State Exchanges: Decoding What Lies Beneath

It has now been established that nearly half the states will be operating healthcare Exchanges individually or in partnership with the federal government. These can be interpreted as state and state-federal Exchanges respectively. This article will help you understand why ACA Exchanges are engaging so much attention and what you should always remember about them.

It should be understand that irrespective of the manner in which an Exchange is run—by the federal or state government, every Exchange will have to take care of some critical functions, such as:

• Eligibility
• Enrollment
• Plan management
• Consumer assistance
• Financial management

All types of Exchanges will essentially be portals powered by the latest in healthcare software solutions. The idea is to create a website so comprehensive that every aspect of healthcare enrolment, from mere queries to actually buying a health plan, is eased. Thus, consumers can expect every query they have regarding healthcare insurance or a particular health plan answered at the Exchanges. For instance, some people might not actually buy from the Exchanges but merely need information about the Medicare application process while some might require guidance about how costs will be shared between their employer-sponsored insurance and CHIP.

Consumers will have the advantage of being offered a wide variety of health plans putting forth varying degree of out-of-pocket expenses. For example, Platinum-category plans will offer the maximum degree of coverage benefits albeit with the highest premiums and lowest copays or deductibles. While Gold and Silver plans represent a descending range of coverage benefits and premiums, Bronze plans just about manage to cover the Essential Health Benefits for very basic premium pricing. The Exchanges are also expected to retail add-on health plans that can be clubbed with a main, primary health plan for a small, one-time fee. Exchanges will be continuously monitored by state and federal authorities apart from stakeholders from the state, including community members and other representative bodies that will ensure that the integrity of an Exchange’s operations are maintained.