Sep 14, 2012
Where We Are: Health Insurance Exchanges
By Marcella Durand
If you had to create a way for millions of people to learn everything they need to know about health insurance, so that they could choose a policy that’s right for them and get properly enrolled with top-notch customer support, how would you do it? That’s the question state lawmakers are facing as they consider how to organize their state’s health insurance exchange, a major component of the ACA (Affordable Care Act) due to begin operation by 2014.
What they are
Health insurance exchanges are web-based “marketplaces” where individuals and small businesses can compare and purchase affordable and qualified health benefit plans. Existing models have been compared to websites like www.travelocity.com or Consumer Reports’ product ratings that offer consumers a choice of options, based on their needs and preferences. In addition to information about the price of various plans, the exchanges will be able to tell people if they qualify for tax credits provided in advance to make the plans affordable. Exchanges also increase competition among insurance companies, which should bring down costs. Members of Congress and other federal employees currently get their health insurance from exchanges — an indication that exchanges will stay good resources for finding quality affordable coverage with good benefits and protections for everyone.
The ACA has established standards that exchanges must meet, but most of the planning and implementation will take place at the state level. State lawmakers can either establish their state’s own exchange through legislation, or allow their eligible residents to use an exchange run by the federal government. Many exchanges are still “under construction” as states across the nation debate what will work best for them.
Some important features of exchanges that will help people with MS and others when they go shopping for health coverage include:
- User-friendly application and enrollment processes. A single, standardized application form and a “no wrong door” approach determine which programs people are eligible for and direct them through the process with a minimum of red tape.
- Security. For many people, if they lose their job, they lose their insurance, too. Exchanges guarantee a secure place where anyone who’s not already covered through an employer plan or Medicare can obtain insurance. Moreover, by law, insurance plans offered through exchanges will not be able to deny coverage because of pre-existing conditions like MS.
- Accessibility. Help with selecting and enrolling in a plan will be available to consumers over the phone, online through the exchange’s website, and in person through specially trained “navigators.” Traditional insurance brokers and agents will continue to play a role by helping business owners and other customers purchase health coverage, too. All services of the exchange should be available to all persons eligible for its products, regardless of any disabling condition. That includes overcoming barriers due to language, as well as physical or cognitive disabilities.
- Reassurance. Exchanges will offer plans that allow people to keep their current healthcare providers. This is important to people with MS or other chronic conditions, who often have established a solid relationship with their doctor, nurse or therapist.
- Transparency. By law, details about all plan options and covered benefits, including out-of pocket costs and benefit exclusions, must be made clear. Greater transparency in coverage will help consumers make “apples to apples” comparisons between options from insurers competing on a level playing field.
Where we are now
To find out more about our state’s plans for establishing a health insurance exchange, visit the Kaiser Family Foundation’s interactive website at www.statehealthfacts.org, or www.healthcare.gov/news/factsheets/2010/07/esthealthinsurexch.html (click the “state-by-state” link). The Society has also set up a Web page devoted to ACA FAQs (Frequently Asked Questions) at www.nationalMSsociety.org/ACAFAQS.