Getting Your Obamacare Basics Right for 2013

2013 is touted as the year of the Health Reforms, the year when Obamacare takes a more definitive shape with the setting-up of health exchanges or health insurance marketplaces. However, in the growing crescendo of support and opposition for the health reforms, it seems that some people are getting overwhelmed with certain basics that lay the foundation for understanding what constitutes health reforms. The following should help you understand terminology that is often in the News and the latest media reports about Obamacare:

Essential Health Benefits 

These are also called EHBs and refer to the most basic of health benefits that most health insurance plans will have to start offering in 2014. It should be noted that it is not necessary for all the insurance companies selling health insurance to be listed on the health exchanges. Similarly, it isn’t necessary for each of them to create a private exchange of their own though many of the insurers have started building portals that will function in a manner akin to health insurance marketplaces. However, each of the insurance plans would have to offer the EHBs like hospitalization, rehabilitation care, office visits, ER services, Lab Tests, maternal and newborn care. 

Health Insurance Exchanges

The actual law that defines the health reforms, i.e. the ACA, says that the health insurance exchange can exist in the virtual or physical format but for all practical purposes, most people realize that exchanges will essentially be online health insurance marketplaces. These would be established in each state, either in coordination with the federal government. States have the freedom to create regional exchanges by merging their marketplaces, i.e. a collaborated exchange or set-up a hybrid exchange where federal and state authorities will pool-in their resources to run and manage the exchange.

Not much time is left for creating the exchanges and states are already in talks with insurance software vendors to create healthcare software systems that help to establish an exchange. Open enrollment from the exchange-bought health insurance plans starts on October 1 and coverage would start from January 1, 2014.

There has been a significant effect of the development of exchanges on insurers who are now creating their private exchanges. Each of these private health exchanges will list all the types of health insurance products offered by an insurer. Some insurers are also seeking collaborations to showcase their products on the private health exchanges set up by other insurers.

Medicaid Expansion

Apart from setting up specialist exchanges like the Shop exchange and expanding Medicare, Obamacare is also worried about the lack of coverage for those who don’t qualify for basic insurance or Medicare. Thus, it seeks to expand the range of coverage provided as a part of the federal-state partnership healthcare insurance program called Medicaid. This is geared towards expanding coverage across the most challenged sections of the low-income people. Nearly 30 million people are deemed to benefit from this expansion though it has been halted temporarily in some States.