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Posted by on Aug 6, 2013 in Uncategorized | 0 comments

The Basics: Health Insurance Exchange

The Basics

Health Insurance Exchange

What is a Health Insurance Exchange?

Health Insurance Exchanges allow consumers to shop for health insurance. Plans will have similar features, like a core package of covered services, making it easy to compare plan options across various carriers or insurance companies. Plans on the exchanges will be available for individuals as well as small groups.

What will the new health insurance plans look like?

Under the Patient Protection and Affordable Care Act, “Obamacare,” health insurance plans must abide by specific guidelines and standards. These standards help ensure that plans provide adequate coverage. The core package of items and services that all plans must include are known as “essential health benefits.”

Essential Health Benefits

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

What will my share of costs be with these new plans?

Actuarial Value or Metal Level

Actuarial Value, or AV, will help consumers to compare plans. These values determine how much a consumer can expect to pay in out-of-pocket expenses. An AV is calculated as the percentage of total costs for covered benefits that a plan will cover. AVs can be easily determined through a plans “Metal Level.” There are four different levels:

Bronze: 60% You can expect to be responsible for approximately 40% of covered benefits.

Silver: 70%

Gold: 80&

Platinum: 90%

Catastrophic plans with lower premiums will be available for individuals under 30 years old, but they generally have higher out-of-pockets costs.

When can I enroll?

Enrollment begins on the exchanges on October 1 of 2013 and coverage takes effect on January 1 of 2014.


Detailed information about each state’s exchange will be Coming Soon!

Follow this blog to receive updates as new information is released about the Health Insurance Exchanges.

Jillian Carlile
Research Analyst & Health Exchange know-it-all

About Strenuus

Strenuus® is the industry leader in delivering network competitive intelligence services. We are the largest collector of managed care data in the country. With a singular focus on the managed care industry, we provide services to support payors, brokers, consultants and healthcare IT companies. Whether you represent employer-based coverage, Medicare, Medicaid, dental, work comp or specialty networks, we have the data and insights you need.

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