By Michelle Andrews
This material was published by Kaiser Health News.
Workers at small companies rarely get a choice of health plans. That could change for some of them when online health insurance marketplaces for businesses open this fall.
The health care overhaul requires every state and the District of Columbia to establish a Small Business Health Options Program, or SHOP exchange, to enable businesses with 50 or fewer workers to offer health insurance to their employees. These exchanges will function much like the online marketplaces for individual coverage that will open this fall, but with some key differences.
Since small employers lack the buying power of larger companies, the insurance plans they offer are often limited and their administrative costs are high. The SHOP exchanges are intended to make it easier for small businesses to offer their employees a variety of good plans, something employees prize.
"[Plan choice] is a big value added for workers," says Linda Blumberg, a senior fellow at the Urban Institute Health Policy Center who co-authored a report on shop exchanges.
Through the exchanges, employers will be able to designate how much they want to contribute toward their employees' coverage, and the exchange will handle the back-office functions, such as making sure the payments get to the correct insurance company. Employees, meanwhile, will be able to compare plans' features and costs online and enroll in a plan.
At least, that’s the way it eventually is supposed to work nationwide. In June, though, the Department of Health and Human Services announced that in the 33 states where it is running the health insurance marketplaces, it would delay for a year giving workers the ability to choose among different plans. HHS said that option would be too complicated for insurers to implement by 2014.
In the remaining states and the District of Columbia, the SHOP exchanges are all generally moving forward with plans to allow employers to offer their workers more than one coverage option. How much choice workers have will be up to the employers and the states, however.
Workers may be able to choose any plan offered by a single carrier such as Aetna or UnitedHealthcare on the SHOP exchange, for example, or they may instead be able to pick any insurer but be limited to plans that are all at the same level or tier. (Health plans will be grouped into four tiers based on how much of their medical claims consumers will be responsible for: In a platinum plan, consumers will owe 10 percent of the costs; in a gold plan, 20 percent; silver, 30 percent, and bronze, 40 percent.) In some states, employers can choose to offer employees just one plan.
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