Before eligible individuals and small employers may purchase insurance coverage through state and federal-run public health care exchanges in 2014, private retiree Medicare exchanges provide a glimpse of what public and private health insurance exchanges could look like.

When Extend Health first introduced retirees to its private Medicare exchange six years ago, many people simply chose the cheapest plan – no matter their health status and needs. Once they realized how high their out-of-pocket costs were in high-deductible health plans, they would call the support team asking to switch plans.

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