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Health Insurance Exchange Fundamentals

Health Insurance Exchange Fundamentals

Written by Alisoun Moore

What are the insurance exchanges and how do I access them?

Health Insurance Exchanges (HIXs) are the electronic marketplaces set up by government and private companies to allow consumers to view, compare and purchase insurance plans from many insurance products on-line.  A distinction must be made, however, between public and private exchanges.

Public insurance exchanges have been set up as a result of the Patient Protection and Affordable Care Act (otherwise known as ObamaCare) by the states and, if for those states who have decided to not build one, the Federal government.  These exchanges will provide individuals who do not currently have Medicare or employer-sponsored insurance an opportunity to purchase a Qualified Health Plan using the public insurance exchanges.  Qualified Health Plans must offer essential health benefits as defined in the ACA.  These include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services (including oral and vision care). Individuals will also be able to determine if they qualify for Medicaid or tax subsidies offered by States and based upon their Modified Adjusted Gross Income (MAGI).  Please check your local state for the internet address to access the States or go to https://www.healthcare.gov.

Private exchanges are exchanges set up by private companies and provide employees of companies to shop for insurance products.  Your company may or may not require you to use a private exchange.  Products sold on these exchanges may or may not meet the essential health benefits.  

Individuals may or may not use these exchanges based on their specific access rules but will not be able to qualify for Medicaid or tax subsidies which can only be done through the public exchanges. 
All systems used to share information must comply with the security rules of the federal Health Insurance Portability and Accountability Act. The systems used to secure records are held to the highest degree to prevent fraudulent access.

 

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