Five things you should know about the D.C. health exchange

Health Care

Five things you should know about the D.C. health exchange

Joanne S. Lawton / Staff

Mila Kofman, executive director of the D.C. Health Benefit Exchange, acknowledges it’s a work in progress — but one with competitive pricing.

Ben Fischer

Staff Reporter- Washington Business Journal

We’ve invested a lot of ink and pixels on the policy side of the new D.C. Health Benefit Exchange, which culminated in a D.C. Council vote on June 4. Now that the legislating is out of the way, here’s a primer to understand it all.

1. Prepare for a small biz mandate.

Council members didn’t exactly simplify things. They voted to require small businesses with 50 or fewer workers to use the exchange starting January 2015, but did so via a temporary law that will expire several months before then. That means reopening the door to lobbying, amending and tinkering that could upend the mandate.

But the safe money’s on the mandate staying put. Opponents would have to turn at least seven out of the 13 yes votes (it was unanimous). That’s a long shot.

2. Some of you have to start using it right away.

If you buy insurance for yourself — or your company wants to start providing insurance for the first time — the mandate applies to you on Jan. 1, 2014. You could fit into those categories without knowing it. That’s because some companies are considering ending their internal health plan, paying the fine and sending workers to government exchanges. If that happens, you’ll have to use the exchange.

3. So far, it looks similar to the existing market.

Your four current options will all be available. Aetna Inc., CareFirst BlueCross BlueShield, Kaiser Permanente and UnitedHealthcare have each filed for permission to offer a combined 300 plans through the exchange, and all are participating in the business market. Only United will stay out of the individual market.

District officials had hoped to convince Maryland insurers to sell plans on the D.C. exchange, but failed.

4. No rate shock — yet.

Based on our limited information so far, the rates insurers are hoping to charge “are largely in line with current premiums for policies in the market today,” planners claim.

For instance, a business would pay about $318 per month to cover a hypothetical 40-year-old employee on a mid-tier, standard CareFirst plan. If you want to tinker with his or her benefits or try a competitor, it could cost as little as $249 or as much as $552.

5. Customer, pricing experience only comes with time.

Will the exchanges work? Will it give a good customer experience? Will the website be intuitive? Will prices stay low? None of those answers will emerge until transactions are actually being logged. “We’re at the tip of the iceberg,” said Scott Golden, a Gaithersburg insurance broker.

Exchange Executive Director Mila Kofman agrees there’s much to learn, but says she can already guarantee more options and competitive pricing.

“Those two things are tangible now,” she said.

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