ACA Overview
The Affordable Care Act provides coverage to individuals and families who do not have access to employer-sponsored insurance and/or are not eligible for government programs (Medicare, Medicaid, Federal Employee Program, etc). The health care law offered a host of coverage changes and opportunities. Blue Cross and Blue Shield of Texas committed to implementing coverage changes to comply with ACA requirements and to better meet the needs and expectations of you and your patients.
This section offers updated information and resources to keep you informed of the issues potentially affecting the administrative and patient care aspects of your practice. We invite you to refer back to this page often for ongoing information on ACA provisions.
Health Insurance Marketplace
ACA established health insurance marketplaces (also known as health insurance exchanges), where consumers can shop, compare and enroll in health insurance coverage. They are intended to create an organized and competitive market by offering a choice of plans, establishing common rules regarding the offering and pricing of insurance and providing information to help consumers better understand the options available.
Administrative Simplification
Under the multiphase initiative known as Administrative Simplification, BCBSTX implemented new operating rules to promote greater uniformity in the exchange of electronic health care information. Learn more.
Patient Perspective
As a result of the ACA law, individuals and families will have more options for managing their health care needs with expanded coverage for women, children and individuals with pre-existing conditions. Other provisions offer greater access to preventive care services with no cost sharing and guarantees coverage of essential health benefits in our individual and small group insurance products. Learn more.
Risk Adjustment
Risk Adjustment, under ACA, identifies the differences in health care risk among specific patients. The goal of the Risk Adjustment methodology is to provide an objective way to compare care and cost performance. Providers play an important role. Risk Adjustment is one of the methods that helps payers and providers focus on quality and service. Learn more.