As a key component of healthcare reform, web-based healthcare insurance exchanges are intended to make buying healthcare benefits easier and more affordable for individuals and smaller businesses. The exchanges will operate as virtual stores where heath plans can be compared; eligibility assessed and benefit plans purchased. They are a new, uncharted venue for insurance carriers, managed care and government healthcare interests! www.healthcaremedicalpharmaceuticaldirectory.com John G. Baresky https://www.linkedin.com/in/johngbaresky #baresky

1. Key Concepts, Challenges and Opportunities For Health Insurance Exchanges
As a key component of healthcare reform, web-based healthcare insurance exchanges are intended to make
buying healthcare benefits easier and more affordable for individuals and smaller businesses. The exchanges
will operate as virtual stores where heath plans can be compared; eligibility assessed and benefit plans
purchased. They are a new, uncharted venue for insurance carriers, managed care and government
healthcare interests!
The exchanges will have several key functions. They will offer 1-800 hotlines to ask questions, standardized
plan descriptions for easy comparison and calculators to determine costs. Plans will be featured in pre-ranked
arrangements based on price, coverage and other variables.
For healthcare insurance providers and managed care organizations, the exchanges offer a new and unique
digital marketing opportunity. They will need to extend their resources to reach customers through the
exchange portals. Some may develop new programs targeted to consumers and small businesses using the
exchanges.
The plans will provide:
 ambulatory patient care
 emergency medical services
 hospitalization
 maternity/newborn care
 mental health, behavioral health and substance abuse care
 prescription medications
 rehabilitative services, devices and patient care
 laboratory testing services
 preventive, wellness and chronic disease services
 pediatric care including oral and vision care
There will be commercial plans offered by insurers, managed care organizations, licensed insurance agents
and brokers. Government plans based on Medicaid and CHIPs programs will be featured as well. Federal and
state governments will be involved with assessing the plans offered through the exchanges, these will be
known as "Qualified Heath Plan" or "QHPs".
Coverage is not guaranteed by any plan. Applicants can be refused. A formal appeal process is being
developed for those parties which are deemed not eligible for coverage.
Exchanges should be operational effective 10/1/2013, consumers and small business can review and
purchase insurance through the portals. The active coverage for beneficiaries is 1/1/2014. Exchanges are not
mandatory sources to obtain health insurance, use of them is optional. Parties interested in buying insurance
can continue to get coverage through their employer, direct from an insurer or through agents and brokers.
During the startup and initial active phases of the exchanges, some states have chosen to let the Federal
government operate the exchanges on their behalf. Eventually, the exchanges will be operated entirely by the
states they are associated with. The Federal government is picking up the tab for startup costs and has doled
out over $2 billion dollars in seed money to the states to get their development underway. By 2014, the
exchanges must be self-supported through fees (insurers will pay HHS 3.5% of the premium to support
exchange costs).

2. There are a number of issues associated with the exchanges:
 Will they be used by enough customers to remain viable over time?
 As technology evolves, can the exchanges keep up?
 Can they be adequately funded over the long term?
 Can growing small businesses economically migrate to a non-exchange plan as they grow larger?
 If persons or businesses move to a different state, can they evenly transition their coverage in the new
state's programs?
 What measures are in place to minimize fraud?
 Will there be enough healthy consumers participating in the plans to offset the costs of higher risk
patients enrolled in the plans for payer to remain in the marketplace?
Extensive information technology resources are required to operate eligibly databases, pay for staff to service
customers and provide IT support, continually update site content and provide ongoing maintenance. The
current ceiling on small business is 100 employees. As a small business evolves into a larger entity, they will
need to transition to a different source for their insurance. Coverages will vary from state to state. There is no
uniform plan offered nationwide for individual or small business customers. If an individual or small business
relocates to another state, they will need to engage the destination stat's exchange to obtain insurance under
different guidelines and costs. Finally, regulatory oversight of the exchanges is necessary. Federal and state
governments will need to accommodate this newly created business segment and provide staffing, financial
and technical resources.
The health insurance exchanges are an innovative and challenging feature of healthcare reform. 2013 is a
busy year as each state's site is developed and the October deadline will quickly arrive. Significant cost,
management and technical considerations remain ahead. Web-based technology plays a pivotal role in its
operations and whether or not they are successful in providing consumers and small businesses with health
insurance. Their viability will have increased scrutiny as the marketplace engages them during the close of
2013 and benefit coverage activates in 2014.
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