Question

Discuss what the functions and requirements are for insurance exchanges since the implementation of the ACA, what is the structure of governance, and management in payer organizations?

Answer 1

Functions of insurance exchanges:-
? -- Facilitate enrollment for uninsured health plans,medicaid,CHIP,and assistance program..
   --Approve health plans exchange..
?    --providing technical knowledge for customer service functions,including data on plans..
?    --Establishing" Navigator" program..
? --validate eligibility of prospective health plans..
? --facilitate application for federal enrollees and these funds to designsted health plans..
? --Assess and collect fines for insufficient coverage options..
?Requirement:-
? --Citizenship for the particular state
   --expected income
      --family and household size
      --eligibility for medicaid and other program..
   --employment and income status for individual..
?    --health plan coverage if available..
   --cost of plans
   --detailed health history..
Structure of governance and mangement:-
?The patient protection and Affordable Care Act(ACA) as passed used state-based exchanges..ACA will extend health insurance coverage to 32 million Americans..
?    --16 million Americans will receive coverage through medicaid programs by states...
      --The remainder through state-operated health insurance exchanges..
? --For individual under age 65 medicaid coverage for adults,including parents for eligibility limited in many states..
?    - - In 2014 ,medicaid will cover under age 65 upto 133% of federal poverty level(FPL)
? --Individual with family income 400% below of FPL and above those levels eligible for Tax credits to help insurance for coverage through the state-run exchange..
? --Recently the rise if alternative trading systems(ATS) first in the states and then in europe had a profound impact..
? --The effect of ATSs on corporate governance is not clear..
? --Two practical concerns voiced are trading fragmentation and traditional regulatory..
      --With in the exchange insurance plans offered low-high premium..plans covers 60% to 90% of bills..