Shopping For Health Insurance

1
Shopping For Health Insurance Using The New State
Exchanges
2
Overview

• The Patient Protection and Affordable Care Act,
  commonly referred to as Obamacare or the ACA,
  creates state-based health insurance exchanges
  for individuals and small businesses to use to
  purchase health insurance. The exchanges are
  organized market places providing a one-stop-shop
  for individuals and small businesses to compare
  competing health plans and enroll in coverage
  programs. The exchanges are an important pillar
  of the new health law and are expected by 2019 to
  serve as the gateway for more than 29 million
  people to obtain health insurance.

3
One-Stop-Shopping

• The new insurance marketplaces will provide
  consumers with important information about
  various insurance plans, including
• Eligibility
• Availability
• Covered benefits
• Premiums
• Cost-sharing
• Provider networks
• Claims vs. administrative costs
• An electronic calculator allowing consumers to
  determine their cost of coverage, including
  assistance from government subsidies

4
Plan Tiers

• The ACA mandates that plans be standardized into
  four tiers, bronze, silver, gold and platinum,
  with bronze plans being the least comprehensive
  and platinum plans offering the most coverage. At
  a minimum, all plans must offer
• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance abuse services
• Prescription drug coverage
• Rehabilitative services
• Laboratory services
• Preventative care
• Pediatric services, including oral and vision
  care

5
Streamlining Enrollment

• The health insurance exchanges will help to
  streamline enrollment, offering annual open
  enrollment periods as well as special enrollment
  periods to account for changes in status, such as
  the birth of a child, marriage, etc. The
  exchanges will also work to direct individuals
  eligible for Medicaid, CHIP or other public
  programs to these services and to decertify
  insurers who attempt to discourage sicker
  individuals from applying.

6
Greater Transparency

• Thanks to the exchanges, consumers will have more
  information about their benefits and their costs,
  allowing them to make better choices with regard
  to their coverage. Insurers participating n the
  exchanges are required to provide consumers with
  a summary of benefits, network availability,
  cost-sharing examples, information on claims
  payment policies and practices and more.

7
Improving Quality

• The ACA is designed to encourage quality
  improvement by requiring insurers to report to
  the government and their clients on what programs
  theyre using to improve health outcomes, reduce
  hospital readmissions, enhance patient safety,
  reduce medical errors, promote wellness and
  reduce disparities in care. To participate in the
  exchanges, insurers must meet requirements set
  forth by the National Committee for Quality
  Assurance.

8
Market Reforms

• Regardless of whether an insurer participates in
  the health exchanges or not, they will have to
  adhere to some reforms intended to level the
  playing field and prevent high-risk individuals
  from being dumped entirely on the exchanges.
  These reforms include
• Guaranteed issue and renewability of coverage
• Banning premium variation based on health status
  or gender and limitations on variation based on
  age, family size, tobacco use and geography.
• Minimum coverage regulations
• Banning lifetime caps on coverage
• Requiring plans to allow insureds to participate
  in approved clinical trials.

9
State Participation Necessary

• Success of the health exchanges may depend on
  individual states to ensure market protections
  are enforced and financial assistance for the
  exchanges. The exchanges can provide insurance
  consumers with a convenient and cost-effective
  method to purchase health insurance, but only if
  state and federal governments stay active in
  improving the technology and policy behind the
  exchanges.

10
About Coverage California

• Coverage California helps to educated
  Californians about their health insurance options
  under the Affordable Care Act and provides
  resources for them to find a plan that best suits
  their needs. The new health care law is complex,
  and Coverage California helps consumers navigate
  the marketplace to find the right policy.
• For more information visit http//www.coverageca.c
  om.