Much happened in the month leading up to the October 1st launch of public exchanges. Here is an overview of some of the notable events and announcements made by the states around the launch of their health insurance exchanges in the month of September:

Outreach efforts continued as states running their own exchanges and states with exchanges run by the federal government alike ramped up their efforts to inform uninsured and underinsured residents about their options for health insurance under the Affordable Care Act.

The State Exchange Table continues to provide the latest information on carrier participation and plan rates.

Latest Developments:

State Run Exchanges Or Partnerships –

California: Thanks to a new calculator feature, Californians can now get a more accurate estimate of health insurance premiums under the plans available through the state’s exchange marketplace, Covered California. The calculator factors in age and region, which are two of the primary determining factors for premiums. The Covered California exchange previously only offered statewide estimates.

Covered California faces a steep learning curve as a recent survey reported that three out of four Californians who “earn modest incomes and could buy government-subsidized private coverage” do not believe they would qualify for federal assistance. California will also be dramatically expanding its Medicaid program. Uncertainty still exists among California’s illegal immigrant population, many of whom erroneously believe they are covered under the state run exchange.

Colorado: At the final hearing before the October 1st launch, Colorado legislators walked back initial skepticism about operating a state health insurance exchange and expressed confidence in exchange leadership within the state. Republican Representative Bob Gardner, despite voting against the exchange bill back in 2011, said he had “become convinced.” The committee remains concerned about access to premium subsidies for family coverage for employees of small businesses, but will continue to work on this issue in the wake of the rollout October 1st.

Connecticut: Connecticut is going far off the beaten path to inform people about its health insurance exchange marketplace, Access Health CT. Program representatives are approaching potential consumers at outdoor music concerts in an effort to reach new populations.

To facilitate enrollment, Access Health CT has partnered with the state’s Office of the Healthcare Advocate to launch the Navigator and Assister Outreach program. The program will train 300 volunteers, librarians, hospital and clinic workers, health department staff and community volunteers to educate residents about the exchange and the options available to them.

District Of Columbia: The District of Columbia’s health insurance exchange, DC Health link, has announced that they will be partnering with DC United, D.C.’s professional soccer team. The soccer team will help with outreach and education efforts around the exchange. The partnership between the team and the exchange is set to include an on-field presence, a public address announcement and tailgating at RFK Stadium.

Idaho: Idaho officials announced that the state will offer 161 health insurance plans at various coverage levels from eight providers. The plans include 76 individual health plans, 55 small-group health plans for small businesses, 13 individual dental plans and 17 small-group dental plans. While Idaho received approval to run its own exchange, the exchange will initially be run as a partnership since its IT platform is still in the works and will need federal assistance with implementation at the outset. Read the rest of this entry »

October 15th marks the beginning of the Medicare Annual Enrollment Period (AEP) for 2014, which runs through December 7th. For seniors on Medicare, this is the time to evaluate current Medicare coverage — including the private Medicare supplemental plans they might be enrolled in — and decide whether to make changes or keep the coverage they have.

What might cause you to consider making changes? Extend Health fielded a survey this past weekend asking its customers who are currently enrolled in plans purchased on its private Medicare exchange whether they plan to re-evaluate or just keep the plans they have, and why.


Of the 449 respondents who completed the survey, 56.7% said they plan to reevaluate one or more of their existing plans and consider replacing one or more of them. Of those who will reevaluate, 23.8% cite their premiums increasing as their reason for reevaluating. However, 62.3% who said they will reevaluate their plans say they will do so simply because they want to confirm they have the best coverage available.

Not all respondents plan to reevaluate their plans: 37.5% said they plan to renew their existing plan or plans without going shopping. Among respondents who do not plan to reevaluate, 69.2% said it was because they are satisfied with their existing coverage.


Willingness to reevaluate plans indicates that Medicare retirees are actively engaged in gaining the best value and most fitting coverage for themselves, as opposed to simply deferring to the status quo and staying with existing plans.

Q1: The 2014 Medicare Annual Open Enrollment Period will begin on October 15, 2013. During the enrollment period, you have the option of renewing your existing private Medicare plans, purchasing new private plans (from your existing insurance provider or from a new provider) or dropping plans without replacing them. During the enrollment period, do you plan to:

Reevaluate one or more of my existing plans and possibly replace one or more of them


Renew my existing or plans without reevaluating them


Definitely replace one or more of my existing plans with a different plan


Drop one or more of my plans without replacing them


Q2: If you plan to reevaluate one or more of your existing plans, what is the most important reason prompting you to do so?

I just want to confirm that I have the best coverage 62.3%
My premiums increased 23.8%
My out of pocket expenses increased 6.6%
My prescription drugs have changed 3.0%
My current plan is no longer offered 2.6%
My benefits changed 1.7%


Dorothy stands at the gates of Oz, where the gatekeeper declares, “Welllll, that’s a horse of a different color.”

The idiom has come to describe a situation that takes on new meaning based on new contextual information. Case in point are the state-run and federally-managed health insurance exchanges, which opened for business on October 1st. These public exchanges mean different things to different constituencies, depending on whether you are a large or small employer, an insurance company, or a consumer.

So before you traipse down the yellow brick road to affordable health care, you should know that the exchanges are indeed “a horse of a different color,” depending on who you are.

