a conversation about healthcare insurance exchanges
DESCRIPTION
Healthcare Insurance Exchanges represent a new marketplace. They are intended to play a significant role in healthcare reform. Given the success of web-based commerce, they stand a good chance of succeeding. As part of the larger government healthcare reform initiative, there are challenges! www.healthcaremedicalpharmaceuticaldirectory.com John G. BareskyTRANSCRIPT
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“A Conversation About Healthcare Insurance Exchanges”
Healthcare
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“A Conversation About Healthcare Insurance Exchanges”
www.HealthcareMedicalPharmaceuticalDirectory.com
Healthcare
Medical
Pharmaceutical
Directory
.COM
![Page 3: A Conversation About Healthcare Insurance Exchanges](https://reader033.vdocuments.us/reader033/viewer/2022060107/554b7786b4c905030a8b5815/html5/thumbnails/3.jpg)
What is the purpose of the exchanges?
• Exchanges are intended to make buying health insurance easier and more affordable, they are essentially virtual stores for selling health insurance
• Their goal is to help individuals and small businesses:
– Compare health plans
– Get answers to questions
– Find out if they are eligible for tax credits for private insurance or health programs like Children’s Health Insurance Programs(CHIPs)
– Enroll in/purchase health insurance
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What will each exchange provide?
• A website and 1-800 hotline to ask questions and purchase insurance
• Standardized plan descriptions for easy comparison by consumers and small businesses
• Websites will feature a calculator to determine costs
• Plans will be pre-ranked according to price, coverage and other variables
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Who is eligible to use the exchanges?
• The Accountable Care Act (ACA) requires:
– Employers with more than 50 full-time workers to offer health insurance for
employees and their families
– Each exchange to offer plans for consumer and small businesses (up to 100 employees)
– The plans offered to feature a minimum set of benefits or pay a tax of $2,000 per employee for failing to do so (the tax will not apply to the first 30 workers)
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What types of plans will exchanges offer?
• Commercial plans will be available through:
– Insurers
– Licensed insurance agents
– Insurance brokers
• Government plans will also be featured:
– Medicaid
– CHIPs (Children’s Health Insurance Program)
– Other
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How are plans chosen for exchanges?
• Plan coverages and other features are reviewed by federal and state governments for the exchanges:
– These are referred to as “Qualified Health Plans” or “QHPs”
– Plans will be accepted, assessed and renewed upon review approval on an ongoing basis
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What will commercial plans provide?
• Ambulatory patient care
• Emergency medical services
• Hospitalization
• Maternity / newborn care
• Mental health, behavioral health and substance abuse care
• Prescription medications
• Rehabilitative services, devices, patient care
• Laboratory testing services
• Preventative, wellness and chronic disease services
• Pediatric care that also features oral and vision care
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What will state government plans provide?
• Medicaid and CHIPs plans differ from state to state
• Some states have more than one type of Medicaid and/or CHIPs plans to better serve different needs
• Coverage will vary between states and the plans they offer
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How will exchange users choose a plan?
• They may choose by cost based on several variables including age, employment status and income
• Some persons may qualify for a plan from a commercial provider (Aetna, BlueCross BlueShield, Human, United Healthcare, etc.)
• Other will be directed to Medicaid or other government-sponsored plans
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Can applicants be refused coverage?
• Yes, applicants may be denied, eligibility/coverage is not automatic
• A formal appeal process will be available for exchange customers
– More detailed guidelines are being developed for acceptance, denial and appeal decisions
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Who will operate the exchanges?
• Some exchanges will be run by individual states
• States may partner with the Federal government to jointly setup and operate an exchange
• A state may opt out of the program and the Federal government will operate one on their behalf
• Exchanges operated by the Federal government are expected to be operated by the states at a later date
• After the election, U.S. Secretary of Health and Human Services, Kathleen Sebelius, extended a January, 2013 deadline to February 14 th, 2013 for states to choose which option to choose
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When will the exchanges be open?
• Exchanges will become operational 10/1/2013
– Consumers and small businesses can begin reviewing and choosing plans
– Active coverage for beneficiaries will be effective 1/1/2014
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Is use of the exchanges mandatory?
• Individuals and small businesses can obtain health insurance from any source they prefer
• The exchanges are intended to provide easily accessible, comparative healthcare insurance information to evaluate / purchase health insurance
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Why is Information Technology important?
• Exchange customer information will be cross-referenced with data on file in state Medicaid and Children’s Health Insurance Program (CHIP) plans to
• Consumer income will be verified through state-based data sources
• Application information will be matched with plans offered in the exchange to determine which ones best align to the exchange customer’s needs
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Who is paying for the exchanges?
• Federal funding is covering much of the startup expenses
• By November, 2012, over $2 billion has been allocated to support state activities to develop websites, enrollment/eligibility management systems, etc.
• By 2014 the exchanges must be self-supporting through fees collected from insurers using the exchanges to market their plans
• For plans sold through federal exchanges, insurers will pay HHS 3.5% of the premium to support exchange costs
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What are some concerns?
• Will exchanges be used by enough customers to remain viable over time?
• Can exchanges be adequately funded over the long term?
• If insurers withdraw from offering plans on an exchange, will remaining ones offer competitive rates?
• As small businesses grow beyond 100 employees, how can they economically migrate to a non-exchange plan?
• How can coverage/cost issues be minimized when beneficiaries move to other states?
• Can federal and state government adequately oversee the exchanges, plan providers and service levels for consumers/small businesses?
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Summary
• Health insurance exchanges are a key component of healthcare reform
• Significant cost, management and technology challenges remain ahead for federal and state governments in launching /maintaining the exchanges
• Internal and external web-based technology will play a pivotal role in the functionality of all exchanges
• Affordability and coverage issues are a concern for potential consumer and small business customers
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Healthcare
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Fifteen Metropolitan Healthcare Markets Are Profiled:
•Atlanta
•Cambridge
•Chicago
•Denver
•Indianapolis
•Minneapolis
•Nashville
•Philadelphia
•Pittsburgh
•Princeton
•Raleigh-Durham
•Seattle
•Salt Lake City
•San Diego
•San Francisco
Each Healthcare Market Is Defined By:
•Hospitals
•Pharmacy, Clinical Services
•Pharmaceutical, Device, Diagnostic, Technology
Companies
•Advertising, Marketing, Public Relations
•Administration, Practice Management
•Managed Care, Healthcare Benefits, Consulting