One of the Affordable Care Act’s two primary avenues for increasing insurance coverage involves the expansion of public insurance programs: increasing the coverage of Medicare, and increasing the eligibility of the Medicaid program. The other is the creation of state-based ‘insurance exchanges’: regulated, virtual marketplaces, administered by either federal or state government, where individuals and small business without insurance can purchase private insurance plans starting January 2014.
The Insurance Exchanges are primarily intended for:
- People who do not have insurance
- People who are not insured by their employer (Companies with less than 50 employees are exempt from penalties if they do not offer health insurance to employees)
- People with pre-existing conditions who may have had trouble getting insurance
- Small businesses
The exchanges will be websites that offer private insurance plans. You will be able to visit these websites or ring a call center, compare the plans offered, fill out a form to the government that will determine your eligibility for subsidies, and then purchase the insurance of your choice from the options available during limited open enrollment periods. The first open enrollment period will last from October 1, 2013, through to March 31, 2014, after which time uninsured individuals generally may not purchase insurance through an exchange until the following open enrollment period. In subsequent years, the open enrollment period will start on October 1 and end on December 7.
Benefits to Health Insurance Exchanges:
- Accessibility. You cannot be declined coverage. This means the policy is guaranteed issue and there will be no medical underwriting. So as long as you apply during the open enrollment, you will have the option to take out a health insurance policy.
- No pre-existing condition exclusion or waiting period. If you have a health condition that needs attention, that medical attention can start immediately.
- Advanced tax credits/subsidies. If your household income is under the 400% Federal Poverty Level, then you could be eligible for subsidies.
Whether you or someone you know is uninsured or been denied coverage in the past, the Health Insurance Exchanges will give more choice and control over health coverage. The Exchanges will operate in all states. In the Exchanges, insurance options can be compared based on price, benefits, quality, and other features important to you.
Insurance companies can offer four types of plans on the Exchange: bronze, silver, gold, and platinum. These “metal level” plans all cover the same benefits in Indiana. What differs is how much insurance providers pay on average toward the costs of the services the plan covers. Here’s how it works:
- Bronze Plan: You pay 40% and the plan pays 60%.
- Silver Plan: You pay 30% and the plan pays 70%.
- Gold Plan: You pay 20% and the plan pays 80%.
- Platinum Plan: You pay 10% and the plan pays 90%.
In Indiana, the federal government will operate the health insurance exchange. Companies may offer multiple plans within the same metal level. The plans and premiums would vary based on the deductible amount, co-payments, co-insurance, and other factors. The federal government’s health exchange will offer 34 different plans to consumers.
Catastrophic plans may be available, especially for people who are under 30 and healthy. These plans cost less up front, but they do not provide as much coverage. The plans generally require you to pay more out-of-pocket costs.
You must have at least a bronze-level plan to meet minimum requirements under the Affordable Care Act and avoid the penalty for not having health insurance.
The Affordable Care Act carries complex penalties for those who remain uninsured.
- In 2014, the flat fee is $95 per adult and $47.50 per child, up to $285 per family; or the penalty could be 1% of family income, if that results in a larger fine.
- In 2015, the flat fee is $325 per adult and $162.50 per child or 2.0% of family income, whichever is greater.
- By 2016, the flat fees grow to $695 per adult and $347.50 per child or 2.5% of family income, whichever is greater.
There are many options to get more information about the Affordable Care Act including www.healthcare.gov and www.whitehouse.gov/healthreform. The Kaiser Foundation can also give you more specific guidance if you have more questions.
US Dept. of Health and Human Services – http://www.hhs.gov/healthcare/facts/bystate/in.html
Obamacare facts – http://obamacarefacts.com/obamacare-health-insurance-exchange.php
Kaiser Foundation – http://kff.org/state-category/health-reform/health-insurance-exchanges/