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Health care reform requires almost everyone to have health insurance in 2016 or face a stiff federal tax penalty. To facilitate that, health insurance exchanges will offer a one-stop shop for health insurance plans. Anyone who can’t get a group health plan at work, or who isn’t eligible for medicare, will be able to buy insurance through an exchange. Individuals may also purchase health insurance outside of the exchanges.
Through the health insurance exchanges, either the state exchanges or healthcare.gov, individuals and small businesses can get information about standardized plan benefits and costs, compare competing health plans and purchase coverage.
The Affordable Care Act provides money for states to conduct research and determine how to set up and govern their exchange. In the beginning, the health insurance exchanges will be open to individuals and small businesses, but later states may open them up to large employers. About 24 million people will buy their own insurance through the exchanges in 2019, estimates the Congressional Budget Office.
Some states might operate just one exchange or set up separate exchanges for different regions. The U.S. Department of Health and Human Services has set up an exchange in any state that has not set up their own exchange.
To sell health insurance through an exchange, health plans will have to meet certain requirements, such as providing a sufficient choice of providers and earning accreditation for clinical quality. In addition, they will have to sell a uniform selection of plans, which must include certain benefits defined by the U.S. Department of Health and Human Services and states, and they will have to offer the package at different value levels, which will be priced depending on the percentage of medical bills the insurers pay.
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