ACA update: Health Insurance Marketplaces

By Emily McKinley, Health Information Specialist

By now, you’ve likely heard of the Affordable Care Act. Sure, you may know it better by the name, “Obama Care,” but either way, chances are you know changes have and are continuing to come. For some, these changes may seem rather abstract. But, for many, the ACA is a key piece of legislation that changes their family’s insurance coverage. During the past 18 months, we’ve covered many provisions of the ACA, including pre-existing conditions, elimination of annual and lifetime limits, essential health benefits and more. One topic we have not yet explored is the topic of the Health Insurance Marketplace, also known as the Affordable Insurance Exchange, Insurance Exchange, Exchanges, or Marketplace(s).

One of the major, though lesser talked about, provisions of the ACA is to ensure that medical coverage is accessible to all. That does not simply mean accessible in that one can purchase insurance; rather, the ACA specifically outlines consumers will also be able to access insurance reform in the sense that purchasing an insurance plan will be consumer friendly. The exchanges are designed to facilitate that.

Beginning in 2014, the exchanges will issue insurance in all states. Consumers will be able to browse and purchase insurance through the marketplace beginning in October 2013. Qualified health plans will be offered on the exchanges, and the goal of the exchanges is to present consumers with all costs of coverage in a comparable, easy to read, transparent, and understandable manner. Further, when applying for health insurance coverage, consumers need only visit one location: their state’s marketplace, which will be available on the internet and via a toll-free telephone number.

The ACA allows states to individually design and implement insurance exchanges; join with the federal government in a cooperative exchange, in which the state still has some decision making ability and enjoys cost-sharing with federal dollars; or, states may participate in a Federally Facilitated Marketplace. The Federally Facilitated Marketplace will be implemented in all states that do not build their own exchange.

While almost all states received funding to design and implement an exchange, not all states have developed a state-specific exchange. Indiana is one of those states. To date, Indiana has received a Planning Grant and a Level One Establishment Grant, worth $1M and nearly $6.9M, respectively.  That said, Indiana will not be designing an individualized marketplace but will instead participate in the Federally Facilitated Marketplace. Regardless of the approach elected by individual states, the state may opt to change the level of collaboration in regards to the administration of the marketplace in future years.

The exchanges will only offer plans that are qualified, meet benchmark standards, and include essential health benefits. Additionally, all plans must conform to the final rules established by the ACA and US Department of Health and Human Services.

As we near the open enrollment period beginning in October, Family Voices will share additional updates to help educate consumers about the Health Insurance Marketplace and choosing an insurance plan that fits the needs of your family.

In the meantime, if you would like additional information on this topic and how the marketplace will work for you, please visit this site, http://www.healthcare.gov/marketplace/index.html, the HHS press release, and the HHS fact sheet. You may also contact Family Voices at info@fvindiana.org or 317.944.8982, and we will be happy to discuss the changes with you.