Health Insurance Exchanges
The health care reform law created a new mechanism for purchasing health insurance called Health Insurance Exchanges (Exchanges). The new law authorizes that states create “American Health Benefit Exchanges,” by January 1, 2014, which will make coverage available to qualified individuals and employers. Prior to 2016, states can limit Exchanges to businesses with 50 or fewer workers and, beginning in 2017, states can allow businesses with more than 100 employees to purchase coverage from an Exchange.
For an example of a state exchange, explore the “Commonwealth Connector” by using zip code 02210.
The Exchange will act as the marketplace where individuals log on to a website or call a phone number in order to buy insurance. For those who work for small employers and if the employer offers insurance, the employer will be able to consult with either a “Navigator” or other insurance professional in order to make an educated selection of plans for their employees.
The Exchange will work with insurance companies to make sure that the insurance that they are offering meets certain regulations. These regulations are available HERE.
Individuals who purchase their own insurance may also be eligible for a premium tax credit. If an individual or family earns less than 400% Federal Poverty Level (FPL) (or about $88,200 for a family of four), then the total amount that they will pay for coverage through the Exchange will be limited to a certain percent of their income.
If the family or individual earn more than 400% of FPL, they are not eligible for additional assistance.
For an expanded explanation of the premium credits and what benefits will be available, please go HERE.
Please Note, while this overview is based upon the law as written, there will be regulations issued by various government agencies, primarily the Department of Health and Human Services (HHS). In addition, the State of Ohio will be primarily involved with setting up the state Exchange.
The Kaiser Family Foundation has produced a 4 page brief that gives an overview of the Exchanges along with how will they be structured, functions they will perform, what subsidies will be available, and finally what benefits will be available.
http://www.kff.org/healthreform/upload/7908-02.pdf
For questions or additional information about the Health Insurance Exchanges email COSE’s advocacy team.