Health insurance marketplaces open Oct. 1

Those who are uninsured may review plans on marketplace websites.

Because of the Affordable Care Act (ACA), optometrists need to be ready for new opportunities to participate in insurance plans and treat new patients.

Many ODs are receiving solicitations from insurance companies to participate in exchange-based health plans with an embedded pediatric vision essential health benefit. As with all insurance programs, practitioners should thoroughly review participation agreements and assess contract terms carefully, according to the AOA Third Party Center.

The new exchanges, or marketplaces, are now open. Insurers offering plans generally will be well-established companies such as Blue Cross/Blue Shield, Aetna or UnitedHealth. These companies will determine if they will use existing provider networks for the new plans or establish distinct new networks, said Stephen Montaquila, O.D., chair of the AOA Third Party Center Executive Committee.

"In some cases, insurance companies may issue separate contracts to health care practitioners for their new exchange-based plans, some of which will likely include lower reimbursement rates," Dr. Montaquila said.

Optometrists should also note that offers to participate will come from insurance companies—not the management of the exchanges. "The exchanges have little, if anything, to do with provider contracting," Dr. Montaquila said.  

How marketplaces work

Uninsured people will be able to log onto marketplace websites—modeled after travel sites such as Travelocity or Expedia—to review plans and purchase a policy online. Many marketplaces will offer 800 telephone lines and "walk-in" offices as well.

Of the 51 health insurance marketplaces being developed across the U.S., 19 will be state-based exchanges, 25 will federally facilitated exchanges, and seven will be "partnership" exchanges, developed jointly by state and federal government. In addition, multi-state plans will be available in 31 states in 2014 and in all states by 2017.

Specifics on the federally facilitated exchanges have not been announced yet. However, information on state-based and partnership exchanges is available now through a state-by-state health insurance exchange locator. These websites include contact information and some details on how to apply to become providers. State optometric associations also may provide additional information for their members.

AOA members have access to resources and FAQs (member log-in required) to help explain the new marketplaces and assess participation in plans. Members also may email the AOA Third Party Center for assistance.

September 4, 2013

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