TONY WILSON: What is a Health Insurance Exchange?

Tony Wilson

Tony Wilson

A key component of the health care reform law is the rollout of the health insurance exchange, and although the exchange for Georgia opens on Oct. 1, there still seems to be a lot of confusion as to what an exchange is and how it will work.

The exchange, also referred to as a marketplace, is a requirement under the Patient Protection and Affordable Care Act and will be a place where people can purchase health insurance coverage from insurance carriers.

Since Georgia didn’t set up its own exchange, the Department of Health and Human Services will be responsible for administering the exchange in the Peach State as well as the exchanges in approximately 30 other states.

The exchange is simply a web-based platform where the various health insurance carriers that elect to participate — carrier participation is not mandatory — can offer plans.

Think of the exchange like Amazon. It will be a website where you can shop and compare an item (in this case, health insurance coverage) offered by multiple vendors. You then would select which vendor you want to purchase the item from or, in this case, do business with for your health insurance coverage.

The website Georgia residents will access for the exchange is the federal website dedicated to this purpose: www.healthcare.gov. Individuals and families will be able to complete a questionnaire on the website and then review all options available through the exchange, including the coverages and premiums.

Once a plan is selected from the exchange — if this is where the individual or family wishes to purchase coverage — the next step would be to enroll via the website. Open enrollment for the exchange plan will begin Oct. 1, and the earliest effective date of coverage will be Jan. 1.

Several weeks ago I accessed the website to see what was available. At the time, some of the links on the website returned error messages like these: “Sorry, we can’t find that page on HealthCare.gov” and “The webpage cannot be found.” Since then it appears the Feds have been hard at work (don’t laugh) and the site has been built out with more information.

However, plans designs and rates will not be available on the site until Oct. 1.

As I mentioned, the exchange will be one option for individuals and families to purchase coverage, and you can maneuver the site on your own or you can utilize the services of a broker certified to assist you on the exchange. (I’ve attended hours of training for this certification. I had flashbacks of being back in high school.)

You still will be able to purchase coverage outside the exchange through local brokers, and many carriers still will offer individual coverage via their websites.

An important note to keep in mind is the customer service of your purchase. If you purchase a plan directly through the exchange and have a billing issue or a claims issue, you must deal directly with the carrier for resolution. If you purchase from a local exchange certified broker, then he or she can serve as an advocate for you, should any issues arise.

I do encourage any individuals and families seeking coverage to look at the exchange and also to look at offerings in the private market and compare the pricing.

While the exchange information for Georgia is not loaded just yet, residents in some states already have access to exchange information, including Massachusetts and California.

I ran my family’s information through the Massachusetts exchange, assuming a Boston ZIP code, and my premium definitely was higher on an exchange plan than what I currently pay for my family’s plan. In California, it was lower.

The key for Georgians will be what the exchange rates will be for those of us who call the Peach State home. We will find out come Oct. 1.

Questions or comments? Feel free to e-mail me at twilson@nfp.com.

Tony L. Wilson is a principal with NUVISION Financial Corporation based in Conyers. NUVISION is a subsidiary of National Financial Partners Corp. (NFP), which provides benefits solutions for companies.