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All health plans offered on a state exchange must provide comprehensive coverage that includes doctors’ visits, lab work, hospital stays, emergency room services, maternity care, prescriptions, mental health services and children’s dental and vision care.

Policies with the most generous benefits will be “platinum” plans; they will have the highest monthly premiums but fewer out-of-pocket costs and lower deductibles. The “gold” and “silver” plans will be somewhat less generous, while those in the “bronze” category will have the cheapest premiums but may require high out-of-pocket costs and deductibles.

Be aware that the plans may have narrow provider networks — your favorite doctor or the hospital down the street may not be a participant. You’ll need to check to see if a certain provider is in the network, advised Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reform.

he actions of these other employers don’t detract from the unique nature of Walgreens’ decision. Two months earlier, the retailer announced its partnership with the Department of Health and Human Services to extol the benefits of Obamacare to its employees and its customers. Their website still features the effort, and brochures continue to be distributed even while the corporation itself realizes that compliance must force it to abandon employer-provided health insurance for the people in the stores distributing the brochures to customers.

With the CBO predicting that rising health-care costs would increase at twice the rate of other federal spending, the same increase in costs will now be borne almost entirely by employees.  Finally, it appears that the private-exchange option will satisfy the employer mandate, which means that the employees cannot bail out of these private exchanges in order to qualify for federal subsidies, which prevents the employers from having to pay increasing fines for non-compliance.

limit the liability of the third-party payer.

Thirty percent of companies that provide coverage to Medicare-eligible retirees (age 65 and over) already have moved to exchanges, according to an Aon Hewitt survey of more than 1,230 employers released last month.

For Medicare-eligible retirees, employer benefits are supplemental. Retirees who use traditional fee-for-service Medicare might be offered a Part D (prescription drug) benefit, and a subsidized Medigap plan, which plugs coverage gaps in fee-for-service Medicare. Retirees using Medicare Advantage (all-in-one managed care plans) receive a subsidy toward buying those plans.

oving to exchanges also can help employers avoid the looming risk of the so-called Cadillac tax on rich-benefit insurance plans.

making unionized workers less competitive and potentially causing unionized employers to drop the plans that cover more than 20 million people.

To offset the expected rising costs of these "multiemployer" plans, several union groups want their lower-paid members to be able to remain on the plans wh

"will shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class," the union officials wrote.

Proposed and final rules issued this spring surprised many by failing to bar large employers from offering insurance policies that could exclude benefits such as hospitalization. Offering bare-bones policies may result in some fines, but that expense could be less than the cost of offering traditional medical coverage. For large employers, "the feds imposed no minimum standard on how skimpy that coverage can be other than to say, in essence, it's got to be more robust than a dental plan or a vision plan," said Ed Fensholt, a senior vice president at insurance broker Lockton Companies. "We had customers looking at offering some relatively inexpensive and skimpy plan designs to satisfy the individual mandate at modest cost.”

The bare-bones plans cannot be offered to small businesses with fewer than 50 workers, or to individuals buying coverage through new online marketplaces that open for enrollment Oct. 1. But benefit experts expect some larger firms that buy outside the marketplaces or that self-insure to consider them. 

Skimpy insurance under the Affordable Care Act won’t be quite the same as it is now. Under the new rules, capping the dollar value of annual benefits isn't allowed, but excluding entire categories from coverage - such as hospital stays - is permitted, say benefit consultants. That's another way of keeping costs down.

A national survey by Aon Hewitt consultants suggests that the Affordable Care Act's taxes and fees add 1% to 2% in direct costs to employers.

The Aon Hewitt survey found that 44% of companies are considering offering workers just one health-insurance plan — a high-deductible plan — rather than offer a high-deductible plan plus a more traditional plan that covers 70% to 80% of medical costs.

But those people will not get government subsidies if their company offers affordable health insurance, defined as costing less than 9.5% of income.And such employees would lose their employer's contribution to their plan unless the company agreed to provide such a payment in lieu of coverage.

Premium prices are influenced by many factors, including what insurers guess their costs will be, a region’s labor costs and how much hospitals and other facilities charge. Competition between insurers is also a significant factor.

While some of the lowest cost plans are in the “bronze” tier of coverage, such plans generally have higher annual deductibles and co-payments than a silver plan.  Also, the silver plans reduce some costs for subsidy-eligible consumers, which could reduce their exposure to big bills if they fell seriously ill.

“Although premiums are generally the first and last thing discussed when comparing plans, out-of-pocket costs may be an equally or even more important consideration, particularly for those with significant health care needs.”

Congress might consider a future subsidy approach that recognizes that the affordability of insurance is a function of expected out-of-pocket costs and characteristics such as chronic disease, not simply premiums.