Community Update

WHAT MAKES U.S. HEALTH UNSURANCE EXCHANGES SO COMPLICATED? BY UWE E. REINHARDT

“…why will American buyers of health insurance need specially trained navigators to help them navigate these exchanges?

There are several reasons.

For one, the exchanges are but one small component of America’s highly complex health insurance system and must be stitched smoothly onto its many facets.

… in the United States, state-based exchanges must coordinate with the Internal Revenue Service to determine eligibility for subsidies and their magnitude.

The American exchanges must also work with the state-administered Medicaid programs, to determine whether an applicant on the exchanges should be referred to Medicaid, and with small employers.

Furthermore, some American exchanges will be “active” — they will actually negotiate premiums with insurers.

The Affordable Care Act does specify the basic benefits that must be covered, which each state can translate into its own basic benchmark package. There will be four levels of covered benefits (bronze, silver, gold and platinum) that are likely to differ mainly by the degree of cost-sharing (deductibles, co-payments and co-insurance

Benefit packages on the American exchanges will also vary by the degree of choice among providers that different policies permit. Presumably, the exchanges will have to ascertain the adequacy of the networks of providers attached to particular policies.

In short, comparing the various offerings on the American exchanges will not be…. simple…. hence the need for the specially trained navigators.”

To read the full article click on
http://economix.blogs.nytimes.com/2013/07/19/what-makes-u-s-health-insur...


Following is a link to a Consumers Report article noted by Prof. Reinhardt. While a little outdated (2009) it summarizes key “suggestions on picking an insurance policy.”
http://www.consumerreports.org/cro/2012/05/hazardous-health-plans/index.htm