Insurance Exchanges

Many states have worked tirelessly over the past two years to develop health insurance exchanges and prepare for the expansion of their Medicaid programs in order to meet the requirements of the ACA. Programs to expand coverage, however, do not necessarily ensure seamlessness for many individuals who are likely to experience shifts in program eligibility due to changing circumstances (e.g., income fluctuations, family composition changes, etc.). A number of states are actively working to limit the impact of changes in program eligibility by developing policies that limit either the incidence of program eligibility changes and/or the impact those changes have on individual consumers. Various emerging state approaches take into account program history, the desire for state flexibility, and the political and operational challenges states face in developing coverage expansions that work for consumers, stakeholders, and policy makers.

The participation of young adults in the health insurance marketplaces has received considerable attention. At issue is whether men and women ages 19 to 34—a group uninsured at disproportionately high rates but generally healthier than older adults—will enroll in marketplace health plans at a rate high enough to ensure the marketplaces' success. The conclusion of health insurance actuaries, health plan representatives, researchers, and federal officials invited to participate in a Commonwealth Fund meeting on the topic is that while young adult participation is important for the stability of the marketplaces and 2015 premiums, it was, and will continue to be, one of many factors that affect premiums.

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.

The Centers for Medicare and Medicaid Services (CMS) is releasing this draft Letter to Issuers in the Federally-facilitated Marketplaces (FFMs). This Letter provides issuers seeking to offer Qualified Health Plans (QHPs), including stand-alone dental plans (SADPs), in an FFM and/or Federally-facilitated Small Business Health Options Program (FF-SHOP), with operational and technical guidance to help them success fully participate in the Marketplaces. Comments on this draft are due by February 25.