What is a healthcare exchange, whom will it serve, and how will it work?

Large Group of Happy People smiling and embracing.
Diversity (istockphoto)

An insurance exchange is a marketplace where you can buy health insurance for yourself and your family. Most people will access them online, but they will also have offices for those who prefer human contact. They will offer a selection of policies at four levels of coverage named for precious metals. Platinum will be the best, followed by gold, silver, and bronze. Of course, the better the policy, the higher the premium will be.
 
The exchange websites will explain your options in simple terms, with clear descriptions of what each policy covers and what it will cost. If your income is lower than four times the federal poverty level (currently about $46,000 for an individual and $94,000 for a family of four), you will qualify for financial assistance, which will automatically reduce the amount you pay.
 
However, not everyone will be able to use an exchange. If your employer offers coverage that meets minimum standards, or if you qualify for Medicare, Medicaid, or another government health insurance program, you must get your health insurance that way. Exchanges are intended mainly for those who are unemployed, self-employed, or work for a company without health benefits.

-----

Robert I. Field, Ph.D., J.D., M.P.H. is a professor of law at the Earle Mack School of Law and professor of health management and policy at the School of Public Health at Drexel University. He also writes for The Field Clinic blog.

Continue Reading