ACA Exchange Health Plans and You

Q. What is the situation on the payment rates offered by the exchange plans in the Affordable Care Act health care marketplace?

A.  The exchange plans offered in the ACA marketplace are not government programs; they are commercial products. Your current contracts dictate the rates you have agreed to accept.

As contract rates are negotiable, no payment information is available.

Q.  Are the plans asking physicians to sign new contracts for these products?

A.  Yes and no. Some plans, Blue Cross and Blue Shield of Texas (BCBSTX) for example, did create new networks for these exchange products and sought agreement from physicians through separate contracts. Other plans are using their current contracts and networks. The products offered on the exchange are HMO and PPO products that offer a level of benefits to permit their sale on the federal exchange.

At this time, TMA has been able to confirm only that BCBSTX has offered new contracts, but we do not know what network BCBSTX will be using. It may use its established network for some products and the new network for others.

As the ACA health care marketplace unfolds, TMA is gathering new information daily. If you have questions, contact the TMA Knowledge Center at (800) 880-7955 or knowledge[at]texmed[dot]org.

If your patients have questions about how the marketplace works, refer them to, where TMA is unrolling a series of videos and answers to the most frequently asked questions about the new coverage rules and options.

Published Oct. 10, 2013


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Last Updated On

May 13, 2016

Originally Published On

October 10, 2013