For years, savvy online shoppers have turned to web sites that allow you to comparison shop for the best price on airfares or hotel rooms. You mark the box next to your must-haves—a non-stop flight or 4-star accommodations—and see how the competition stacks up.
While the process is sure to be much more complex, starting October 1, 2013 and continuing through March 31, 2014, millions of Georgians should be able to click their way to health coverage on HealthCare.gov, the federally-run online Health Insurance Marketplace or, as it is often called, health insurance "exchanges." Small business owners with fewer than 50 full-time employees will have an exchange of their own, the Small Business Health Options Program (SHOP), to find plans for their employees.
What are health insurance exchanges?
The exchanges are a central part of health care reform. Under the Affordable Care Act, all U.S. citizens and people who are legal residents will be eligible for some form of coverage and cannot be turned down because of a medical condition.
The exchanges are just a new avenue to health coverage—employers and individuals can still purchase plans directly from insurance companies or through brokers. In fact, the 169 million Americans covered under employer-funded insurance plans will have little reason to peruse the exchanges' offerings or do anything at all to keep their current health plans.
However, if you are uninsured or purchase your own health coverage, shopping on the exchanges could have an advantage—federal subsidies. HealthCare.gov will require users to fill out an application to determine eligibility for financial assistance, which can reduce the out-of-pocket cost of health plans and medical expenses. The federal subsidies are only available to those who purchase health plans through HealthCare.gov.
Small business owners could also see savings by purchasing coverage through the SHOP marketplace, which is designed to give them similar power to large businesses when it comes to getting better choices and lower prices for health insurance. Small businesses with 24 or fewer full-time employees may qualify for a tax credit to offset the cost of providing coverage, if they purchase health plans through SHOP.
What will the health insurance exchanges look like?
We're beginning to get a clearer picture of what the exchanges will look like. All health plans sold on the exchanges will be broken into four "metal tiers": bronze, silver, gold and platinum. The purpose of the tiers is to make it easier for consumers to understand the cost and value of benefits. These four categories offer different levels of copayments, coinsurance and deductibles.
Every health plan sold on HealthCare.gov must provide what the federal government has identified as "essential health benefits" and meet new standards related to quality and cost-sharing. So, the offerings in each metal tier will look very similar online, with cost being the most obvious differentiator. But to get the best value, shoppers have to do some research.
HealthCare.gov will provide limited information about each health plan on the site, but the onus is on the buyer to determine what's offered beyond the basic requirements. If you are considering a new insurer, find out how its plans compare to the competition. Each year, the National Committee on Quality Assurance (NCQA) and J.D. Power and Associates rank health plans based on a number of factors, ranging from quality of care to customer satisfaction.
What if I need help navigating the health insurance exchanges?
If the thought of obtaining insurance through the exchanges is overwhelming, "navigators" and "assisters" will be available to guide shoppers through the online marketplaces. The navigators will have expertise in eligibility and enrollment options. They cannot be affiliated with insurance companies and are required under law to provide impartial and accurate information. Assisters can provide in-person help and actually enroll you in a health plan.
With coverage effective January 1, 2014 for health plans purchased through the new health insurance exchanges, insurers and health care providers alike are preparing for unprecedented change. Every business and individual will feel the impact of health care reform differently. Now is the time to get educated on the choices ahead.
Kerry W. Kohnen
Kaiser Permanente of Georgia
Nine Piedmont Center,
3495 Piedmont Road NE,
Atlanta, GA 30305
Kerry W. Kohnen is president of Kaiser Permanente of Georgia, a health care organization serving 240,000 members through 29 medical centers across metro Atlanta and Athens.