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Health Care Reform:

Health Insurance & Affordable Care Act

Insurance Marketplaces: What Your State Decides

Health reform is affecting the whole nation. Every state will have a health insurance Marketplace, also called an Exchange. So every state has some control in shaping health reform for people who live there.

The Marketplace is where people who don't have health insurance through an employer can enroll in a comprehensive health plan. Small businesses with 100 workers or fewer can also buy health insurance on the Marketplace. The main way to use the Marketplace is online, but you can also access it by phone or in person.

Your health benefits and costs may differ -- in important ways -- from a family like yours in another state. It's worth your time to find out what choices your state can make and what they decide.

What's the Same in Every State?

When it comes to your health care options on the Marketplace, some things are the same in every state.

Basic coverage. The U.S. government sets basic guidelines for essential benefits. Every health plan sold in the Marketplace has to offer them. They include emergency care, pediatric care, maternity care, lab testing, and more.

Protections. There are upper limits on how much you have to spend before your insurance company starts paying toward your care.  No plan can charge more based on your health or whether you're a man or a woman.

Four levels of coverage. To make it easier to compare plans, every Marketplace will rank the types of plans according to the level of benefits they offer, from platinum (the most) to bronze (the least.) There's also a special plan for young adults.

What Decisions Your State Can Make

Aside from those basic requirements, states that set up their own Marketplaces have a lot of control over what to include in their health coverage.

Which insurance companies get to sell on their Marketplace? States can choose insurance companies and can set tougher rules for coverage than the federal guidelines require.

How many insurance companies can sell?  Some states,  like California, are limiting the number of insurance companies selling on their Marketplace. They hope it will improve the quality of the plans offered. Other states are taking a different approach. For instance, Colorado will allow any insurance company to sell plans.

Treatments that are covered. States running their own Marketplaces can tell companies that they must make the essential benefits more generous than the federal guidelines.

For example, some plans may pay for weight loss surgery, but others may not. Some plans may cover fertility treatments to get pregnant under maternity care, but others may not. 

One plan may only cover a few drugs for your condition -- like medicine for high blood pressure -- while another plan may cover many brands.

States can also decide what complementary and alternative treatments count as essential benefits. For instance, some states -- like California, Maryland, New Mexico, and Washington -- are including acupuncture as an essential health benefit. Many other states probably won't.

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