Additional tools and information

Are there new tools or information sources for small businesses and individuals to explain options and help with decision-making? For example, to compare benefits and prices?

Yes. Launched on July 1, 2010, provides information about coverage options in each state, including eligibility, availability, premium rates, cost-sharing, and how much is spent on medical care vs. administrative costs. The site also helps people determine whether they’re eligible for a variety of programs, including existing or new high-risk pools, Medicaid, Medicare and CHIP.

In addition to educational content and details on small business tax credits and the early retiree reinsurance program, the site provides information that enables consumers to evaluate their options in the private market.

The website provides detailed pricing and benefit information on private insurance options. It shows cost-sharing per service, deductibles and premiums and has a tool to help compare plans.

It also has detailed information on services covered by the state Medicaid and CHIP programs, and on the federal and state high-risk pool program, including premiums and cost-sharing.

The HHS secretary is developing procedures for the exchanges to help consumers. For example:

  • Each exchange will have an electronic calculator to help consumers figure out plan costs, including the impact of tax credits and subsidies, if eligible.
  • The exchange will help determine eligibility for coverage and tax credits, whether an individual is exempt from the requirement to purchase coverage and whether their employer coverage is deemed “unaffordable.”
  • Each exchange will also maintain a call center for customer service.
  • Plans will be required to provide an explanation of benefits and policies using a standard format, which will help make comparisons easier.
  • Individuals will be able to apply for coverage through the exchange, and will be informed if they qualify for Medicaid, CHIP or any other state or local public health program through one state-sponsored website, listed below. The exchange will determine whether an individual qualifies for a tax credit and/or subsidy to reduce cost sharing.
  • HHS has created a single website,, where small businesses and individuals can find detailed information about coverage options.

There are also a number of new requirements for insurers on standardized operating rules to simplify elements of health insurance administration such as eligibility verification, service authorizations, claims status, payment procedures, and referrals. These changes should reduce waste, administrative cost and hassle; they were adopted July 1, 2011 and fully implemented as of January 1, 2013.