The Affordable Care Act (ACA) establishes Exchanges, also called health insurance marketplaces, in each state where individuals and small businesses may compare and purchase health benefit plans starting Jan. 1, 2014.
Exchanges are available in each state where individuals and small businesses can buy health insurance from a variety of private health insurance companies. There are two types of public Exchanges – a Small Business Health Option (SHOP) Exchange for small businesses to purchase insurance for its employees, and an Individual Exchange for consumers to purchase a policy if they don?t have access to affordable health insurance through an employer.
In 2014-2016, only individuals and small group employers are eligible to participate in the Exchange; beginning in 2017, states may permit employers in the large group market to participate. States may also form regional Exchanges.
A Health Benefit Exchange is a competitive marketplace for Americans shopping for health insurance. Individuals can choose from a variety of plans that are administered by private insurance companies, which may include HMO or PPO type plans. Individuals are not required to purchase a plan that is included in the Exchange.
The health plans offered in an Exchange must meet standard requirements for affordability, Essential Health Benefits, and consumer protections. The Act defines four coverage levels:
These Exchanges must include:
In addition, the Exchanges must provide specific support services including: