Universal healthcare has been at the forefront of the political realm for centuries and, in an effort to compromise between federal regulated insurance and state and citizen rights, the Affordable Care Act (ACA) came into full effect in 2014 (Nadash & Day, 2014). Although many questions and debatable terms remain active in the political policies, the fact remains that citizens must either be insured, or pay a penalty to the federal government. However, the requirements are dependent on a number of factors including the state of residence and desired amount of coverage for the individual and their family. Therefore, it is the intention of this author to explore the options, requirements, and details of the health insurance market exchanges as presented in the Affordable Care Act.
Nadash and Day (2014) explain that the market place exchanges are virtual locations where individuals and businesses will shop for approved insurance policies. These policies must adhere to the requirements laid out by the ACA and have specific descriptions based on the level of coverage. According to Nadash and Day (2014) these exchanges can either be federally or state based, but still must adhere to the same guidelines of availability. For example, “all plans must cover ten categories of essential health care benefits” (“Choosing the Best Plan for You,” 2014, pg. 5). Additionally, the plans cannot deny acceptance based on medical history or current medical needs. This provides the protection of the ACA while still providing options in health care coverages.
These options are based on the amount of coverage needed and the amount of costs for the coverage. These levels are referred to as bronze, silver, gold, and platinum and reflect the copays and amount out-of-pocket expenses versus the amount that the insurance provider will pay (“Choosing the Best Plan for You,” 2014). Additionally, individuals are qualified for coverage based on their ability to pay. In other words, financial assistance must be given to those who qualify and the individual cannot be denied based on their income (“Choosing the Best Plan for You,” 2014). This serves to make certain that all individuals have the option to receive coverage or to pay the penalty at the end of the tax year.
This still leaves that question as to what exactly the marketplace exchanges do and how they are determined at a state or federal level. Carpenter (2013) explains that the simple answer to this question is that the exchanges sell insurance. The exchange itself is not an insurance provider, but rather a virtual collection of possible coverages that are available for the consumer and guarantees that these coverages are adherent to the ACA. This provides for a more easily understandable explanation of the differences in the coverages and allows for the consumer to compare multiple coverages in one location. This also serves for the ability to request financial assistance based on income verification. Carpenter (2013) further explains that the marketplaces are state operated in twenty-three states and federally operated in the remaining twenty-seven states.
In sum, the health insurance marketplace exchanges serve the consumer in an effort to provide coverage, adhere to the ACA, and answer policy related questions. The exchanges do not offer coverages directly, but function as a housing authority for the various insurance companies. This middle man concept provides a voice for all parties and allows for the consumer to feel confident in their decisions in regards to coverage levels and related expenses. Although the federal government has mandated the exchanges, the individual states and citizens reserve the right to choose their coverage options. This right is secured by the implementation of the health insurance marketplace exchanges.
- Carpenter, C. E. (2013). State Health Insurance Exchanges. Journal Of Financial Service Professionals, 67(3), 26-28.
- Choosing the Best Plan for You: A Tool for Purchasing Coverage in the Health Insurance Exchange. (2014). South Carolina Nurse, 21(1), 4-5 2p.
- Nadash, P., & Day, R. (2014). Consumer Choice in Health Insurance Exchanges: Can We Make It Work?. Journal Of Health Politics, Policy & Law, 39(1), 209-235 27p. doi:10.1215/03616878-2395217