The Affordable Care Act (ACA) is a comprehensive reform law, enacted in 2010, that increases health insurance coverage for the uninsured and implements reforms to the health insurance market. This includes many provisions that are consistent with AMA policy and holds the potential for a better health care system. The ACA represents a tremendous step forward on the path toward meaningful health system reform, and additional steps will follow.
Under the Affordable Care Act, patients who may have been uninsured due to preexisting conditions or limited finances can secure affordable health plans through the health insurance marketplace in their state. The AMA is committed to providing information for physicians to help their patients get coverage, along with securing changes to improve the law moving forward.
General ACA resources and links for physicians
- Navigating open enrollment (PDF)
- Fact sheet on Section 1557 (PDF)
- Section 1557’s sex discrimination requirements: Myth v. fact (PDF)
- What health system reform means to physicians and patients (PDF)
- Facts about ACA implementation (PDF, sign-in required)
- Major provisions relating to coverage under the Affordable Care Act (PDF, sign-in required)
- Medical practice checklist for ACA health insurance exchanges (PDF, sign-in required)
- Sample letter to patients about potential provider network changes (DOCX, sign-in required)
- The Affordable Care Act: Answers to common questions from patients (PDF, sign-in required)
- HHS HealthCare.gov implementation center
- Kaiser Family Foundation health reform source
- CMS.gov outreach and education resources
Understanding the ACA grace period
Under the Affordable Care Act, a patient who receives a premium subsidy to purchase health insurance coverage through a health insurance exchange and is late in paying his or her health insurance premiums enters a 90-day grace period.
During the 1st month of the grace period, the patient continues to have health insurance coverage, and the patient's health insurer will pay claims for health care services provided to the patient during that time. However, if the patient enters the 2nd or 3rd month of the grace period, the health insurer may pend claims for services provided to the patient during that time.
If the patient pays before the end of the 90-day period, the insurer will pay those claims. If not, the insurer will terminate the patient’s coverage and will not cover charges made in the 2nd and 3rd months of the grace period. The patient then becomes responsible for those charges, potentially exposing physicians to significant financial risk if the patient does not pay the charges.
Insurers must notify physicians about their patients’ grace period status. To minimize nonpayment, physicians must determine how their patients’ insurance provides such notice and handles other grace-period issues.
The AMA has several resources to help physicians navigate grace period payments in their practices:
- Step-by-step guide to the ACA grace period (PDF, sign-in required)
- Grace period collections policy checklist (PDF, sign-in required)
- Model financial agreement language for patients receiving Advance Premium Tax Credits (PDF, sign-in required)
- Sample letter: Grace period notice to patients (DOCX, sign-in required)
- Electronic notifications and the health insurance exchange premium payment grace period (PDF, sign-in required)