Shopping For Health Insurance Using The New State Exchanges

OverviewThe Patient Protection and Affordable Care Act, commonly referred to as Obamacare or the ACA, creates state-based health insurance exchanges for individuals and small businesses to use to purchase health insurance. The exchanges are organized market places providing a one-stop-shop for individuals and small businesses to compare competing health plans and enroll in coverage programs. The exchanges are an important pillar of the new health law and are expected by 2019 to serve as the gateway for more than 29 million people to obtain health insurance.

One-Stop-ShoppingThe new insurance marketplaces will provide consumers with important information about various insurance plans, including:• Eligibility• Availability• Covered benefits• Premiums• Cost-sharing• Provider networks• Claims vs. administrative costs• An electronic calculator allowing consumers to determine their

cost of coverage, including assistance from government subsidies

Plan TiersThe ACA mandates that plans be standardized into four tiers, bronze, silver, gold and platinum, with bronze plans being the least comprehensive and platinum plans offering the most coverage. At a minimum, all plans must offer:• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance abuse services• Prescription drug coverage• Rehabilitative services• Laboratory services• Preventative care• Pediatric services, including oral and vision care

Streamlining Enrollment

The health insurance exchanges will help to streamline enrollment, offering annual open enrollment periods as well as special enrollment periods to account for changes in status, such as the birth of a child, marriage, etc. The exchanges will also work to direct individuals eligible for Medicaid, CHIP or other public programs to these services and to decertify insurers who attempt to discourage sicker individuals from applying.

Greater Transparency

Thanks to the exchanges, consumers will have more information about their benefits and their costs, allowing them to make better choices with regard to their coverage. Insurers participating n the exchanges are required to provide consumers with a summary of benefits, network availability, cost-sharing examples, information on claims payment policies and practices and more.

Improving QualityThe ACA is designed to encourage quality improvement by requiring insurers to report to the government and their clients on what programs they’re using to improve health outcomes, reduce hospital readmissions, enhance patient safety, reduce medical errors, promote wellness and reduce disparities in care. To participate in the exchanges, insurers must meet requirements set forth by the National Committee for Quality Assurance.

Market ReformsRegardless of whether an insurer participates in the health exchanges or not, they will have to adhere to some reforms intended to level the playing field and prevent high-risk individuals from being dumped entirely on the exchanges. These reforms include:• Guaranteed issue and renewability of coverage• Banning premium variation based on health status or

gender and limitations on variation based on age, family size, tobacco use and geography.

• Minimum coverage regulations• Banning lifetime caps on coverage• Requiring plans to allow insureds to participate in

approved clinical trials.

State Participation NecessarySuccess of the health exchanges may depend on individual states to ensure market protections are enforced and financial assistance for the exchanges. The exchanges can provide insurance consumers with a convenient and cost-effective method to purchase health insurance, but only if state and federal governments stay active in improving the technology and policy behind the exchanges.

About Coverage CaliforniaCoverage California helps to educated Californians about their health insurance options under the Affordable Care Act and provides resources for them to find a plan that best suits their needs. The new health care law is complex, and Coverage California helps consumers navigate the marketplace to find the right policy.

For more information visit http://www.coverageca.com.