CMS Reveals 10 Things Providers Need to Know about HIEs

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HIE-thumb5In preparation for the Oct. 1, 2013, launch of enrollment for the Health Insurance Exchanges, CMS has released a handy breakdown of what it thinks healthcare providers need to know about the Health Insurance Marketplace.

First, providers should understand where this Marketplace exists: online. According to CMS, the goal is to make this online Marketplace the only place consumers have to go in order to explore their insurance options. The agency hopes to provide a resource “that makes it easy to make side-by-side comparisons of private insurance plans’ benefits, quality, and price, and find out if they’re eligible for assistance with the costs of health coverage.”

Second, a Marketplace will exist in each state specific to the insurance options offered within that state. If you’ve been reading our coverage of the set-up process for these state exchanges, you’ll know that most of these exchanges are being run via a state-federal partnership or solely by the government, with a few being run solely by the states themselves.

Third, as previously mentioned, Open Enrollment runs from Oct. 1, 2013, until March 31, 2014, with coverage beginning at the earliest on Jan. 1, 2014.

Fourth, CMS wants providers to know that this Marketplace “will generally offer comprehensive coverage, including a set of ‘essential health benefits.’” These benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, behavioral health treatment, prescription drugs, and several other areas. Looking at the list, the government is taking “comprehensive” very seriously.

Fifth, every U.S. citizen or U.S. national can participate in the Marketplace, prisoners excepted.

Sixth, no discrimination of cost or coverage will be tolerated against genders or pre-existing conditions.

Seventh, if a consumer is worried about the cost of monthly premiums or deductibles and co-pays, tax credits will be provided that should help lower the price. These credits, of course, depend on one’s income and family size.

Eighth, four health-plan categories will be offered in the Marketplace: bronze, silver, gold, platinum. CMS notes: “The differences among the categories will be based on the average percentage of the costs the plan will cover. This system makes it easier to compare similar plans based on price and coverage. Catastrophic plans and stand-alone dental plans also may be available.”

Ninth, should a consumer wish to apply for Medicaid, CHIP, or other financial help, an application can be found at that will determine their eligibility.

Speaking of which, consumers can find more information about the Marketplace at and or by phone at the Health Insurance Marketplace Call Center, 1-800-318-2596 or 1-855-889-4325 for TTY users.

As healthcare executives, what additional information do you need regarding the HIEs? We’ll do our best to weed out the information for you in future postings.

-by Pete Fernbaugh

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