Implementing Consumer-Friendly Health Insurance Marketplaces

The Affordable Care Act requires each state to have a health insurance marketplace (also known as an “exchange”), and it sets minimum standards for health plans sold in  the marketplaces. But states have flexibility in how they design and implement their marketplaces.

These briefs explain how to design consumer-friendly marketplaces and discuss five key elements of marketplace implementation:

• governance
• plan options
• financing
• navigators
• coordination with Medicaid and CHIP (the Children’s Health Insurance Program)

They also explain how states can apply the minimum requirements for plans sold in the marketplace in ways that ensure these plans meet consumers’ needs. The requirements for 11 components of these health plans are:

• plan design
• provider networks
• provider directories
• essential community providers
• marketing
• tobacco rating
• accreditation
• quality reporting
• quality improvement strategies
• continuity of care
• plan selection

State policy makers and advocates can also learn about nine states that have implemented these standards in consumer-friendly ways: California, Connecticut, Delaware, the District of Columbia, Maryland, Minnesota, Oregon, Vermont, and Washington.