Published on March 2, 2014
Please take this moment to convert the display to “Full Screen” “A Conversation About Healthcare Insurance Exchanges” Healthcare Medical Pharmaceutical Directory .COM www.HealthcareMedicalPharmaceuticalDirectory .com
“A Conversation About Healthcare Insurance Exchanges” Healthcare Medical Pharmaceutical Directory .COM www.HealthcareMedicalPharmaceuticalDirectory .com
What is the purpose of the exchanges? • Exchanges are intended to make buying health insurance easier and more affordable, they are essentially virtual stores for selling health insurance • Their goal is to help individuals and small businesses: – Compare health plans – Get answers to questions – Find out if they are eligible for tax credits for private insurance or health programs like Children’s Health Insurance Programs(CHIPs) – Enroll in/purchase health insurance
What will each exchange provide? • A website and 1-800 hotline to ask questions and purchase insurance • Standardized plan descriptions for easy comparison by consumers and small businesses • Websites will feature a calculator to determine costs • Plans will be pre-ranked according to price, coverage and other variables
Who is eligible to use the exchanges? • The Accountable Care Act (ACA) requires: – Employers with more than 50 full-time workers to offer health insurance for employees and their families – Each exchange to offer plans for consumer and small businesses (up to 100 employees) – The plans offered to feature a minimum set of benefits or pay a tax of $2,000 per employee for failing to do so (the tax will not apply to the first 30 workers) Healthcare Medical Pharmaceutical Directory .COM
What types of plans will exchanges offer? • Commercial plans will be available through: – Insurers – Licensed insurance agents – Insurance brokers • Government plans will also be featured: – Medicaid – CHIPs (Children’s Health Insurance Program) – Other
How are plans chosen for exchanges? • Plan coverages and other features are reviewed by federal and state governments for the exchanges: – These are referred to as “Qualified Health Plans” or “QHPs” – Plans will be accepted, assessed and renewed upon review approval on an ongoing basis
What will commercial plans provide? • • • • • • • • • • Ambulatory patient care Emergency medical services Hospitalization Maternity / newborn care Mental health, behavioral health and substance abuse care Prescription medications Rehabilitative services, devices, patient care Laboratory testing services Preventative, wellness and chronic disease services Pediatric care that also features oral and vision care
What will state government plans provide? • Medicaid and CHIPs plans differ from state to state • Some states have more than one type of Medicaid and/or CHIPs plans to better serve different needs • Coverage will vary between states and the plans they offer Healthcare Medical Pharmaceutical Directory .COM
How will exchange users choose a plan? • They may choose by cost based on several variables including age, employment status and income • Some persons may qualify for a plan from a commercial provider (Aetna, BlueCross BlueShield, Human, United Healthcare, etc.) • Other will be directed to Medicaid or other governmentsponsored plans
Can applicants be refused coverage? • Yes, applicants may be denied, eligibility/coverage is not automatic • A formal appeal process will be available for exchange customers – More detailed guidelines are being developed for acceptance, denial and appeal decisions
Who will operate the exchanges? • Some exchanges will be run by individual states • States may partner with the Federal government to jointly setup and operate an exchange • A state may opt out of the program and the Federal government will operate one on their behalf • Exchanges operated by the Federal government are expected to be operated by the states at a later date • After the election, U.S. Secretary of Health and Human Services, Kathleen Sebelius, extended a January, 2013 deadline to February 14 th, 2013 for states to choose which option to choose
When will the exchanges be open? • Exchanges will become operational 10/1/2013 – Consumers and small businesses can begin reviewing and choosing plans – Active coverage for beneficiaries will be effective 1/1/2014 Healthcare Medical Pharmaceutical Directory .COM
Is use of the exchanges mandatory? • Individuals and small businesses can obtain health insurance from any source they prefer • The exchanges are intended to provide easily accessible, comparative healthcare insurance information to evaluate / purchase health insurance Healthcare Medical Pharmaceutical Directory .COM
Why is Information Technology important? • Exchange customer information will be cross-referenced with data on file in state Medicaid and Children’s Health Insurance Program (CHIP) plans to • Consumer income will be verified through state-based data sources • Application information will be matched with plans offered in the exchange to determine which ones best align to the exchange customer’s needs
Who is paying for the exchanges? • Federal funding is covering much of the startup expenses • By November, 2012, over $2 billion has been allocated to support state activities to develop websites, enrollment/eligibility management systems, etc. • By 2014 the exchanges must be self-supporting through fees collected from insurers using the exchanges to market their plans • For plans sold through federal exchanges, insurers will pay HHS 3.5% of the premium to support exchange costs
What are some concerns? • Will exchanges be used by enough customers to remain viable over time? • Can exchanges be adequately funded over the long term? • If insurers withdraw from offering plans on an exchange, will remaining ones offer competitive rates? • As small businesses grow beyond 100 employees, how can they economically migrate to a non-exchange plan? • How can coverage/cost issues be minimized when beneficiaries move to other states? • Can federal and state government adequately oversee the exchanges, plan providers and service levels for consumers/small businesses?
Summary • Health insurance exchanges are a key component of healthcare reform • Significant cost, management and technology challenges remain ahead for federal and state governments in launching /maintaining the exchanges • Internal and external web-based technology will play a pivotal role in the functionality of all exchanges • Affordability and coverage issues are a concern for potential consumer and small business customers
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