health insurance exchanges

• Health Insurance Exchanges

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Health care reform - United States

1 The law includes health-related provisions to take effect over the next four years, including expanding Medicaid eligibility for people making up to 133% of the federal

poverty level (FPL), subsidizing insurance premiums for people making up to 400% of the FPL ($88,000 for

family of 4 in 2010) so their maximum out-of-pocket payment for annual premiums will be from 2% to 9.5%

of income, providing incentives for businesses to provide health care benefits, prohibiting denial of

coverage and denial of claims based on pre-existing conditions, establishing health insurance exchanges,

prohibiting insurers from establishing annual coverage caps, and support for medical research


Affordable Care Act - Overview of provisions

1 * #Insurance exchanges and the individual mandate|Health insurance exchanges will commence operation

in every state


Affordable Care Act - Change in number of uninsured

1 Starting January 1, 2014, state health insurance exchanges will be required to offer a child-only coverage option, and Medicaid eligibility will be made

available to 16 million individuals with incomes below 133% of the

federal poverty level.


Affordable Care Act - Insurance exchanges and the individual mandate

1 The Act establishes state-based health insurance exchanges. The exchanges are

regulated, online marketplaces, administered by either federal or state government, where

individuals and small business can purchase private insurance plans starting October 1,

2013, with coverage beginning January 1, 2014. Individuals with incomes between 100% and

400% of the federal poverty level who purchase insurance plans via an exchange will be eligible

to receive federal subsidies to help pay premium costs.


Health insurance in the United States - Reform

1 The Affordable Care Act of 2010 was designed primarily to extend health

coverage to those without it by expanding Medicaid, creating

financial incentives for employers to offer coverage, and requiring those

without employer or public coverage to purchase insurance in newly

created state-run health insurance exchanges


Health insurance exchange - Background

1 Health insurance exchanges in the United States are intended to help

insurers comply with consumer protection laws, compete in cost-

efficient ways, and expand insurance coverage to more people


Health insurance exchange - History

1 The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010.

The law required that health insurance exchanges commence operation in every state

on October 1, 2013. In the first year of operation, annual enrollment|open enrollment

on the exchanges runs from October 1, 2013, to March 31, 2014, and insurance plans purchased

by December 15, 2013, began coverage on January 1, 2014. For 2015 open enrollment will begin November 15, 2014 and end on January

15, 2015.


Health insurance exchange - Subsidies

1 Department of Health and Human Services (HHS) and Internal Revenue Service (IRS) on

May 23, 2012, issued joint final rules regarding implementation of the new state-based health

insurance exchanges to cover how the exchanges will determine eligibility for

uninsured individuals and employees of small businesses seeking to buy insurance on the

exchanges, as well as how the exchanges will handle eligibility determinations for low-income

individuals applying for newly expanded Medicaid benefits


Health insurance exchange - First week of operation

1 On the date the Patient Protection and Affordable Care Act of 2010 was enacted, only a few health insurance exchanges across the country were

up and running


Patient Protection and Affordable Care Act - Overview of provisions

1 * #Insurance exchanges and the individual mandate|Health insurance exchanges operate as a new avenue

by which individuals and small businesses in every state can

compare policies and buy insurance (with a government subsidy if

eligible)


Health care in the United States - Reform

1 The law includes a large number of Provisions of the Patient Protection and Affordable Care Act|health-related

provisions to take effect over the next four years, including expanding Medicaid eligibility for people making

up to 133% of federal poverty level|FPL, subsidizing insurance premiums for peoples making up to 400% of

federal poverty level|FPL ($88,000 for family of 4) so their maximum out-of-pocket pay will be from 2% to 9.8% of

income for annual premium, providing incentives for businesses to provide health care benefits, prohibiting denial of coverage and denial of claims based on pre-

existing conditions, establishing health insurance exchanges, prohibiting insurers from establishing annual

spending caps and support for medical research


United States federal government shutdown of 2013

1 The health insurance marketplace|health insurance exchanges created by the Affordable Care Act launched

as scheduled on October 1


United States federal government shutdown of 2013 - End of shutdown and temporary debt limit suspension

1 Despite Republican efforts to strip the Affordable Care Act of funding or

delay the law as part of a deal to reopen the government, the Senate

plan's only concession to the Republican leadership on the issue

was stricter income verification rules for citizens accessing the health

insurance exchanges


President Obama - Health care reform

1 The Patient Protection and Affordable Care Act|ACA includes Provisions of the Patient Protection and

Affordable Care Act|health-related provisions to take effect over four years, including expanding Medicaid eligibility

for people making up to 133% of the federal poverty level (FPL) starting in 2014, subsidizing insurance premiums for people making up to 400% of the FPL ($88,000 for family of four in 2010) so their maximum out-of-pocket payment

for annual premiums will be from 2 to 9.5% of income, providing incentives for businesses to provide health care

benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, establishing

health insurance exchanges, prohibiting annual coverage caps, and support for medical research


