Health Insurance Navigator

By Lisa Zamosky

Perhaps the most important piece of President Obama’s health reform law is that starting in 2014 millions of people who are currently uninsured will gain access to health insurance. That is, of course, assuming the Supreme Court doesn’t deem the law unconstitutional; a ruling on the matter is expected later this month.

Both small businesses with up to 100 employees and individuals who buy coverage on their own will shop for and buy health plans through newly built state-based health insurance exchanges.

Pharmacy giant CVS Caremark recently conducted research to learn just how well insurance exchanges – which are essentially online marketplaces where people will shop for insurance – are understood by those who will be eligible to use them.

So, how much does the public know? Not much, it turns out. After polling 1,000 consumers, CVS Caremark found that 78% of those who would be eligible for new health care coverage under the law have never heard of state-based health care exchanges.

Understanding What’s to Come

If you work for a small company, buy insurance on your own, or expect that for the first time in a while you’ll be able to get insurance coverage because of health reform, there’s a good chance you’ll be buying a plan through your state’s health insurance exchange.

Here are 7 things you should know about health insurance exchanges:

1) Exchanges are required to be fully operational in every state by January 1, 2014. States that choose not to set one up on their own will have one established for them by the federal government.

2) Exchanges will take the form of a website where consumers can log on to shop for health coverage. On the site you’ll be able to compare and enroll in a plan and determine whether you are eligible for financial help to pay for it. Many states are aiming to make the experience as easy as shopping for products on Amazon.

3) Each plan sold on the exchange must offer services from a list of “essential health benefits,” which include 10 different categories of care.

4) Consumers shopping for insurance on the exchanges will choose from at least four different benefit levels – from bronze to platinum – each based on cost and the level of benefits offered.

5) Health plans offered through the exchanges will be required to accept all applicants, meaning they cannot deny insurance to anyone who applies.

6) Plans will have no lifetime or annual dollar limits.

7) Each health plan must place a cap on a person’s total annual out-of-pocket costs. Currently, that amounts to $6,050 for an individual and $12,100 for a family.

Your turn: Have you heard of insurance exchanges before? What questions do you have about how they’ll operate? Leave your thoughts, comments, questions below.