Learn more about the health insurance marketplace
Effective beginning on or after January 1, 2014, individuals and small groups will be able to buy insurance directly in an exchange—a transparent and competitive insurance marketplace. Exchanges will offer a choice of health plans that meet certain benefits and cost standards.
Here are some basic guidelines:
- Exchanges will be established for individuals and for small groups in each state. In some states the Exchanges will be implemented by the federal government.
- Small groups will be defined as having fewer than 50 eligible employees, depending on the Exchange definition. In 2016, small groups will be defined as those with 100 or fewer eligible employees.
- Exchanges will be run by a government agency or nonprofit entity.
- Insurers must create a single risk pool for individuals, regardless of whether individuals purchase coverage inside or outside the exchange. The same requirement applies to exchanges for small groups.
Kaiser Permanente's Position on Exchanges
We support the development of exchanges, since this will likely be the marketplace where millions of low- and middle-income individuals and small business owners will be able to buy affordable health coverage. Although the basic guidelines for exchanges have been laid out, it remains to be seen exactly how the exchanges will function. However they’re structured, we believe exchanges should:
1. Provide consumers a broad choice of high-quality health plans—an open, transparent marketplace promotes competition among plans and empowers consumers
2. Encourage the transformation of delivery systems—system reform helps standardize quality and service measures, providing consumers with consistent performance metrics
3. Facilitate informed consumer choice and competition based on value, quality, and service—helps consumers make fair and informed choices on factors other than price, such as benefits, cost sharing, quality, service, and ease of access
4. Minimize adverse selection relative to the outside market—active consumer outreach will inform consumers about the importance of coverage, potential penalties for non-coverage, and the advantages of purchasing through an exchange
5. Be administered by independent entities dedicated to the success and stability of exchanges and the market—exchanges should be insulated from health plan competitors to guard against potential undue influence or control
We also believe exchanges should facilitate the compensation of licensed brokers or agents used by a purchaser. Currently, federal law allows for qualified health insurance "navigators"—educators and facilitators who will help consumers and business owners explore their exchange options.