The Basics Of Health Insurance Exchanges.
As part of the Affordable Care Act (ACA or health care reform law), starting in 2014
all Americans must have a minimum amount of health insurance or be taxed by the
government. The law also requires each state to have a health insurance exchange
where people can buy health insurance coverage. People who don’t get health
insurance at work, or can’t afford it, may be able to get it through an exchange. The
exchanges do not replace buying health insurance privately. They are simply a new
place to shop and buy.
Exchange plans will be offered in a tiered format. The tiers are named
after metals: bronze, silver, gold, & platinum. Each tier will have
several plans to choose from and will include essential health benefits.
Bronze plans will have the lowest monthly premium, but cost shares will
be more when health care services are provided. Platinum plans will
have the highest monthly premium, but cost shares will be less.
All plans must include “essential health benefits” as defined by the
health care reform law. Specifically, the plans must include items and
services from at least these 10 categories of care:*
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral
health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care
Subsidies & Credits For Individuals:
Those who don’t have access to affordable, minimum essential health
coverage can buy a health plan from the exchange and get a credit or
subsidy if they meet income requirements. Credits and subsidies help
with the cost of premiums and out-of-pocket health care expenses.
Income requirements:
133% to 400% of federal poverty level
For an individual that equals $15,282 to $45,960 per year (in 2013).
For a family of four that equals $31,322 to $94,200 per year (in 2013).