Military Health System - Coverage gaps

1 Another 40.1% of veterans and 49% of their families have incomes that qualify for new subsidies through

health insurance exchanges with the PPACA


Medicaid expansion - Overview of provisions

1 * #Insurance exchanges and the individual mandate|Health insurance exchanges operate as a new avenue

by which individuals and small businesses in every state can

compare policies and buy insurance (with a government subsidy if

eligible)


Medicaid expansion - Change in number of uninsured

1 Multiple 2014 studies and surveys indicated that the number of uninsured had fallen due to

expanded Medicaid eligibility and health insurance exchanges

established due to PPACA


Access Health CT - Background

1 Health insurance exchanges were established as a part of the 2010 Patient Protection and Affordable Care Act to enable individuals to

purchase health insurance in state-run marketplaces. In this legislation, states could choose to establish their own health insurance exchanges; if

they choose not to do so, the federal government would run one for the

state. https://store.theartofservice.com/the-health-insurance-exchanges-toolkit.html

HealthSource RI - Background

1 Health insurance exchanges were established as a part of the 2010 Patient Protection and Affordable Care Act to enable individuals and

businesses to purchase health insurance in state-run marketplaces. Under this legislation, states could

choose to establish their own health insurance exchanges; if they chose

not to do so, the federal government runs one for the state.


Health insurance coverage in the United States

1 Multiple surveys indicate the number of uninsured has fallen due to

expanded Medicaid eligibility and health insurance exchanges

established due to the Patient Protection and Affordable Care Act, also known as PPACA or Obamacare


Health insurance coverage in the United States - Estimates of the number uninsured

1 Gallup estimated in July 2014 that the uninsured rate for adults (persons 18 years of age and over) was 13.4% as of Q2 2014, down from

18.0% in Q3 2013 when the health insurance exchanges created under the Patient Protection and Affordable Care Act (PPACA or Obamacare)

first opened. The uninsured rate fell across nearly all demographic

groups.[http://www.gallup.com/poll/172403/uninsured-rate-sinks-second-quarter.aspx In U.S.,

Uninsured Rate Sinks to 13.4% in Second Quarter-July 10, 2014]


DC Health Link

1 As of January 10, 2014, DC Health Link had enrolled 3,646 people in

individual or family insurance plans. The District has had more success than the states' health insurance exchanges in signing up young

people. Many members of Congress are enrolled in DC Health Link.


Public health insurance option - History

1 and the public option was never included in the final Senate bill, instead opting for state-directed

Health insurance marketplace#Health insurance

exchanges in the Patient Protection and Affordable Care Act .28ACA.29|

health insurance exchanges.Bankrate:

[http://www.bankrate.com/finance/insurance/key-details-of-health-reform-

bills-1.aspx Key details of health reform bills]


Public health insurance option - Alternative plans

1 The final bill, the Patient Protection and Affordable Care Act, included provisions to open

health insurance exchanges in each state by October 1, 2013. As the Act requires Americans

to purchase health insurance, the federal government will offer subsidies to Americans

with income levels up to four times the federal poverty level.CNN:

[http://money.cnn.com/2013/06/21/news/economy/obamacare-outreach/index.html The

marketing of Obamacare exchanges begins.] June 21, 2013.


Romneycare

1 As such it is one of the models of the Affordable Care Act's health insurance

exchanges


Provisions of the Patient Protection and Affordable Care Act - Effective October 1, 2013

1 Open enrollment through the health insurance exchanges ends on March 31, 2014, after which time uninsured

individuals generally may not purchase insurance through an

exchange until the following open enrollment period


Provisions of the Patient Protection and Affordable Care Act - Effective January 1, 2014

1 Department of Health and Human Services (HHS) and Internal Revenue Service (IRS) on

May 23, 2012, issued joint final rules regarding implementation of the new state-based health

insurance exchanges to cover how the exchanges will determine eligibility for

uninsured individuals and employees of small businesses seeking to buy insurance on the

exchanges, as well as how the exchanges will handle eligibility determinations for low-income

individuals applying for newly expanded Medicaid benefits



1 * Two federally regulated multi-state plans (MSP)—one of which must be offered by a non-profit insurer, and

the other cannot cover abortion services—become available in a

majority of state health insurance exchanges



1 * The two federally regulated multi-state plans (MSPs) that began being phased into state health insurance

exchanges on January 1, 2014, become available in every state.


Annual enrollment

1 The term also applies to the annual period during which individuals may buy individual health insurance plans

through the online, state-based health insurance exchanges

established by the Patient Protection and Affordable Care Act


Health care reform debate in the United States - Similarities between the House and Senate Bills

1 * Establish health insurance exchanges making easier price and

coverage comparisons and purchasing for people and small businesses buying health care

coverage


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