HEALTH INSURANCE MARKETPLACE/EXCHANGE

The Health Insurance Marketplace, or Exchange is a new feature of the Affordable Care Act and allows individuals who do not receive health insurance through their employer and do not qualify for public health insurance to shop for coverage and find a plan that fits their needs. Since marketplaces are new and consumers will likely have many questions regarding them, we feel this topic deserves it's own discussion.

What is the Health Insurance Marketplace/Exchange?

The health insurance marketplace, also known as exchange, was established to serve as an online marketplace for the uninsured and those currently purchasing individual health insurance plans to make it easier for them to comply with the Affordable Care Act's individual mandate. It is a place where individuals can go to find available health insurance plans in their area, compare benefits, and purchase coverage. Some small businesses can utilize the marketplace as well. The marketplaces are state-based, although some states have opted out of operating their own exchange and have left that task to the federal government. Marketplaces are open to everybody; however, those who receive coverage through their employer or through public health insurance like Medicare and Medicaid generally won't have a need for the marketplace. The marketplaces opened on October 1, 2013 and are generally being run under one of three scenarios: operated by the state, operated through a state and federal partnership, or operated solely by the federal government. To find out the status of the marketplace in your state, click here. You can find the marketplace in your state by visiting Healthcare.gov or by calling 1-800-318-2596.

Overview of the Marketplace

The ability to use the marketplace is restricted to U.S. citizens and legal residents who are not incarcerated. Some small businesses can also utilize the marketplace to offer their employees coverage as we've mentioned above. The marketplace works in conjunction with other Affordable Care Act provisions including the individual mandate, premium credits and cost-sharing subsidies, guaranteed issue, and essential health benefits. To briefly sum it all up, the individual mandate requires everybody to obtain health insurance coverage while premium credits and cost-sharing subsidies are available to help pay for coverage for those who fall within certain income limits. All health insurance plans offered in the marketplace meet set minimum standards of coverage and offer ten essential health benefits, and guaranteed issue requires insurers to offer those plans to everybody regardless of any pre-existing conditions. In general, individuals will only be able to purchase health insurance in the marketplace during open enrollment periods with few exceptions such as losing a job, getting married, or having a child. The limited open enrollment period discourages individuals from simply waiting until they get sick to seek coverage. The very first open enrollment period runs from October 1, 2013 to March 31, 2014, and all subsequent open enrollment periods will begin on October 15 and end on December 7. If you're seeking coverage and are unsure whether or not you qualify for Medicaid coverage in your state, the marketplace will tell you during the enrollment process.

Health Insurance Benefit Tiers

The plans offered in the exchange fall into one of four benefit categories or into a seperate catastrophic category. These benefit tiers are as follows:

• Bronze plans represent minimum qualifying coverage and provide essential health benefits, cover at least 60% of the plan's benefit costs, and have an out-of-pocket limit equal to the current Health Savings Account (HSA) limit, which was $5,950 for individuals and $11,900 for families in 2010.
• Silver plans provide essential health benefits, cover at least 70% of the plan's benefit costs, and have the same HSA out-of-pocket limits.
• Gold plans provide essential health benefits, cover at least 80% of the plan's benefit costs, and have the same HSA out-of-pocket limits.
• Platinum plans provide essential health benefits, cover at least 90% of the plan's benefit costs, and have the same HSA out-of-pocket limits.
• Catastrophic plans are only available to individuals under age 30 or those who are exempt from the individual mandate. These plans provide catastrophic coverage with deductibles set at the current HSA limits, but preventive services and coverage for three primary care visits per year are exempt from the deductible. These plans are only available in the individual market.

Choosing the right benefit tier for you will depend on your circumstances, and we suggest you peruse our health insurance section to learn more about picking the right plan for you. Health insurance carriers have the option to participate in the marketplace or not, so not all carriers may be available in your state.

Essential QSA Knowledge

The health insurance marketplace, also referred to as exchange, was developed as part of the Affordable Care Act and is meant to serve as a tool for individuals to obtain qualified health insurance coverage and comply with the individual mandate. The marketplace is meant to work in harmony with other provisions of Obamacare for the benefit of patients. The Healthcare Whiz health insurance section is a great resource for information on choosing the right insurance plan for you.

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