Health Insurance Exchange Lingo: Terms you should know

This won't hurt...much.

Here are just a few of the terms you’ll be hearing a lot about in the coming months as the exchange market gets up and rolling.

Public exchange
A government-regulated online marketplace that can be run by the federal or state government. It will be the only place where individuals, families, and small groups may purchase health insurance that’s eligible for new federal subsidies—tax credits and cost-sharing assistance—as of Jan. 1, 2014. (Small groups are only eligible for tax credits.) In Washington state, the Public exchange is called the Washington Healthplanfinder.

Washington Healthplanfinder
The online marketplace for individuals, families, and small businesses (1–50 employees) that provides side-by-side plan comparisons based on factors such as cost and quality. For individuals, it will include a calculator to help consumers
determine if they qualify for financial assistance (subsidy) to help pay for their coverage, and allows them to purchase coverage online. It becomes operational on Oct. 1, 2013 for enrollment in plans becoming effective Jan. 1, 2014.

SHOP
This is an acronym for the Small Business Health Options Program, the part of the exchange specifically for small employers and the self-employed. It begins in 2014, and Group Health plans to participate in 2015.

10 essential benefits
The minimum health benefits all Individual & Family and small businessplans must provide in Washington state: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative services and devices, lab services, preventive and wellness services and chronic disease management, and pediatric services—including dental and vision care. Plan designs should be published sometime in the summer of 2013.

Metal tiers
Plan options will be broken down into tiers based on the level of coverage they provide. Each tier corresponds to an actuarial value. The actuarial values are bronze (60 percent), silver (70 percent), gold (80 percent), and platinum (90 percent). As you can imagine, platinum plans will cost more than the other "metals." Rates may not be published until summer of 2013 but you should be prepared for Sticker Shock.