To help manage a backlog of revalidation applications stemming from the transition to Medicaid’s new Provider Enrollment Management System (PEMS), the state’s Medicaid claims payment contractor announced it will extend revalidation timeframes for physicians and other health care practitioners and suspend disenrollments related to that process.

Private Health Plans Must Cover Women’s Obesity Counseling, Other Preventive Services - 04/05/2022

Starting next year, private health plan policies that began after the Affordable Care Act (ACA) went into effect now will have to cover multiple types of prevention counseling for women, as well as contraceptive care, double electric breast pumps, and more.

Tell Your Uninsured Patients About HealthCare.gov Marketplace Enrollment - 11/19/2021

Enrollment in the federal health insurance marketplace on HealthCare.gov is now open, so it’s a good idea to let your uninsured patients know the option is there. And if they sign up by Dec. 15, their coverage will begin at the start of 2022.

Enrollment for Marketplace Plans Extended by One Month - 09/24/2021

The Biden-Harris administration has announced a 30-day extension of the upcoming open enrollment period for federal marketplace health plans available through HealthCare.gov, as well as a new monthly special enrollment period targeting people with low incomes.

Remind Uninsured Patients: ACA Enrollment Ends Aug. 15 - 07/21/2021

The Texas Medical Association encourages physicians to remind uninsured patients to take advantage of the Affordable Care Act’s (ACA) Special Enrollment Period , which has been extended to Aug. 15 in response to the COVID-19 pandemic.

CMS Finalizes Lower-Than-Proposed Cost-Sharing for Marketplace Plans; Enrollment Closes Aug. 15 - 06/17/2021

The Centers for Medicare & Medicaid Services (CMS) has settled on a lower maximum for consumers’ out-of-pocket costs for federal health insurance marketplace plans in 2022 than what the agency proposed last November.

When Patients Don’t Pay Their Premiums in the ACA Marketplace - 04/17/2018

Will physicians have to refund payments to an insurer if a patient who bought coverage from that insurer in the Affordable Care Act marketplace doesn’t pay his or her premiums?

Can I Pay My Patient’s ACA Premium to Ensure Coverage? - 03/30/2017

If I receive notice that patients who are covered by a health plan in the Affordable Care Act exchange are within the three-month grace period for paying their premiums, may I just pay their premiums to make sure they have coverage while I provide services?

Health Care Coverage for Low-Income Texans - 02/03/2017

Medicaid and the Children’s Health Insurance Program (CHIP) cover more than 4 million low-income Texans. That includes half of all children in the state and about two-thirds of people in nursing homes. As the Texas Medical Association has long cautioned, however, a Medicaid card does not equal access to health care. Extremely poor payment rates and extraordinarily high bureaucratic burdens lead most Texas physicians either to refuse to accept all new Medicaid patients or to limit the numbers they can see. TMA encourages the Texas Legislature to increase Medicaid and CHIP payments and reduce administrative hassles, and to search for creative new ways to provide more health insurance coverage for low-income Texans.

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