10 facts providers need to know about health exchanges

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The Centers for Medicare & Medicaid Services has issued a list of 10 facts healthcare providers "need to know" about the online health insurance exchanges, or marketplaces, created by healthcare reform. The publications include the following must-know information:

  • The exchanges are "a new way to shop for health coverage," and allow customers to compare private insurance plans in terms of cost, quality and benefits.

  • Each state will have its own marketplace; some of these will be run by the state, others by the federal government and others by a partnership between the two.

  • Open enrollment in the exchanges will last from Oct. 1, 2013, through March 31, 2014; coverage will begin as early as Jan. 1, 2014.

  • Most plans offered through the exchanges will provide basic services including emergency services, maternity/newborn care, prescription drugs, rehabilitative services and devices, hospitalization, pediatric services, and ambulatory patient services.

  • Any U.S. citizen or national who is not currently incarcerated is eligible to buy insurance through the exchanges.

  • Discrimination on the basis of gender or pre-existing condition is not allowed within the exchange marketplace.

  • Exchange participants may qualify for tax credits depending on their household income and the size of their families.

  • Participants will be able to choose a plan from four categories: bronze, silver, gold and platinum. The categories are distinguished by the average percentage of costs they cover. Stand-alone dental plans and catastrophic plans will be offered as well.

  • Participants can find out through the HealthCare.gov website whether they are eligible for Medicaid, the Children's Health Insurance Plan or assistance with a private plan offered through the exchanges.

  • Further information and resources are available through Marketplace.cms.gov, HealthCare.gov and the Health Insurance Marketplace Call Center.

Dissemination of accurate information about healthcare reform has been a priority as its implementation draws nearer; according to an August poll from the Kaiser Family Foundation, most Americans are not receiving information from sources they consider reliable. Only 22 percent said they had heard information about healthcare reform from doctors and nurses, the most trusted source of information in the poll.

To learn more:
- here's the CMS list (.pdf)

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