Health Care Reform
As of January 1, 2014, the Affordable Care Act (ACA) requires every state to create (or provide access to the Federal) Health Insurance Exchanges for businesses, employees and individuals.
A health insurance exchange is an insurer’s, broker’s, or government’s insurance offering to individuals and/or employees; a place for businesses and individuals to shop for insurance.
THE AFFORDABLE CARE ACT IDENTIFIES FOUR CATEGORIES FOR CONSIDERATION
1. Employers with more than 50 employees
2. Employers with less than 50 employees
3. Individuals with income of more than $94,000 per year (family of four)
4. Individuals with income of less than $94,000 per year (family of four)
5. Individuals under $46,000 with no dependents
WHAT IS UNIQUE ABOUT HEALTH INSURANCE EXCHANGES?
A health insurance exchange may offer unique or “special” services to the businesses, employees or individuals participating in the exchange. These unique offerings might include:
- Exclusive products
- Special rates
- Tax advantages, etc.
- Easy way to shop for options
A HEALTH EXCHANGE HAS SPECIFIC ELIGIBILITY RULES
- An individual’s household income
- An individual’s employer
- A business’ size (i.e. number of employees)
- A business’ ability to meet minimum employer contribution requirements
- A business’ ability to meet minimum employee participation requirements, etc
- Is the health insurance exchange Public or Private? A public health insurance exchange is a health insurance exchange managed by a state or federal government (or government-contracted) entity. A private health insurance exchange is a health insurance exchange managed by a private company.
- Is the exchange group or individual based? The ACA requires states to create both a Group Market (Small Business) Health Insurance Exchange (SHOP) and an Individual Market Health Insurance Exchange (American Heath Benefit Exchange) in 2014. Group Market Health Insurance Exchange – An exchange that sells “group” health insurance to employees of employers. Individual Market Health Insurance Exchange – An exchange that sells “individual” health insurance to individuals and families (that may be employees) in the individual health insurance market.
- Who is eligible to participate with a subsidy?
- What products are available in the health insurance exchange?
- A health insurance exchange may offer a variety of insurance products from a variety of insurance providers. There is no minimum or maximum requirement. For example, a health insurance exchange might offer
- Different Medical Plans from Multiple Carriers, and/or
- Different Medical Plan Designs from a Single Carrier.
- Both the SHOP Exchange and the American Health Benefit Exchange will provide multiple major medical carriers with multiple plan design options.
Dates to Remember
January 1, 2015 “Employer Mandate” effective (originally January 1, 2014)
October 15 – December 7, 2015 Annual open enrollment period for marketplaces