Optimizing Consumer Protections in State Health Insurance Exchanges

This NYHealth-funded report, issued by the Community Service Society (CSS), puts the spotlight on a critical feature of the Health Insurance Exchange that has thus far been widely overlooked: consumer safeguards.

Basic consumer supports, accessible appeal rights, and quick dispute resolution can ensure fair and accurate determinations of eligibility and maximize coverage.

This report, “Optimizing Consumer Protections in State Health Insurance Exchanges,” lays out a framework to buffer the simple act of obtaining and maintaining health insurance. The report outlines a number of actionable, adoptable recommendations and makes clear how the complicated menu of current approaches to ensuring procedural fairness and consumer protections in health insurance coverage can be improved upon in the context of the Exchange.

Navigating the differences between the public and private coverage rules, the report identifies the policy choices needed to build this critical channel for consumers and makes the case for how a system that safeguards each individual’s right to redress serves the broader goals of the Exchange.