Health Insurance Marketplaces
How do health insurance marketplaces work?
Will purchasing health insurance through an exchange be as straightforward as purchasing a book on Amazon.com, an airline ticket on Orbitz.com, or a pair of shoes on Zappos.com? No one knows for sure, but the new health care reform bill includes provisions to make it relatively easy for consumers to purchase health insurance.
How will consumers access the health insurance exchanges?
To begin, each state will have an exchange, and any consumer or small business owner who wants to acquire health insurance coverage can go to a website. There will also be the option to enroll via a toll-free hotline or in person.
What will the shopping experience be like?
First, users will be asked to provide financial information to assess whether their income level qualifies them for federal tax credits to help pay for premiums, co-payments, and deductibles. They will then be prompted to select a health plan. The health plans will be pre-certified, and consumers will be required to show that they fulfill basic quality, benefit, and customer service standards.
Will the exchanges make it easy for consumers to compare the plans?
Customers will be able to compare various health plans based on their priorities. So, if you're primarily concerned with the cost of the premium, you'll be able to compare on that basis. If you are more concerned with the generousness of the benefits, the cost-sharing arrangement, or the deductible, you can evaluate plans accordingly. You'll be able to check to see if a frequent care provider is in the network of your insurance plan. An exchange will also provide a cost calculator that takes into account any tax credits you may be eligible for, allowing you to determine your real out-of-pocket costs.
Will there be reviews or any other information to help consumers choose amongst available plans?
The exchanges will be required to grade the health plans on a quality scale, thus Plan A may receive a four-star rating from the exchange while Plan B receives two stars, with an explanation as to why.
Can you explain the concept of an essential benefits package? What are the plans available through exchanges required to offer?
It is critical to discuss what is now available in the individual insurance market for the majority of consumers. If you are looking for coverage on your own now, nearly no plans include maternity care. Few provide coverage for mental health or substance misuse treatment. Prescription medication coverage is also uncommon.
The (health-care-reform) law mandates that the essential health benefits be comparable to those found in a normal employment plan, and it specifies ten areas of coverage that must be included. Prescription medicines, mental health and substance addiction therapy, emergency department visits, hospitalization, and doctor visits are among them. (Beginning in 2014, all health insurance plans must provide essential health coverage.)
What different types of plans will be available?
People will be able to shop for various degrees of coverage. If you qualify for a premium tax credit, most people will choose the silver level of coverage, which means the health plan will cover roughly 70% of the costs when you utilize care services. Of course, rates will vary depending on the magnitude of the tax credit you qualify for. It's a tax credit on a sliding scale. Your premium payment will be lower if your income is low.
What else should consumers know about the types of plans they will be able to buy through the exchanges?
All swaps will necessitate the accreditation of plans. This means that third-party accrediting agencies will conduct a thorough examination of how health plans really manage health care.
For example, are the plans ensuring that diabetics receive sufficient care coordination, or that hospitals discharge patients with the proper instructions and that someone checks in on them when they return home? Accrediting agencies examine how health plans perform on various aspects, as well as customer service. What happens if you have an issue or if there is a dispute regarding claim payment?
What else should consumers know about exchanges?
If the consumer requires assistance, it will be provided. The exchanges must have reasonably adequate customer assistance services in place. So, if you log onto the website and don't understand something, you can contact a call center. The navigator program has real-life folks who can sit down with you and walk you through it. People should be aware that they are not completely alone.