Health Insurance Exchanges


 

Individuals and small businesses now have access to reduced-cost coverage from private insurers through the marketplace.

Created by the Affordable Care Act, health insurance exchanges or marketplaces operate in each state to provide comprehensive coverage to the uninsured.

 

 

How the Marketplace Works

Plans are sold by private insurers who have designed products to fit exchange requirements. Also considered the “retail market” of insurance, you can shop for a plan online, buy coverage and pay premiums according to what you can afford.

 

Find Individual + Family Plans

Like other individual health plans, marketplace plans are sold for a monthly rate, called a premium, and include various cost sharing methods. This means when you receive care, you’ll pay a copayment — a fixed rate, coinsurance — a percentage of the bill, or a deductible — the full cost of the service until you reach a certain amount.

 

Cover Your Workers

The Small Business Health Options Program, or SHOP exchange, connects employers with less than 50 employees. Small businesses are not required by federal law to offer coverage to their full-time workers, however, this option allows employers to choose plans with a potential price break.

 

Like individual exchange plans, policies on the SHOP Marketplace can be compared on an apples-to-apples basis between companies. Some employers may also qualify for a Small Business Health Care Tax Credit, which could cover up to 50 percent of premiums depending on number of employees and their incomes.

 

Get Help Paying For Coverage

One difference between traditional plans and the marketplace is the ability to reduce your premium costs and out-of-pocket expenses through subsidies.

 

If you qualify for a tax credit, you pay less each month to stay insured. Subsidies are given to low-to-moderate income individuals in order to help them pay for care and coverage.

 

Shop Online

While the ability to shop online for health insurance and compare plans predates the exchange, many individuals may not have utilized this option, or were ineligible. Websites selling exchange plans allow anyone with internet access to view their health insurance options and discounts conveniently.

 

To accommodate those who aren’t web-savvy, public health centers and other community organizations may staff “navigators”. Navigators can guide you through the exchange’s website, their health plan options and how to apply for tax credits, but are not insurance agents and therefore cannot help you choose a plan.

 

 

Health Plan Ingredients

 

Essential Health Benefits

Individual Marketplace Health Plans

Insurers participating in the exchange must cover a set of ten essential health benefits. Therefore, no matter which insurer or coverage level you choose, similar types of benefits are covered in every plan.

  • Office visits
  • Emergency care
  • Hospitalization
  • Laboratory testing
  • Maternity and newborn care
  • Mental health and substance abuse care, including behavioral health care
  • Rehabilitative and habilitative devices and services (help recovering from injury, chronic illness or disability)
  • Pediatric services
  • Prescription drugs
  • Prevention, wellness and disease management

 

Coverage Levels

Each insurer offers the four tiers of coverage required by the exchange. This allows you to choose how much you pay each month for coverage and how much you pay for medical care after your deductible is met.

 

An additional coverage type is available for healthy young adults under age 30 who don’t require much medical care. Catastrophic plans help individuals avoid the penalty for being uninsured while costing little and providing coverage for four office visits, preventive care and emergencies.

 

When + How to Apply

October 1, 2013 marked the beginning of open enrollment for exchanges in all 50 states, giving access to guaranteed issue health insurance for the following year. Open enrollment dates vary each year, and are the only time you can apply for a plan on the exchange.

 

Find coverage in your area by calling 888 803 5917 and speaking with a licensed agent. You can also view estimates of your premium and subsidy in our States section by selecting your state.