Healthcare exchanges are growing and, as a result, employees have a lot of questions about them. Do you have the answers? If you don’t, here’s a look at a few common questions and how to respond to each.
What’s an exchange?
An exchange is like an online marketplace. It’s a website where shoppers can research all their options and then buy health insurance. There are both public and private exchanges. The biggest difference between the two are the sponsors. For public exchanges, the sponsor is the government, whether state or federal. With a private exchange, the employer is still considered the sponsor.
Which plans have the lowest cost?
It depends on each individual and family’s unique situation. While premium cost for a plan may be lower when compared to another plan, if a family member has a chronic illness, for instance, then that “less expensive” plan may wind up costing more in the form of co-pays and deductibles. Therefore, it’s important to direct employees to consider their health status, the doctors and hospitals they use, and the medicines they take when shopping for plans.
What are gold, silver, bronze and safety net plans?
These different tiers are mandated by the Affordable Care Act and designed to help consumers and small businesses more easily shop for and compare plans. However, coverage, premiums and out-of-pocket costs can vary greatly within metal plans. So employees shouldn’t simply rely on this hierarchy; they need to thoroughly review the details of each plan to find the one that’s right for them.
Will my doctors be a part of my plan?
Being able to continue a relationship with a current healthcare provider is critically important to most employees. However, it’s hard to say which plans will cover which providers since that can change each year based on contracts. That said, it’s important to encourage employees to review plans they’re interested in ahead of time to ensure their physicians are a part of a particular plan’s network.
What health services are covered in exchange plans?
Every plan has to cover 10 “essential health benefits.” These include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, and rehabilitation and lab services, among others. In addition, recommended preventive services, such as preventive mammograms, must be covered. That said, insurance companies do have some discretion in terms of which specific therapies they’ll cover within each category of benefit. As a result, it’s important for employees to evaluate the plans carefully to make sure what’s offered meets their needs.
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