DC’s Health Care Exchange Will Help Small Businesses Shop for the Best Health Plan
Starting in 2014, the DC health insurance exchange will improve the quality and affordability of health plans offered to individuals and small employers, groups that traditionally have had difficulty finding plans that covered what they wanted with a reasonable price. The exchange will make it easier to find a quality health plan and to compare plan options with regard to both services and price. The exchange also will create new entities with the sole purpose of helping consumers navigate the process for identifying a health plan.
While the District has been a national leader in health coverage and innovative health policies for lower-income residents, efforts to ensure consumer choice for individuals and small businesses who must buy health insurance in the private market have not kept up. Small employers in DC often have few health insurance choices, with a couple of major insurance companies dominating the market and offering plans that have shrinking coverage but are increasingly expensive. Moreover, individuals and small businesses lack detailed information about plans’ provider networks, fees, and limitations, making comparisons across plans difficult, if not impossible.
The District’s mission for the health insurance exchange is to provide a robust set of quality options to consumers. To ensure quality, the District will impose minimum standards on plans sold through the exchange – requiring plans to have an adequate number of doctors and specialists and imposing reporting and disclosure requirements for a plan’s services, quality measures, and costs. All insurers in the exchange will have to play by the same rules.
The exchange also will create an online shopping portal where plan information will be available in a standardized, user-friendly format. By increasing the standards and transparency of what is offered on the exchange, consumers will be able to compare plans side-by-side and know exactly what to expect with their purchase. This will increase competition and create incentives for innovative products to emerge in the market, leading to higher levels of quality and a greater number of plan options at more affordable prices.
The District’s exchange also provides new options for individuals in poorer health and small employers – two groups whose choices are particularly limited. First, the exchange will ensure that individuals and small business employees who are in poorer health have more affordable plan options that meet their higher health care needs. Secondly, small businesses can choose to offer their employees multiple health insurance options through the exchange and not face additional expenses or administrative red-tape.
On top of these features, brokers, agents, and other assisters will be available to help individuals and small businesses make choices. The exchange will create new entities – known as “navigators” that will be paid by the exchange to provide unbiased information on all plans available and guide residents through the exchange’s enrollment process. Navigators will also help families determine if they are eligible for programs such as Medicaid or for other subsidies to help pay premiums or reduce co-pays and deductibles.
Overall, the District exchange will offer a greater selection of quality plans that meet the needs and pocketbooks of DC’s residents and small businesses.