ObamaCare | Health Insurance Exchange

What is the ObamaCare Health Insurance Exchange (HIX)?

The ObamaCare Health Insurance Exchange (HIX) opens Oct 1st, 2013. The ObamaCare health insurance exchanges, or ObamaCare exchanges, are State or Federal run online marketplaces. Americans can use the "Affordable" Insurance Exchange exchange to buy health insurance from private health care providers. Shoppers can use a price calculator to find the best deal for them and their family. The health insurance exchange is estimated to provide up to 23 million people with affordable health insurance.

A State Health Insurance Exchange vs Federal Health insurance Exchange

"ObamaCare's" State Health Insurance Exchanges: States can build a health insurance exchange (HIX) on their own, partner with one or more other states, or have the federal government build and run the insurance exchange for them.

Understanding the Exchange Semantics: The HIX, ObamaCare Exchanges, Health Benefit Exchanges, Health Insurance Marketplace, Health Insurance Exchanges and Affordable Insurance Exchanges are all the same thing. There is no official term yet. Just like ObamaCare is also called health care reform, the Affordable Care Act or ACA, etc.

ObamaCare Exchanges: State Insurance Exchange Time Line

The states had until November 16th to submit a declaration letter of how they will handle their state health insurance exchange.

States who were going to run their own "ObamaCare" exchanges had until December 14th 2012 to submit an initial Blueprint application. The HHS approved the states exchange on Jan 1st, 2013.

The final deadline for both the Declaration Letter and Blueprint Application for State Partnership Exchanges was extended to Friday, February 15, 2013. The states can apply for funds from the federal government for assistance with the exchange. Get the Update on Your States State Health Insurance Exchange

How Will The ObamaCare State Run Health Insurance Exchanges and Federal Run Exchanges Work?

The ObamaCare health insurance exchanges allow all Americans above the poverty line to be able to buy health insurance through providers (who meet the standards of ObamaCare) via an online market place (similar to how buying online car insurance works now).

Each health care provider will try to attract customers by providing affordable quality health care packages.

You will be able to compare coverage options using an online calculator to figure out which plan is right for you.

The Department of Health and Human Services (HHS) administers the requirements for the Exchanges and the health plans they offer.

Watch Movie Videos on the Health Insurance Marketplace

What Type of Plans Are Available on the ObamaCare Exchange?: Bronze, Silver, Gold and Platinum

There are three tiers of plans you or your employer can purchase on the exchange they range from lower quality, but more affordable "Bronze plans", to "Silver plans" to a more expensive plan with better coverage called a "Gold plan". There is also a "Platinum plan" which is the highest quality and cost plan. Lower premium plans will have higher deductibles.

Minimum Benefits Required by ObamaCare for Plans Sold on the Exchange

All plans sold on, and off the ObamaCare Health Insurance Exchange, must include:

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

Learn more about health insurance regulations on our ObamaCare health insurance rules page

Affordable Insurance Exchange: How Much Does the Health Insurance Exchange Cost?

The cost of your health care on the online Health Insurance Exchange depends on many factors. The primary factors are income and what type of plan you want to purchase. Plans range from basic with minimal coverage to all encompassing high-end plans. (ObamaCare has raised the standards of health care, so all plans have the new basic benefits laid out by ObamaCare).

Even though we don't know the exact cost of insurance bought through the health insurance exchanges, the ObamaCare exchanges should lower the cost of health insurance premiums by 7% to 10%. The following factors are projected to decrease the cost of premiums:

• Increased competition among private insurance plans via comparative shopping and consumer information available on the exchanges.
• Small businesses get same purchasing power on the Health Insurance Exchanges as large businesses.
• Administrative costs are streamlined by standardizing forms and reducing the amount of paperwork doctors have to do.
• Insurance companies can't discriminating against Americans with pre-existing conditions. This provision will force insurance companies to provide high-quality benefits at more competitive prices.

Currently the average American pays about 20% of their income for health insurance. Based off of what we know so far the exchanges "Bronze plans" and "Sliver plans" are capped at 9.5% of your income for 300 - 400% FLP. It's a sliding scale so those under will pay less. "Gold plans" and "Platinum plans" can cost no more than 12% of income. Although high end plans may be subject to a 40% excise tax depending on cost. Depending on your income you may pay only a percentage of the total cost.

The ObamaCare Health Insurance Exchanges are affordable insurance exchanges run by the state or federal government. Using the ObamaCare exchanges low to middle income individuals, employers and congress can buy affordable health insurance using a wide range of customer assistance tools.

Health Insurance Marketplace Tax Credits For Families and Small Businesses

After enrolling on the Health Insurance Marketplace you will be able to apply for tax credits on your Health Insurance Marketplace application in order to help lower your monthly payments. Tax credits work in the form of advanced payments applied to your monthly premium and are sent directly to your insurance company.

