Insurance Exchanges

This is the fourth in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace. This brief includes data for states that are implementing their own Marketplaces, and states with Marketplaces that are supported by or fully run by the Department of Health and Human Services. This brief also includes updated data on the characteristics of persons who have selected a Marketplace plan (by gender, age, and financial assistance status), and of the plans that they have selected (by metal level); along with additional data on the characteristics of people who have selected plans in the FFM and the plans they have selected.

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.

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 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.

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.

This is OPM’s annual call for applications and recertification submissions from prospective and current Multi-State Plan (MSP) issuers for the contract term beginning January 1, 2015. The MSP Program was created to bring choice and competition to the Health Insurance Marketplace. The Program’s charge is to make available at least two quality, affordable MSP options in the Marketplace in every State and the District of Columbia. In the inaugural year, OPM certified more than 150 MSP options that are now available to consumers in 30 States and the District of Columbia. OPM also certified MSP options for the Small Business Health Options Program (SHOP) in four States and the District of Columbia. For 2015, OPM’s goal is to expand MSP coverage to at least five additional States, and to add one or more new MSP issuers or groups of issuers.

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.

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.

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.

This is the third in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace. This brief includes data for states that are implementing their own Marketplaces, and states with Marketplaces that are supported by or fully run by the Department of Health and Human Services. This brief also includes some preliminary data on the characteristics of persons who have selected a Marketplace plan by gender, age, and financial assistance status, and of the plans that they have selected by metal level.