What is an Insurance Exchange?

insurance exchange

A health insurance exchange is a set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies. All exchanges must be fully certified and operational by January 1, 2014 under federal law. An Insurance Exchange is a State-based competitive marketplace where individuals and small businesses will be able to purchase affordable private health insurance and have the same insurance choices as Members of Congress.  Each State has the opportunity to create its Insurance Exchange to meet its needs.  Exchanges will serve as a one-stop shop where individuals will get information about their options, be assessed for eligibility for the Exchange, tax credits for private insurance, or programs like the Children’s Health Insurance Program, and enrolled in the plan of their choice.  Small businesses will also have the option to purchase insurance through a program offered by each Exchange.

According to healthcare.gov, the main functions of an Exchange, laid out in the Affordable Care Act, include:

  • Certifying, recertifying, and decertifying health plans offering coverage through the Exchange, called qualified health plans;
  • Assigning ratings to each plan offered through the Exchange on the basis of relative quality and price;
  • Providing consumer information on qualified health plans in a standardized format;
  • Creating an electronic calculator to allow consumers to assess the  cost of coverage after application of any advance premium tax credits and cost-sharing reductions;
  • Operating an internet website and toll-free telephone hotline offering comparative information on qualified health plans and allowing consumers to apply for and purchase coverage if eligible;
  • Determining eligibility for the Exchange, tax credits and cost-sharing reductions for private insurance, and other public health coverage programs, and facilitating enrollment of eligible individuals in those programs;
  • Determining exemption from requirements on individuals to carry health insurance, granting approvals to individuals relating to hardship or other exemptions; and
  • Establishing a Navigator program to assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers.

In addition to these basic functions, the Notice of Proposed Rulemaking (NPRM) proposes that Exchanges implement outreach and education programs and comply with oversight and program integrity requirements. For more information, contact Blue Star Benefits to get help with any questions or concerns you may have about the upcoming changes.

One Response to “What is an Insurance Exchange?”

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  1. urstrinath says:

    Nice Tips all are these thanks for sharing the information..

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