Health System Reform

Health System Reform

Health Insurance Marketplace  

2016 Open Enrollment for the Health Insurance Marketplace ended on January 31, 2016.  Open Enrollment for 2017 coverage through the Health Insurance Marketplace will begin the fall of 2016.  

Where can patients get more information or assistance?

Special Enrollment - Some people can sign up for health insurance outside of the Open Enrollment period if they have a change in their life – known as a “qualifying life event” – that makes them eligible for a Special Enrollment Period. More information is available at www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/.

Changes in someone's life that allow them to sign up for a Marketplace plan during a Special Enrollment Period include:

  • Getting married
  • Having a baby, adopting a child or placing a child for adoption or foster care
  • Losing other health coverage
  • Permanently moving outside your plan’s coverage area
  • Gaining citizenship or lawful presence in the U.S.
  • Gaining or continuing status as a member of an Indian tribe or an Alaska Native shareholder.
  • Leaving incarceration
  • For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions

A Healthcare Navigator, Certified Assistance Counselor (CAC) or broker can help consumers review coverage options and apply for a health insurance plan.  For enrollment assistance and information about the Marketplace, call the Maine HelpLine at 800-965-7476 or visit www.enroll207.com to find an Assister in your area.

For additional information about the Marketplace and enrollment, resources for patients or health care providers, or a Marketplace update or presentation at your practice or office, contact Susan Kring, ACA Outreach Coordinator at 662-2364 skring@mainemed.com.

Health Insurance Marketplace Presentations

Maine Quality Counts Lunch & Learn webinar recorded on September 29, 2015 Marketplace Open Enrollment: A Primer for Providers

 

Maine Quality Counts Lunch & Learn webinar recorded on May 5, 2015 Progress Report: Five Years of the Affordable Care Act, 2010-2015

 

Maine Public Radio Maine Calling Program recorded on January 25, 2015 Signing Up for the ACA in 2015

 

Maine Public Radio Maine Calling Program recorded on December 8, 2014  The Health Insurance Marketplace and Open Enrollment 2015

 

Maine Quality Counts Brown Bag Forum webinar recorded on October 28, 2014  Get Covered, Stay Covered: Looking Ahead, Open Enrollment 2015

 

Patients

Where to find information about the Health Insurance Marketplace:

HealthCare.Gov Apply online and get information about enrollment in the Marketplace and frequently asked questions.  Or call the Health Insurance Marketplace Call Center at 1-800-318-2596 to talk with someone about enrolling or to apply by phone.

enroll207  Information about the Marketplace in Maine.  Find a Navigator or Certified Application Counselor (CAC) near you.

Consumers for Affordable Health Care Information about the Marketplace in Maine.  You can also call the Maine Health Care Helpline at 1-800-965-7476.

Legal Services for the Elderly Information on how the ACA applies to you if you are a senior or have Medicare.

Kaiser Family Foundation features information about the ACA, including a summary of the law, other resources and reports, and an online calculator to estimate health insurance premiums and eligibility for subsidies.

Patients and Physicians

From Coverage to Care, an initiative of the Center for Medicare & Medicaid Services (CMS), provides information to help people make the most of their new health coverage, as well as tools to promote patient engagement. 

Coverage to Care's Roadmap to Better Care and a Healthier You includes 8 steps to inform consumers and health care providers about health care benefits and accessing primary care and preventive services. 

Physician Practices

The MMA has attorneys on staff who can assist physicians and medical practices understand how the ACA applies to them and their patients. Contact us at 207-622-3374 for more information.

MMA's ACA Outreach Coordinator is available to provide resources for patients, physicians and practices, or to schedule a presentation or meeting about enrolling in the Marketplace.  Contact Susan Kring at 662-2364 or skring@mainemed.com for more information. 

ACA Background

The Affordable Care Act (ACA) is a national law passed by the U.S. Congress and signed into law by President Obama in March 2010. It is also called the Patient Protection & Affordable Care Act and sometimes just the Health Care Reform law. It applies to the entire country and has parts that will go into effect over the next ten years.  The goals of the ACA are to:

  • Expand health insurance coverage. Through a variety of mechanisms it will expand health insurance coverage to 32 million more Americans by 2019.
  • Improve coverage for those with health insurance by creating strong consumer protections and administrative simplification provisions in the health insurance industry.
  • Improve access to and quality of care, including by promoting preventive and primary care.
  • Control rising health care costs.

Here are links to information about the Health Insurance Marketplace, Health Reforms of the ACA, Preventive Care Benefits and Essential Health Benefits

Other useful resources:

Policy Issues

enroll207

 

Health Insurance Marketplace