• Health Insurance tax credit eligibility depend on family size and income.
• Small businesses will be able to apply for tax credits to cover up to 50% of premium costs of low to moderate wage employees.

Tools Used For Shopping on the Affordable Insurance Exchange

In the past individuals and small businesses have paid higher premiums than larger firms since they lack the ability to pool risk and purchasing power. The Affordable Insurance Exchange provides consumers with a number of customer assistance tools for shopping on the exchange. Tools to access affordability and quality include comparisons of prices, quality, and physicians and hospital networks.

Who Participates in the State Run Health Insurance Exchange

The ObamaCare health insurance exchanges are meant to offer affordable, quality health insurance to small employers and people purchasing their own health coverage. These groups have historically had trouble obtaining affordable healthcare plans that meet the current standards of health care under ObamaCare, the online marketplace is meant to remedy this.

Although, the Health Insurance Exchanges are available to everyone, those who have other options that meet the standards of ObamaCare will not receive financial help. This includes those who make over 400% of the poverty level.

Workers who already have health insurance through an employer can use the Health Insurance Exchanges. However, they may not be eligible for premium tax credits or cost-sharing reductions, unless their employer-based coverage is inadequate or unaffordable.

Using the ObamaCare Health Insurance Exchange As an Employer

To start employers with less than 100 full-time employees can use the exchanges to purchase affordable health coverage for their workers. The employer side of the exchange is called a SHOP. Learn more about Small Business Health Exchange SHOPs

Who Can't Participate in the HIX Health Insurance Exchange

• Anyone who doesn't qualify for Medicaid (under the new ObamaCare Medicaid expansion). This includes people under 133% poverty line. This will help to make healthcare more affordable as everyone will be pitching in a more equal share.

• People who choose to stay on their existing insurance either through a private insurer or through their workplace. NOTE: If your coverage at work costs you more than 9.5 percent of your income, or if your employer's plan does not meet the law's minimum standards.
• People who chose to pay the tax instead of purchasing health insurance
• Other exceptions apply such as being in the country illegally or being incarcerated.
• Although anyone can use the HIX not everyone will receive discounts. By 2017 large employers will be able to use the online insurance exchange to buy insurance for their employees as well.

When Does Coverage Begin for Insurance Purchased Through the Online Marketplace?

The ObamaCare state-based health insurance marketplaces open October 1, 2013, although you can buy coverage starting on Oct 1st the coverage doesn't kick in until January 1, 2014.

Do I Qualify for Discounts via the ObamaCare Health Insurance Exchanges?

Part of the Affordable Care Act (ObamaCare) is focused on providing "affordable" health care. This means that those who can pay more do, but most of us will qualify for discounts to help pay for health insurance premiums. While most Americans will pay less, some will not. However the Affordable Health Care Act doesn't promise, "cheaper insurance for everyone". It promises "Affordable, quality health care for everyone".

If you make between $11,505 to $46,021 you can buy subsidized private insurance in the state-based online marketplaces. If you make less than $15,302 you may qualify for Medicaid.

You may qualify for discounts to help pay for premiums if your income is from $15,302 to $46,021 for an individual and $31,155 to $93,700 for a family of four.

You can also find out if you qualify for extra subsidies to help with out-of-pocket costs or for government programs such as Medicare, Medicaid and the Children's Health Insurance Plan.

How Do I Buy Insurance Through the ObamaCare Exchange Online Marketplace?

If your states offers access to the ObamaCare exchanges buying insurance through the Online Marketplaces is easy. It's very similar to buying car insurance online.

You go to the website, Fill out a simple application to see if you qualify for discounts or other coverage such as Medicaid or Medicare. (it's a simple form that you can update with any changes such as an income or job change throughout the year). You will then be able to use the Online Marketplace to compare different coverage options from health care providers that meet the requirements laid out in ObamaCare.

The ObamaCare exchanges are as simple as that. Keep in mind that any insurance bought on the exchange won't begin until January 1st, 2014.

NOTE: Discounts are offered in the form of tax credits, subsidies or even help with out of pocket costs.

Resources: Health Insurance Exchange images from news.xerox.com and statehealthfacts.kff.org

ObamaCare Health Insurance Exchange 2014

Now that you understand the ObamaCare Health Insurance Exchanges (HIX) a little better you are ready to go to the online marketplace and start shopping for private insurance on Oct 1st, 2013. Depending on the state you live in you will either use a state run Health Insurance Exchange or a federal run Health Insurance exchange. Remember the insurance you purchase on the ObamaCare Health Insurance Exchange Online Marketplace won't kick in until 2014.