The ACA mandates that States have an obligation to provide citizens with access to affordable health insurance offering minimum essential coverage. This obligation is met by the Health Insurance Exchange (or Exchange for short), an online marketplace for insurance plans offered by insurance carriers. Once a household has been determined eligible for some kind of assistance within the range of insurance affordability programs, or even when not eligible for assistance but still determined eligible to use the Exchange, then citizens can search for and compare different Qualified Health Plans (QHPs) - the name given to plans that are offered by health care providers through the Exchange.
These QHPs are certified by the Department of Insurance and given a rating based on the actuarial value of the plan (bronze = 60%; silver = 70%; gold = 80%;platinum= 90%). This actuarial value promotes plan competition based on a number of cost-sharing factors: premiums, quality, provider network and customer service. Better coverage is typically available in a platinum-level plan however this will also be reflected in the premium associated with that coverage. Plans offered by different carriers with similar cost-sharing designs will have the same actuarial value, thereby allowing citizens to choose among plans of comparable levels of coverage.
The Exchange creates an organized and competitive market, and promotes easy comparison of available plan options based on price, benefits, and quality so that an individual seeking health care coverage can obtain comprehensive information on the coverage options currently available and make informed health insurance choices. Equality and consistency are ensured by establishing common rules on the offering and pricing of insurance, and information is made readily available to help consumers better understand the options available to them.
The Exchange is also responsible for filtering plans based on the citizen's eligibility and adjusting the different cost factors of plans based on their entitlement. For example, insurance assistance offers financial assistance to citizens in the form of premium tax credits and cost-sharing reductions. Since cost-sharing reductions are only allowed to be used on silver plans, this should be reflected in the list of plans shown to any citizen eligible for a cost-sharing reduction. Equally, all plan premiums should be adjusted based on the premium tax credit that is available to a citizen or family.
As mentioned above, citizens can shop directly for QHPs without having to apply for assistance. When shopping directly for a QHP individuals are presented with the full range of health care programs available; plan premiums are not adjusted as there is no financial assistance available to help with the costs when purchasing insurance. However, Citizens must still be determined eligible to purchase QHPs through the Exchange; a subset of the information needed for the assistance application process is captured and used in this determination.