Understanding Healthcare Exchanges: The Basics
Healthcare exchanges are a hot topic in the news today, but many people don’t have an adequate understanding of what these organizations are, what they offer, and how to use them effectively. This guide will help the layperson gain a deeper, practical understanding of the process and their purposes.
Healthcare exchanges are also known as health exchanges and health insurance marketplaces. These organizations help those who use them to purchase health insurance in their local region. Typically, when people refer to a healthcare exchange, they are describing the organizations particular to each state in the United States. These organizations were formed due to the Patient Protection and Affordable Care Act. This help citizens by consolidating health care plans from various insurance companies which meet government regulations and standards in one place for easy comparison. They also help citizens to identify which plans are available with the assistance of government subsidies.
Healthcare exchanges are an important part of the Affordable Care Act (sometimes called Obama Care). They create a one-stop marketplace for Americans, allowing them to compare and contrast different plans in terms of coverage, cost, benefits, and financial aid. All insurance policies that part of a government regulated healthcare exchange must offer certain features. For example, they can’t deny individuals or families coverage based on pre-existing conditions. They must also offer a benefits package which includes basic coverage for health related emergencies as well as adequate coverage for preventative healthcare.
Insurance companies that participate in a healthcare exchange also can’t discriminate based on gender. This is an important consideration because of the different healthcare needs of men and women; insurance companies can’t charge either gender more under these regulations. Also, insurance companies that participate in these marketplaces are not allowed to enforce spending caps on a yearly basis when it comes to basic benefits. These benefits include all emergency services, necessary hospitalization (in the event of surgery, for example), maternity services like maternal care and newborn services, substance abuse treatment, psychological and psychiatric counseling and medical services, and prescription drugs. In addition, they must cover rehabilitation and habilitation for those who have disabilities, chronic illnesses or conditions, or injuries as part of their basic coverage. Laboratory tests, pediatric medicine, and wellness medical services are also required coverage. These basic benefits are considered to be essential benefits by the healthcare exchange.
Individuals in the United States are required to have health insurance coverage, due to the individual mandate provision of the Affordable Care Act. This provision is sometimes referred to by different names, including the mandatory minimum coverage requirement or the shared responsibility requirement. However, regardless of name, it indicates that those who are not covered will be subject to a fine or fee which starts at about a hundred dollars annually. It can cost up to one percent of an individual’s income if they choose not to get health insurance which fits the government’s minimum requirements. Choosing healthcare through a healthcare exchange is often the best and simplest way to avoid this fee.