Insurance Exchanges

This brief explores ways that states are sharing the responsibility of consumer assistance with the federal marketplace in three key areas: marketing and advertising initiatives, the work of navigators and other in-person assisters, and the development of a system for eligibility decision appeals. It also provides specific examples of states utilizing the Federally Facilitated Marketplace (FFM) or those partnering with it (SPM) for consumer assistance, and illustrates some of the ways that FFM and SPM states can work with their existing consumer assistance structures and with the federal government to help consumers find their way in a new coverage landscape.

The small-business exchanges, created under the law's Small Business Health Options Program (SHOP), offer group health plans to small companies. Employers with fewer than twenty-five employees must purchase coverage through a SHOP if they wish to take advantage of the small-business tax credit for health insurance established in the ACA. States had the option of creating these as separate exchanges or combining the individual and small-business insurance markets into one exchange. This Health Policy Brief focuses on issues that states have had to confront in designing and operating SHOP exchanges as well as challenges that these exchanges are likely to face in the future.

In recent months, there has been considerable focus on cancellations of nongroup health insurance policies. It is difficult to directly obtain data on premiums that individuals were paying prior to the ACA, but this brief provides data on the premium cost to enrollees for the lowest cost bronze plans and the second lowest cost silver plans by age and income group in each state. The authors conclude that it would be difficult for the majority of individuals, particularly those qualifying for subsidies, to obtain coverage for a lower premium than those available in the Marketplaces today. Unsubsidized individuals, particularly those in older age groups, are more likely to face higher premiums.

With the launch of Open Enrollment on October 1, 2013, millions of individuals and families started to enroll in Medicaid, CHIP, or private insurance with or without federal subsidies through Health Insurance Marketplaces. As the Marketplaces’ doors opened for business, technological glitches surfaced, making the role of consumer assistance organizations even more important. This report examines states’ health coverage consumer assistance efforts to date. Based on the major categories of consumer assistance entities – Navigators, In-Person Assisters, Certified Application Counselors, and Health Centers – the report takes a closer look at each state’s consumer assistance and health center entities and the funding used to support these efforts.

This brief discusses the new health insurance marketplaces created under the Affordable Care Act and associated structural and process-related regulations that aim to ensure the quality and value of plans sold. To qualify to be sold in these marketplaces, new plans must be certified as a "Qualified Health Plan" (QHP), meet quality accreditation standards, and implement a quality improvement strategy. These steps require the collection of information from insurers, which will result in the disclosure of information about health insurance policies, practices, cost, and quality.