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Small groups could head to exchange system

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For groups with two to 50 people, some employers might consider moving to the health care exchange system, especially as the private exchanges come into play, says Ron Goldstein, founder and president of CHOICE Administrators, a developer and administrator of health care exchanges in Orange, Calif.

With private health care exchange systems, there are many valued-added benefits, such as stand-alone dental, vision and even chiropractic care, Goldstein says. State health care exchanges are also an option for employers, but the value-added benefits are not ready for the most part in the state health care exchanges. Goldstein believes that the value-added benefits will eventually come to the state health care exchanges because of the way the Patient Protection and Affordable Care Act (PPACA) was built, though it may take some time.  

“You’ll see probably two to three years from now that the states will be sound enough to go out and add those value adds, but the carriers themselves might be able to offer more value adds initially than the state exchanges,” Goldstein says.

However, micro-groups, which have somewhere between two and six lives, are more likely to disband and send their employees to the health care exchange system to buy individual coverage, and many of these employees will probably qualify for subsidized care, Goldstein says. By 2017, larger groups might consider the exchange system, as well, but with the current focus being on 2014 and 2015, Goldstein doesn’t expect to see much movement from that size of employers.

Employees can especially benefit from the health care exchange system because of the variety of choices available, Goldstein says. When using an exchange, employees can choose from multiple carriers, all of which that are offering several plan designs. This allows employees to research a variety of plans and pick the one that best suits their needs.

“This could be better for employees because they have a choice,” Goldstein says. “If I go directly to a carrier, I’m buying that product, but in an exchange, it’s typical to have three or four carriers and three or four benefit designs per carrier, so the private exchange offers more choices versus a direct carrier.”

See also: The math behind PPACA

Of course, many workers hear of state-run health care exchanges and immediately worry about the quality of service, but this isn’t necessarily an issue, Goldstein says. Depending on the health care exchange, many are partnering with a business process outsourcer that is responsible for customer service activities, such as maintaining a call center. That outsourcing is designed to improve the quality of customer service.

“A lot of people are worried that the state exchange will turn into the DMV, but most of the state exchanges will have some type of outsourced customer service, so I don’t think the level of service drops at all,” Goldstein says.

While Goldstein believes the health care exchange system has its potential benefits, there are some unknowns as to exactly how everything will operate. The health care exchange systems are still being created and are likely to continue to adjust once they are in place.

“Everything is being built as we speak,” Goldstein says. “There’s about 15 states that will establish exchanges, and the rest will default to the feds, so you’ll have probably 15 different types of models out there, and then you’ll have the federal model. It’s hard to say what model works best with an employer, what model doesn’t, and there are all going to tweak once they go live.” 

For more exchange news, see:

Pollsters: Tenn. Republicans prefer state exchange

Pennsylvania forgoes state exchange

Idaho governor opts for state-based exchange


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