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Patient Enrollment
As an HIV care provider, some of your patients will soon have the option to enroll in new Qualified Health Plans in the state Insurance Exchange (Marketplaces).
One-Stop Enrollment
The ACA sets out a consumer-friendly approach to patient enrollment in the new programs – an approach referred to as “no wrong door.”
Patients will be able to utilize a single-form application that will determine which programs, and what types of assistance, they are eligible for. Patients will be able to apply through online, by phone, and through in-person enrollment.
Learn More: Patient Enrollment
Enrollment in the Exchanges
The period of time during which individuals who are eligible to enroll in a Qualified Health Plan can enroll in a plan in the Marketplace is called “Open Enrollment.” There are 3 key dates important to new patients and to providers:
October 1, 2013: Exchange/Marketplace open enrollment starts
January 1, 2014: Health coverage can start
March 31, 2014: Open enrollment ends
For 2015 and later years, the Open Enrollment Period is October 15 to December 7 of the previous year. Individuals may also qualify for “Special Enrollment Periods” outside of Open Enrollment if they experience certain “Qualifying Life Events” including, moving to a new state, changes in income, and changes in family size (a marriage, divorce, birth, or pregnancy).
Enrollment in Medicaid
The ACA simplifies Medicaid enrollment in states that take up the Medicaid Expansion, making all individuals with income up to 138% of the federal poverty level eligible for the program. In states that have not taken up the Expansion, the program is only open to certain populations and has varied income qualifications. Coverage under these programs begins immediately. There is no enrollment period for these programs.
Patients who qualify for Medicaid or the Children’s Health Insurance Program (CHIP) will be able to learn about their eligibility for these programs in the same process as applying for the State Insurance Exchanges.
Assistance in Applying
To help patients understand their new options and to apply for and enroll in appropriate coverage, the ACA includes a number of consumer assistance programs, including Patient Navigators, In-Person Assisters, and Certified Application Counselors.
Some of these programs offer funding for training of personnel to perform these positions. HIV providers should consider how these roles may be incorporated into their practices.

Learn MoreEnrollment Counselors & My Practice 


What Plan is Best for Your Patients
Patients are also likely to ask their providers which plan is best for them. Providers can offer their patients key guidance using the document below.


Additional Information

Outreach and Enrollment Toolkit- Michigan Primary Care Association
Tools for HIV Service Providers: Tools for the Ryan White Community - HRSA HIV/AIDS Bureau
Enrollment Profile Creation- HHS (Will be online beginning October 1st)
Issue Brief: Cost-sharing and Tax Credit Guide for Assistors- State Health Reform Assistance Network