Health Insurance Exchanges

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Helping states expand health insurance coverage

Health Insurance Exchange Solutions

The Affordable Care Act (ACA) establishes Health Insurance Exchanges as state-based entities that create a more organized, competitive and accessible health insurance market  for individual consumers and small businesses. Exchanges offer a choice of plans and establish common rules regarding the offering and pricing of insurance. They also provide information to help consumers better understand the options available so they can choose the best plan for them and their families.

Leveraging Your State’s Existing Infrastructure

As your state’s programs have grown, you’ve continually improved the operational functions and invested in critical technology. An Exchange shouldn’t be a reason to scrap it all and start over – it can be an opportunity to leverage your proven processes and systems with best-of-breed tools and technology. With extensive experience administering Medicaid, CHIP and other unique state-designed programs, MAXIMUS has the knowledge and proven tools to understand your programs’ valuable assets and how to match them with new processes and technology to create an Exchange that is cost-effective, improves program operations, and maximizes consumer choice. We offer a wide range of solutions for:

  • Individual Exchanges
  • SHOP Exchanges

Helping States Meet the Deadline for Implementation

Under health care reform, states are required to establish an operational Exchange for offering qualified health insurance plans to individuals and small businesses (SHOP Exchange) by January 1, 2014. As a leading administrative provider in helping states run health insurance programs, we can help states assess, design, implement and operate cost-effective and efficient consumer and SHOP Exchanges that meet all federal and state requirements. Our Exchange solutions provide:

  • Eligibility determination and plan enrollment
  • Multilingual customer support
  • Consumer Web portal
  • Navigator services
  • Exception and exemption processing
  • Grievance and appeals assistance
  • Health plan oversight