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10/02/2013

The MarketPlace is Open!

Despite all the ongoing debate in DC over the Affordable Care Act, (ObamaCare),
implementation of a key component rolled out yesterday.   Now, US citizens are be able to purchase health insurance through an online marketplace called the Health Care Exchange.  Purchasing insurance through this mechanism is not available to employees who choose to receive insurance through their employer, or those citizens who receive Medicare.

A key aspect of the law is that each state has the option to setup their exchange (marketplace) or have it partially or fully run by the Federal Government.  Twenty-four states will have a State run or Partnership run marketplace and the remaining states will have a Federal Marketplace.  To qualify for as a member of the marketplace, each plan must offer a minimum set of benefits.  These benefits include Ambulatory/outpatient care, Emergency services, Prescription drugs and Preventive and wellness services as well as other essential health services.

The benefit designs are organized into one of four tiers – also called metal levels: Bronze, Silver, Gold and Platinum – each differ in costs and provider networks.. In terms of deductibles, co-payments and other charges, the Bronze plan covers 60% of a patient's health costs, the Silver 70%, the Gold 80% and the Platinum 90%.    The lower tier plans offer more restrictive plans, such as HMOs (Health Maintenance Organizations) and the higher tier plans use less restrictive networks such as  PPOs (Preferred Provider Organizations).  Patients can go to the HealthCare.gov to find out specifics for their own state. 

The purpose of the marketplace is to encourage competition, reducing the cost of health insurance all the while improving access to health care to all citizens.   However, we will not know until 2014 if the competition aspect worked and not likely for several years if the marketplace translated to more affordable insurance and cheaper health care.   See here for an entertaining and informative video of the Health Care Exchange.

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