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Mon July 23, 2012
KPR Investigates: How Health Exchanges Likely Will Work
LOUISVILLE, Ky. - Kentucky Governor Steve Beshear recently signed an executive order to create an insurance exchange for Kentucky. Under the Affordable Care Act, states must create marketplaces in which residents can purchase insurance, or else the federal government will do so for them.
“It’s a lot easier to adapt your policies and regulations to personalize it to your population, so we think Kentucky is in a better position to respond to the needs of Kentuckians,” says Kentucky Voices for Health Executive Director Jodi Mitchell, who believes state-run exchanges are the way to go.
But how will the exchange work? We called the Kaiser Family Foundation to get the details.
The concept of the exchange is to create a place, a website in most cases, where people without insurance can go to compare plans and sign up for the coverage they want.
But it can't just be a website. There must be a call center and an opportunity for residents to fill out paper applications. The exchanges must be either state-run or administered by a nonprofit, and while Kentucky is seeking an outside vendor, the exchange will be overseen by an executive branch office.
Insurance for Individuals
Let's say you're 30. You don't have insurance, and you need it. Well, if you have Internet access, you'll be able to go to the exchange and choose a plan that fits your budget. If you think you qualify for federal subsidies to purchase a plan, the Kaiser Family Foundation says you will be able to apply online.
If you qualify for subsidies to purchase insurance, you can apply on the exchange website. If you qualify for Medicaid, you can either apply the same way you do now or you will likely be able to apply through the exchange. Since Kentucky has Medicaid Managed Care, Medicaid patients will be able to sign up with one of the Managed Care Organizations in the exchange.
Small businesses—those with fewer than 100 employees—will be able to visit insurance exchanges, too. Like individuals, small businesses will be able to gauge different plans and purchase one that's right for their workforce.
The Kaiser Foundation people say there are two options many businesses will likely have. First, they can choose a plan, either modest or generous, and offer it to all employees. Or, the business can choose a level of a plan (the Kaiser people compared them to “bronze, silver or gold”) and allow individuals to choose their insurer from within a specific range of options.