ACA 101 Training for Agents and Brokers - How Obamacare FFM & SBM Works

Описание: ACA 101 Training for Agents and Brokers - How Obamacare FFM & SBM Works
46 views Jul 29, 2022 How Obamacare Works
Training For Brokers and Consumers
This is a comprehensive look at individual on-exchange health insurance basics for brokers and agents.

States that choose to rely on the Federal Government to manage all Marketplace functions use the FFM are states that manage all Marketplace functions are SBMs. Some states use an SBM that uses the federal platform (SBM-FPs), meaning they hold primary responsibility for managing Marketplace functions, but rely on the federal HealthCare.gov platform to manage their eligibility and enrollment functions.
Brokers and consumers can use the Marketplace to find and apply for health and sometimes dental and vision coverage that fits their budgets and specific needs. Consumers are always encouraged to use a broker to apply for coverage as their services are typically provided at no cost and can help consumers enroll on the exchanges.
Consumers in FFM and SBM states can find health insurance coverage, and if they are eligible for Medicaid or CHIP
Some individual health insurance companies provide a co-on system with the exchanges to do enrollments from their sites. .
Consumers can use a web-broker to enroll, however, consumers who want to enroll on their own are encouraged to go directly to their exchange, as use of a web-broker is simply an additional point of failure to reach the policies, prices, and benefits.
Marketplacesoffer Marketplace plans and certify each Marketplace plan sold in a state.
Health insurance companies can sell Marketplace plans through the Marketplaces if:
They’re licensed and in good standing in the state(s) where the plan is sold
They offer at least one Silver level and one Gold level plan category option throughout each service
area in which the health insurance company offers coverage through the Marketplace.
Provide qualifying health coverage, including a minimum set of comprehensive benefits called “Essential Health Benefits” (EHBs);
Follow established limits on cost sharing, such as deductibles, copayments, and out-of-pocket maximum amounts; and
Meet nondiscrimination requirements, network adequacy requirements, and applicable state-specific requirements.
MARKETPLACE PLANS MUST PROVIDE COVERAGE FOR THE FOLLOWING ITEMS AND SERVICES IN THE 10 EHB CATEGORIES:
Ambulatory patient services (like doctor and clinic visits)
Emergency services (like ambulance, first aid, and rescue squad)
Hospitalization
Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices (like, therapy sessions, wheelchairs, and oxygen)
Laboratory services
Preventive and wellness services and chronic disease management (like blood pressure screening, and
immunizations)
Pediatric services, including dental and vision care
Companies can offer additional products and services in addition to these 10 EHB, however, those benefits are optional for the provider and not necessarily offered by all providers in a market.
BRONZE LEVEL - A health plan that has an actuarial value of 60 percent
SILVER LEVEL - A health plan that has an actuarial value of 70 percent
GOLD LEVEL - A health plan that has an actuarial value of 80 percent
PLATINUM - A health plan that has an actuarial value of 90 percent