Insurance Marketplace and Exchanges

The Affordable Care Act (ACA) makes substantial changes to the health insurance marketplace. Health insurance companies are required to spend a specific portion of consumers' premiums on direct care (the "medical loss ratio" provision) and publicly justify unreasonable rate increases.

The law also creates health insurance exchanges to give individuals and small businesses access to affordable health coverage. Before the exchanges are operational, the law creates a transitional program to offer coverage to uninsured individuals who have been unable to obtain health coverage because of a preexisting health condition.

See specific headings in column at right for more details.

Accountable Care Organizations (ACOs)   

Government Resources 


Centers for Medicare & Medicaid Services (CMS) has announced the selection of the first 27 accountable care organizations (ACOs) to participate in the Medicare Shared Saving Program (Shared Savings Program).

Accountable Care Organizations (ACO), CMS, 4/5/12

Selected Participants in the Pioneer ACO Model, CMS, 12/19/11  

The Centers for Medicare & Medicaid (CMS) has released a notice announcing the testing of the Advance Payment Model for certain accountable care organizations (ACOs) participating in the Medicare Shared Savings Program scheduled to begin in 2012, and provides information about the model and application process. 11/2/11  

The Centers for Medicare & Medicaid (CMS) has issued guidance for two initiatives, the Medicare Shared Savings Program and the Advance Payment model. These programs will help providers form Accountable Care Organizations. 

The Centers for Medicare & Medicaid Services (CMS) announced three ACA initiatives related to Accountable Care Organizations (ACOs). The Center for Medicare and Medicaid Innovation (Innovation Center) will support a new Pioneer ACO model that will be available to providers this summer. The Innovation Center is seeking comment on the idea of an Advance Payment ACO Model that would provide additional up-front funding to providers to support the formation of new ACOs.  And provider groups interested in learning more about how to coordinate patient care through ACOs can attend free new Accelerated Development Learning Sessions. 


The Department of Health and Human Services (HHS) has released proposed rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower health care costs while meeting performance standards on quality of care and putting patients first. Patient and provider participation in an ACO is purely voluntary.  

Analysis