Health Insurance Marketplaces Continue to Take Shape

by Cooper B. Wilhelm

The option of getting health insurance through a Health Insurance Marketplace is set to come into effect in January, with enrollment opening in October. In anticipation, the Centers for Medicare & Medicaid Services (CMS) have announced revised rules and grants for “navigators” to help people looking for health insurance.

As part of the Affordable Care Act (better known as the ACA or “ObamaCare”), Health Insurance Marketplaces will appear in each state starting in 2014. The hope is that Health Insurance Marketplaces will make it easier for virtually all Americans to choose a health insurance plan based on clear, unbiased information. According to the CMS, “Every health insurance plan in the new Marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare all your insurance options based on price, benefits, quality, and other features that may be important to you, in plain language that makes sense.”

While the health insurance plans available through Health Insurance Marketplaces will come from private companies and will vary by location, health insurance plans available through the Marketplaces will not be allowed to charge a person more or refuse him coverage because of preexisting conditions. They are also barred from charging women more than men for coverage.

Each state has a say in what form its Health Insurance Marketplace will take, and while some states are taking the lead, the federal government will be primarily responsible for managing the Health Insurance Marketplaces in others. To make things easier for consumers, Health Insurance Marketplaces will be staffed with a mixture of “Navigators,” “In-Person Assisters,” and “Certified Application Counselors” to guide consumers as they choose between different kinds of health insurance.

The CMS (the federal agency regulating the implementation of Health Insurance Marketplaces) has recently proposed expanded rules to flesh out the roles health insurance navigators will play. According to a press release from the CMS, these navigators will “provide unbiased information to consumers about health insurance, the new Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.” But even with these expanded rules, navigators will still provide more or less the same services as in-person assisters and certified application counselors. The differences between the three designations have more to do with whether the person works in a state- or federally-run marketplace and whether his training was provided through the state or federal government.

The CMS also plans to provide assistance through a 24-hour call center, and a Web site where people can “chat” with a live representative.
Certain kinds of financial assistance will be available directly through the marketplaces. However, the CMS points out that you may be eligible for certain tax credits and other assistance programs to help with covering the cost of health insurance right now.

Although enrollment in Health Insurance Marketplaces doesn’t begin until October, the CMS has released a list of seven things people can do to get ready. The list includes such items as collecting information about your household income to see if you are eligible for discounted or free health insurance, and learning more about different kinds of insurance for when you choose a plan.

To receive updates about the Health Insurance Marketplace in your state as the program continues to take shape, you can sign up with HealthCare.gov here. You can also contact your state government directly to learn more.

Last Reviewed May 30, 2013

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Cooper B. Wilhelm is an Assistant Editor at Arthritis Self-Management

Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

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