1.  Large Employers: 3 big opportunities

Public exchanges will create a viable market for individual health plans for the first time in American history. This presents three big opportunities for large employers.

First, part-time and seasonal workers now have a viable and federally funded alternative to selecting their company’s so-called “limited medical plan” or going uninsured.  This has the dual benefit of providing access for more of these workers to insurance they need, without the additional cost being absorbed by the company.

Second, if a company chooses to sponsor health benefits for its early retirees (under the age of 65), it has a once-in-a-generation opportunity to compare early retiree group plans with individual plans in state exchanges and determine which option offers more value.

Third, COBRA participants, who pay 102% of the premium for their company’s health plan, now have access to plans that offer equivalent or better plans, probably at dramatically lower cost.

2.  Small Employers:  First-time opportunity

State exchanges provide employers with fewer than 50 workers a great first-time opportunity to evaluate whether to continue their group plans (which can be subject to large annual premium increases) OR allow their employees to tap into state exchanges for individual plans. If they choose state exchanges, many small employers are looking at grossing up pay to assist their workers in purchasing individual plans.

In addition, although delayed this year, the 2015 SHOP exchanges will provide more attractive small group health insurance alternatives.

3.  Insurance Companies:  Bigger market opens opportunities

Insurances companies have the opportunity to participate in a much bigger market for individual health plans with sustainable profits as millions more Americans purchase plans on public exchanges.

The transition to exchanges also invites change to the delivery model from business-to-business (B2B) to business-to-consumer (B2C).  Alongside the opportunity to access a larger market, there is also the opportunity to deal directly with health care consumers.

4.  Consumers: Take steps to find the best plan

The millions of Americans who will shop for insurance for the first time starting October 1st would be well-advised to Stop, Wait, Look, and Ask for Help.

STOP: Don’t be in a hurry to buy a plan. Start your research and plan comparisons when exchanges open on October 1st. But since the plan you purchase will not go into effect until January 1, 2014, there is no rush to make your final decision right away. The advisors and agents handling enrollments on the new exchanges will be more skilled at helping you a few weeks after enrollments begin – and you’ll be more familiar with your exchange. Don’t wait too long, though: there will likely be lots of people who will wait until the last minute to enroll and you don’t want to be part of the last-minute rush. And be aware that you must enroll by December 15, 2013 if you want your coverage to start on January 1, 2014.

WAIT: First, set a budget for your health plan. Use the online tools and offline support available to you to find out whether you qualify for a federal subsidy for health insurance based on your income.  If you do qualify, the amount of your subsidy will help you figure out how much you can spend on a health plan.

LOOK: Do a thorough comparison of your plan options. Most exchanges will offer plans at four levels based on the coverage and price: platinum, gold, silver and bronze. Don’t fall into the trap of buying the plan with the cheapest premiums. Instead, use the help available to you to figure out what kind of coverage you need based on your health, the doctors and hospitals available in your area and your expected out-of-pocket expenses.

ASK FOR HELP: Lots of help is available to you in the form of online tools and telephone support — take advantage of it. Buying health insurance can be complicated. But help is available to make it less confusing. Your exchange will provide online tools and telephone support. In addition, community organizations in many states have been enlisted to act as “navigators,” guiding consumers through the process. If you live in one of the 36 states that have chosen to have the federal government run their exchanges, some independent companies have been authorized as brokers to help you select and enroll in plans. You are not alone!

In this brave new world of exchanges, you can’t just click your heels three times and end up at home. To get the most out of the state exchanges, it’s all about identifying the choices and opportunities unique to who you are and starting to take advantage of them.

Public exchanges, a key provision of the Affordable Care Act, opened for business on October 1st, and millions of Americans went online to check out their health plan options on either state- or federally-managed exchanges.

As expected, there were glitches – more even than were anticipated. But the overwhelming demand signals the potential success of these public health insurance marketplaces.

How many people visited the public exchanges? On the first day, 4.7 million people visited, the federally-managed exchange, and 133,000 called the federal portal’s call center. About 104,000 requested live chats.

While the federal exchange, which serves 36 states, was inaccessible for much of the day, administrators “added capacity and made adjustments” to put it back into service by late afternoon.

As for state exchanges, New York officials said 2.5 million people visited the  New York State of Health exchange in its first half hour. California reported as many as 16,000 hits a second on Kentucky’s Kynect exchange website had a more modest 24,000 visitors by 9:30 am, but by midday Wednesday had successfully enrolled 2,600 individuals and families in plans.

Some states running their own exchanges, including Colorado and Oregon, failed to open their online enrollment portals for business as scheduled, but assured that this delay is only temporary and both states are enrolling people over the phone in the interim.

Citizens have until December 15th to enroll in health plans to guarantee that they have coverage by January 1st, when the tax penalty applies for those who have not enrolled in some form of insurance.

Precise enrollment numbers are still unclear, and it is not yet known if the technical glitches deterred consumers from enrolling. Despite criticisms and access issues, the takeaway from October 1st is that people are visiting public exchanges in huge numbers, giving an early indication that a viable new market for health plans on public exchanges will develop over the next months and years. We will continue to monitor the status of these exchanges and report back here.