The Health Insurance Marketplace (Health Insurance Exchange). Health Insurance Marketplace. Established under the Affordable Care Act Goal to increase competition and transparency in the insurance market as well as to provide a “one-stop-shop” for consumers.
Iowa Responsibilities Under Iowa’s Partnership Model
Accept applications; conduct verifications of applicant information; determine eligibility for enrollment in a Qualified Health Plan and for insurance affordability programs; connect Medicaid and CHIP-eligible applicants to Medicaid and CHIP; and conduct redeterminations and appeals.
Plan selection approach (e.g., active purchaser or any willing plan); collection and analysis of plan rate and benefit package information; issuer monitoring and oversight; ongoing issuer account management; issuer outreach and training; and data collection and analysis for quality.
Federal Responsibilities Under Iowa’s Partnership Model
3. Consumer Assistance
Consumer support assistors, education and outreach; Navigator management; call center operations; website management; and written correspondence with consumers to support eligibility and enrollment.
Enrollment of consumers into qualified health plans; transactions with Qualified Health Plans and transmission of information necessary to initiate advance payments of the premium tax credit and cost-sharing reductions.
User fees; financial integrity; support of risk adjustment, reinsurance, and risk corridor programs.
Essential Health Benefits
Ambulatory patient services
Rehabilitative and habilitative services and devices
Maternity and newborn care
Mental health and substance abuse use disorder services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
Navigators: Navigators will have a vital role in helping consumers prepare electronic and paper applications to establish eligibility and enroll in coverage through the Marketplace.
Non-Navigator assistance personnel: Non-Navigator assistance personnel (also known as in-person assistance personnel) will perform generally the same functions as Navigators but will exist in either a State-based Marketplace or a State Partnership Marketplace.
Certified application counselors:
Agents and Brokers: To the extent permitted by a state and if all Marketplace requirements are met, licensed health insurance agents and brokers may enroll individuals, small employers, and employees in coverage through the Marketplace.