What is a health insurance exchange?

What is a health insurance exchange?

A closer look at what ACA's health insurance marketplaces will do for you, starting October 1

August 20, 2013
State exchanges
What is an exchange?
Shopping the exchanges
Consumer protections
State exchanges
Essential benefits in ACA
The federal exchange
Will you get a subsidy?
Will you owe a penalty?
Cost-sharing subsidies
Types of exchanges
Exchange FAQs

Price check
health insurance
near you

  • Each exchange will operate a toll-free help hotline and set up a Navigator program to help consumers understand and purchase coverage.
  • Exchanges will certify which individual are exempt from the individual mandate.

Health insurance exchanges are set to launch across the United States on October 1 and bring radical change to how people shop for and buy individual health insurance. Yet, a startling percentage of people are unaware that exchanges are coming, and even fewer understand exactly what they will do.

Forty percent of people don’t know the Affordable Care Act, which authorized health insurance exchanges, is a valid law according to an April survey by the Kaiser Family Foundation. Given that result, it stands to reason that at least 40 percent — and probably a much higher percentage — know nothing about health exchanges. And of those who recognize the term health insurance exchange, most don’t know more than the de facto comparison to Travelocity or Expedia.

With that backdrop, here is a basic description of what services you’ll get when you shop for insurance through an exchange.

What the exchanges will do

A health insurance exchange is an online store where consumers can compare and buy health insurance plans. Each state had the option to run its own exchange, work in partnership with the federal government to run an exchange, or to use a federal exchange. About half the states decided to use the federal exchange, and the rest selected either the state-run or partnership model.

Each exchange will:

  • Present benefit options in a standard format — so it’s easy for consumers to compare plans
  • Operate a toll-free hotline where consumer can ask question and get help
  • Set up a Navigator program to help consumers understand and purchase health insurance
  • Certify the health plans that sell policies through the exchange and make sure health plans comply with regulatory standards and requirements
  • Provide an online calculator so consumers can determine their costs; the calculator will factor in tax credits or subsidies available to the consumer
  • Interact with other computer systems and databases to determine if consumers are eligible for tax credits or subsidies on the exchange or if they qualify for Medicaid or the Children’s Health Insurance Program (CHIP); this is called “no wrong door,” and it will make it much easier for consumers to get signed up for some kind of health coverage
  • Certify which individuals are exempt from the individual mandate.

Tags: Affordable Care Act, health insurance exchange, health insurance marketplace, navigators, premium subsidies

About Carla Anderson

Carla Anderson

Carla Anderson has more than 15 years of experience writing sales, marketing and corporate communications for a major pharmacy benefit manager. She was the lead writer for her former employer’s initial certification as a Prescription Drug Plan under Medicare Part D. She also researched and wrote…

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