Part of health reform (also known as the Affordable Care Act) was the creation of Health Insurance Exchanges/Marketplaces, where individuals, families, and small businesses that do not provide health care coverage to their employees can learn about affordable health coverage, compare insurance plans, and enroll in coverage. As part of Marketplace coverage, many enrollees receive financial help through tax credits, increased preventative care, the right to appeal when denied coverage, and choice of doctors. Furthermore, barriers to care such as denial of benefits for pre-existing conditions ensures affordable, quality health care coverage for everyone.
Marketplaces can be created by individual states but the federal government will step in to operate the marketplace for any state that opts out. For more information on the Marketplace in your state, visit healthcare.gov.
Health plans offered through the Marketplaces are known as Qualified Health Plans (QHP). The requirements for QHPs depend on the type of exchange (State-based, State Partnership and Federally Facilitated) within the state, creating some slight differences in rules that apply to participating plans. This can impact the provision of care by health centers insofar as network adequacy, contracting, and payment are concerned.
NACHC works on an ongoing basis to ensure that Community Health Centers are both fully participating in, and are appropriately reimbursed by, plans sold on the marketplaces.
Healthcare.gov– The federal government’s health care coverage website. Individuals, families, and small businesses can sign up for insurance.
Letters and Comments
- Letter from CCIIO on payment to FQHCs by Qualified Health Plans (QHPs) participating in the Exchanges, June 2012
- Essential Community Providers (ECPs) Coalition comments- HHS Notice of Benefit and Payment Parameters for 2016, December 2014
- Senator Menendez’ comments to CMS on FQHC payment for plans participating in the Exchanges, February 2014
- Senators Waxman, Levin and Miller comments to CMS’ draft 2015 Letter to Issuers in the Federally Facilitated Marketplaces, February 2014
- NACHC comments to CMS’ draft 2015 Letter to Issuers in the Federally Facilitated Marketplaces, January 2015
NACHC QHP Fact Sheets