States have taken steps to enhance Exchanges, but more can be done

All 50 states and the District of Columbia have already taken steps to enhance their Health Insurance Exchanges to make them more patient-friendly, according to recent research from the National Health Council (NHC). However, NHC cautions that there is a wide variety in what has been done in each state, and a need for greater action to ensure plans sold through the Marketplace meets the needs of individuals with chronic diseases and disabilities.

The report identified five key principles of concern to the patient community: nondiscrimination, transparency, state oversight, uniformity, and continuity of care. Within these key principles, 15 specific enhancements were singled out as metrics to ensure individuals can access plans that address their health and budget requirements. The report identified several different state marketplace leaders, including:

Montana: Even though the state has a federally-facilitated Exchange, Montana established a requirement that issuers offer at least one silver, gold, and platinum plan that uses copayments (rather than coinsurance) and subjects all drugs, including those in the specialty tier, to the deductible.

Delaware: The state runs a state-partnership Exchange and created transition periods for enrollees, allowing them to access prescription and medical treatments while changing plans or sources of coverage.

California: This state-based Exchange standardized benefit designs across all metal levels meaning that all enrollees in the same metal level encounter the same cost sharing for the same benefits.

“We learned that regardless of the type of Exchange established by the state, there are effective ways to improve the health insurance Marketplace,” said Marc Boutin, CEO of NHC. “While some states have emerged as leaders in implementing patient-centered standards and reforms, there is still more work left to do.”


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