider consultant.

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by U.S. Treasury regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

**BCBSM does not control this website or endorse its general content.