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How do health insurance marketplaces work?

Will shopping through a health insurance exchange be as simple as buying a book on, a plane ticket on or a pair of shoes at No one knows for sure, but there are measures in place to make it fairly simple for consumers to buy health insurance under the new health care reform law. chatted with Sabrina Corlette, research professor at Georgetown University’s Center on Health Insurance Reforms, to learn more about what consumers can expect from health insurance exchanges, also known as health insurance marketplaces.

How will consumers access the health insurance exchanges?

First of all, there will be an exchange in each state, and any consumer or small business owner who wants to obtain health insurance coverage can go to a website. There also will be an opportunity to enroll through a toll-free number or in person.

What will the shopping experience be like?

First, consumers will be asked to enter some financial information to determine whether their income level makes them eligible for federal tax credits to defray the cost of premiums, as well as co-payments and deductibles. Then, they’ll be asked to choose a health plan. The health plans will be pre-certified and (consumers will be) required to demonstrate that they meet minimum standards for quality, benefits and customer service.

Will the exchanges make it easy for consumers to compare the plans?

Consumers will be able to compare different health plans based on what their priorities are. So, if you’re mostly interested in the price of the premium, you’ll be able to compare based on price. If you are more interested in the generosity of the benefits, what the cost-sharing structure looks like or how high the deductible is, you can compare plans based on that. If you have a regular care provider you want to make sure is in the plan’s network, you’ll be able to look at that. An exchange also will offer a cost calculator, taking into account any tax credits you might get, so you can figure out what your actual out-of-pocket costs are going to be.

Will there be reviews or any other information to help consumers choose amongst available plans?

The exchanges will be required to rate the health plans based on a quality scale, so you might see Plan A has a four-star rating from the exchange but Plan B gets two stars, and there will be an explanation as to why.

Can you explain the concept of an essential benefits package? What are the plans available through exchanges required to offer?

It’s important to talk about what is available in the individual insurance market today for most consumers. If you are out there trying to buy coverage today on your own, almost no plan covers maternity care. Very few cover mental health treatment or substance abuse treatment. Coverage of prescription drugs also is relatively rare.

The (health insurance reform) law requires that the essential health benefits be similar to what’s in a typical employer plan, and it lays out 10 categories of coverage that must be included. They include maternity, prescription drugs, mental health and substance abuse treatment, emergency room visits, hospitalization and doctor visits. (Essential health benefits must be offered by all health insurance plans starting in 2014.)

What different types of plans will be available?

There will be different levels of coverage that people can shop for. If you are eligible for a premium tax credit, most people will be shopping in what they call the silver level of coverage, and that means the health plan is picking up about 70 percent of the tab when you actually use care services. And, of course, premiums will vary based on what size of tax credit you’re eligible for. It’s a sliding scale tax credit. The lower your income is, the lower your premium payment.

What else should consumers know about the types of plans they will be able to buy through the exchanges?

All of the exchanges will require plans to be accredited. What this means is that third-party accrediting agencies will do a very detailed review of how health plans are actually managing health care.

For example, are the plans making sure that diabetics are getting appropriate care coordination, or making sure that hospitals discharge patients with the right instructions and that there is somebody checking up on them when they get home? Accrediting agencies look to see how health plans are doing on these dimensions, as well as in the area of customer service. If you have a problem or if there’s a dispute over payment of claims, how is that being resolved?

What else should consumers know about exchanges?

If the consumer needs help, that will be available. The exchanges are required to have fairly robust consumer assistance services in place. So, if you log onto the website and you don’t understand something, there will be a call center that you can call. There is a program called the navigator program, which has real live people who can sit down with you and help you through it. People should know they’re not totally on their own.

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