Health Insurance Exchanges / Health Insurance Marketplaces

Starting October 1, 2013, health insurance exchanges (also known as health insurance marketplaces) will provide individuals and small businesses access to:

• An online marketplace of Affordable Care Act bronze, silver, gold or platinum health insurance options (sometimes referred to as metal plans)
• “Catastrophic” health plans available to individuals up to age 30 who cannot afford a metal plan
• Premium subsidies and medical cost-sharing reductions for individuals & families with qualifying income levels
• Assistance personnel known as “navigators” to answer questions about the exchange as well as the insurance enrollment process
• Online enrollment forms for health insurance plans (applications can also be submitted by mail or in person with the help of a navigator)
• Eligibility information regarding Medicaid and the Children’s Health Insurance Program (CHIP)

Because plans from many different insurers can be reviewed at once, the exchanges are intended to promote price competition.

The earliest a person can begin coverage for a new Affordable Care Act health plan is January 1, 2014. People needing coverage for the remainder of 2013 may want to investigate the possibility of short-term health insurance.

Health Insurance Options Available On an Exchange

Not every health insurance plan will be available on an exchange. Some exchanges (e.g. New Hampshire and Connecticut) will have very limited health insurance options. Other exchanges (e.g. Oregon) will have many options.

Some health plans will only be available outside the exchange. These are known as “off exchange” health plans. Depending on the state, some off-exchange plans will have more competitive premiums than the health plans available on the exchange. However, people eligible for subsidies can only receive premium subsidies for a health plan sold on an exchange.

Exchange Administration

27 states will have a health insurance exchange run by the federal government (e.g. Texas). 17 states will have a health insurance exchange run by the state government (e.g. California). 7 states will have a health insurance exchange run by a partnership between the federal and state government (e.g. Illinois).

Premium Subsidies & Cost Sharing Reductions

As mentioned earlier, premium subsidies can only be obtained on an exchange. Personal information such as employer and income information, social security number, address, marital status, and dependents will be required by the exchange in order to determine if you are eligible for a premium subsidy or a reduction in the out-of-pocket costs you pay for covered medical services.