The federally-hosted Arizona Health Insurance Marketplace launched in 2013. Here are some frequently asked questions (FAQs) to assist you with concerns your patients or your employees might have.
- What is the federal health insurance marketplace? Healthcare.gov, or cuidadodesalud.gov, is the federal health insurance marketplace for people who do not have health insurance.
- What am I required to tell my employees? The Affordable Care Act requires that employers who are subject to the Fair Labor Standards Act notify their existing employees about the Marketplaces. Employers will be required to provide notifications to new employees hired as they come on board. The Department of Labor has full responsibility for this provision, but guidance is available in the SHOP section of healthcare.gov that should help explain the requirements. Notably, there is a link to a DOL website that will help employers figure out if this requirement applies to them.
- Own your medical practice? Check out the Small Business Health Options Program (SHOP) by pointing your browser to healthcare.gov and click on the Small Businesses tab.
- Who runs the Arizona Health Insurance Marketplace? U.S. Department of Health and Human Services (HHS), at healthcare.gov. This website is where Arizonans can apply for coverage, compare plans, and enroll according to the federal marketplace enrollment time lines.
- When is it accessible? Each year, open enrollment begins in November, and ends in the January of the following year. The Open Enrollment Period for 2017 is November 1, 2016 — January 31, 2017.
- Who can participate? Individuals or families not covered under an employer health plan.
- What kind of coverage is available? The Marketplace will provide four tiers of coverage standardized according to the benefits: bronze, silver, gold, and platinum. Bronze plans will have lower premiums but higher out-of-pocket expenses. Platinum plans will have higher premiums but lower out-of-pocket expenses.
- What are the projected costs of health plans? Estimates based on entering some personal information can be accessed on healthcare.gov.
- What kinds of subsidies are provided? A cost-savings estimate is available at healthcare.gov.
- What if a patient might qualify for AHCCCS? If you think a patient may qualify for AHCCCS, the Arizona state Medicaid program, patients can apply at healthearizonaplus.gov.
- Questions about the Health Insurance Marketplace can be answered by local operators of the federal Navigator programs. For a complete directory of Navigators in Arizona, visit coverAZ.org.
- How do you verify a patient's coverage? Since the marketplace in AZ is run by the Federal government, it is best to call their plan’s customer service line; a list of all plans and their customer service numbers can be found in this data base (https://data.healthcare.gov/dataset/QHP-Customer-Service-Phone-Numbers/vryg-tdzf). If you can’t find the number, call the Marketplace Call Center (1-800-318-2596).
- How else can you help your patient? Encourage your patients to remain current on their premium payments in order to retain their insurance coverage. Remind your patients to keep all of their paperwork and receipts from all of their doctor’s appointments and from the pharmacy as well. They may need them for their insurer. Remind them they should carry their card at all times. If they don’t have a card, they can contact their plan to get a card. If a patient is uninsured, encourage them to visit HealthCare.gov and see if they qualify to enroll outside of the normal enrollment period.
- "Hey, Doc" - a resource for physicians to share with their patients, created by the Texas Medical Association (TMA) and available at www.texmed.org/heydoc/.
- Patient Protection and Affordable Care Act (PPACA): Looking for something to read on your vacation? Need help falling asleep? Read the entire bill, amendments, official summary, and legislative history at Congress.org: http://thomas.loc.gov/cgi-bin/bdquery/z?d111:H.R.3590:
- American Medical Association (AMA) Health System Reform Resources: The American Medical Association (AMA) has created a section dedicated to information on the ACA.
- Accountable Care Organizations (ACOs)