The Patient Protection and Affordable Care Act (ACA)
Health Insurance Exchanges
Patient Protection and Affordable Care Act
What They Are
Health insurance exchanges, more recently referred to as "marketplaces," are one-stop market places for the purchase of health insurance. As one of the mandates of the ACA, the exchanges will enable consumers and small businesses to choose a quality, affordable private health insurance plan that meets their individual needs. The exchanges will be user-friendly and may be accessed online, by phone, or at a physical location where citizens can compare health insurance plans, enroll in a plan, find out about available subsidies, and obtain customer support to access health insurance solutions and fulfill regulatory requirements.
The framework for the mandate allows states flexibility so that the exchanges meet the needs of the individuals in each state, with federal grants provided to the states to assist with the set-up of the exchanges. The final rule, released by the U.S. Department of Health and Human Services (HHS) expanded the flexibility given to the states, allowing them to determine whether the exchange should be operated by a non-profit organization or a public agency, how to select health insurance plans that will be included for participation, and whether to partner with HHS for key functions.
The exchanges will perform a variety of functions, including
- certifying health plans as "qualified health plans" to be offered in the exchange;
- operating a website that facilitates comparisons among the qualified plans for consumers;
- operating a support hotline, funding grants for assistance, and offering other consumer services;
- determining eligibility of consumers for the plans and providing information about credits and other programs, such as Medicaid;
- facilitating enrollment in the plans.
The exchanges will include plans for the purchase of private health insurance, but many of the plans will be available for Medicaid recipients as well, with tax-credits and advance payment of a premium tax in some situations, making it easier for more individuals to participate in the exchanges.
What This Means for SLPs and Audiologists
Because each state will employ a different model for exchange development and management, it is important for the provider to find out the specifics of the exchange in his or her state. Some states are currently developing the exchange boards; there may be opportunities for speech-language pathologists (SLPs) and audiologists to serve as members or consultants, especially for boards run by a public agency. Once the exchanges are established, it is important for providers to become familiar with the insurance plans that have been certified by an exchange and understand the coverage categories and limits for billing speech-language pathology and audiology services. For more information on how to get ready for exchanges, see:
Implementation Time Line
The exchanges will begin operation in 2014 and will initially target the 24 million Americans who are currently uninsured and work for small employers; by 2017 plans will expand to include larger employers.
ASHA continues to monitor the development and implementation of exchanges in the states and will also provide information regarding actions that audiologists and SLPs can take to participate in the developing exchanges.