ACA Roundup: Government Reopens with Minor Change to Health Law

ACA Roundup: Government Reopens with Minor Change to Health Law

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Government Reopens with Minor Change to Health Law

The 16-day government shutdown is over with Obama's signature health law almost entirely intact. The only change to the Affordable Care Act was a new income verification measure for those who receive subsidies to help pay for monthly premiums, reports Politico. By Jan. 1, 2014, Health and Human Services Secretary Kathleen Sebelius must submit a report to Congress explaining how income will be verified for those who receive subsidies. The inspector general will have until July 1, 2014 to report on the success of the verification process, six months after subsidies are scheduled to have been mailed.

Provider Search Tools on State Exchanges

Computer glitches have prevented millions from enrolling in Obamacare's new, online health insurance marketplaces, and those who manage to log in and view plans have run up against another problem: most states don't offer a way to find out if a provider is in-network. Provider directories, a search tool that allows customers to see which doctors and hospitals are included within a given health plan, are embedded in just a handful of state exchanges, reports the New York Times. For consumers who don't live in Colorado, Kentucky, Nevada or Washington state, those who sign up will have a difficult time figuring out their health coverage options. Maryland, Oregon and Rhode Island are in the process of creating provider directories for their exchanges. But other states like Connecticut, Hawaii, Minnesota, New York and Vermont just provide users with links to the participating insurers' websites. Oftentimes, insurer provider lists are not up-to-date, difficult to understand, or merely list every single provider or health system in-network in a format that cannot be easily searched through. But search tools are also not error-proof. Last week, California had to take its search tool offline due to both inaccurate information and technical issues.

Introducing Health Insurance Co-Ops

Those shopping for health insurance this fall have a new group of insurers to consider: consumer oriented and operated plans,or co-ops. With federal loans, 23 states have established co-ops to give consumers more affordable health coverage options on the exchange. Co-ops are non-profit, member-driven organizations, which means that those who purchase plans may also be elected to the board and help shape the organization's outlook. Though all co-ops are required to include the 10 essential health benefits, many are experimenting with new ways to encourage participation, reports Kaiser Health News. In New York, those with Health Republic Insurance do not have to pay copayments when seeing their primary care doctor and the deductible doesn't apply to ambulatory care services. In Maryland, those with Evergreen Health Co-op may visit one of four one-stop care centers along I-95 to receive help from doctors, nurses, health coaches and care coordinators. In Colorado, HealthOp offers rewards to customers for keeping up with their health care by getting blood work or a checkup.

Medicare Open Enrollment Begins

With the opening of the new health insurance exchanges in early October, and the beginning of the open enrollment period for Medicare on Oct. 15th, it's easy to get things confused. But it's important to keep in mind that despite the overlap in enrollment periods, the two insurance programs apply to different age groups. Medicare is not affected by the Affordable Care Act, among other important distinctions. "That's important for people to understand," explains Juliette Cubanski, a Medicare policy analyst at the non-profit Kaiser Family Foundation, told U.S. News & World Report. For those age 65 years and older, there's no "need to worry" about the mandates or penalties.

Paying Up-Front for Non-Emergency Care May Become the Norm

A low monthly premium may make one health plan look more affordable than another. But the deductible -- the amount you pay out-of-pocket before the insurance company pays -- can paint a more realistic picture of your health coverage costs. The notion of paying up-front for medical services seems taboo, but trying to collect payments after treatment is often impossible, reports Bloomberg News. Some hospitals and clinics have begun to demand money before offering treatment for non-emergency procedures. At New York University's Langone Medical Center, doctors and hospitals collect co-insurance and deductibles up front for inpatient and outpatient services. "People get excited to buy a TV, but health care is a service they don't like to pay for," explains Andrew Rubin, Vice President for Medical Center Clinical Affairs and affiliates. In Albuquerque, at the nonprofit Presbyterian Healthcare Services, patients must pay their deductible, copayments and co-insurance up front or, if they're uninsured, they must pay their entire bills in full immediately.

Affordable Care Act
health care reform
health care
health insurance
  • Evi Heilbrunn

    Evi Heilbrunn is Associate Editor of Health Care Analysis at U.S. News. You can follow her on Twitter or email her at

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