FAQ • Intermountain Agency, Inc.
Q&A on Exchanges
Health insurance exchanges will change the way people buy coverage. Nearly 49 million people are uninsured in the United States, but the numbers vary dramatically by state.
Some questions and answers on how the exchanges will work:
Q: What's a health insurance exchange?
A: "Exchange" is just another word for "marketplace." We are heading into the 2023 enrollment period. Each state will have its own exchange serving people who buy their health insurance directly, as well as a separate one for small businesses. The vast of majority of people now covered by employer plans will not see a change.
There will be three types of exchanges at the beginning: those run by states, those run by the federal government, and partnerships. Most Republican governors opposed to "ObamaCare" are letting Washington run the exchanges in their states. For consumers, the benefits should be the same no matter who runs the exchange.
Q: How will exchanges work?
A: Exchanges are supposed to have the feel of an online travel site — think Orbitz or Expedia. Open Enrollment is October 15, 2022 through December 15, 2022 after which only people with a Special Enrollment Period will be able to select a Medical Insurance Plan.
Middle-class people will be able to pick from a range of private insurance plans, and most people will be eligible for help from the government to pay their premiums.
Low-income people will be steered to safety-net programs for which they might qualify. This could be a problem in states that choose not to expand their Medicaid programs under a separate part of the health care law. In that case, many low-income residents in those states would remain uninsured.
Q: What is a Special Enrollment Period?
A: Special Enrollment Period (SEP) is a determination that will give you an opportunity to enroll in a Medical plan outside of the Open Enrollment Period. The following is a few examples of Special Enrollment Period. A SEP allows the Individual 60 days to make a choice regarding coverage.
- Moving in or out of a State
- Losing Group coverage
- Losing Medicaid
- Adding a Child
- Adoption
- A Death
Q: How will I know if I can get help with my health insurance premiums?
A: You will disclose your income to Your Health Idaho at the time you apply for coverage. Health and Welfare will make the determination regarding if and what the recipient will receive as a Tax Credit. Only legal residents of the United States can get financial assistance.
The health care law offers sliding-scale subsidies based on income for individuals and families making up to four times the federal poverty level, about $54,360 for singles, $111,000 for a family of four on the high end. But do yourself a favor and read the fine print because the government's help is vastly reduced as household income increases.
Q: What will the benefits look like?
All plans in the exchange will have to cover a standard set of "essential health benefits," including hospitalization, doctor visits, prescriptions, emergency room treatment, maternal and newborn care, and prevention. Insurers cannot turn away the sick or charge them more. Middle-aged and older adults can't be charged more than three times what young people pay. Insurers can impose penalties on smokers.
Because the benefits will be similar, the biggest difference among plans will be something called "actuarial value." A new term for consumers, it's the share of expected health care costs that the plan will cover.
There will be four levels of coverage, from "bronze," which will cover 60 percent of expected costs, to "gold," which will cover 80 percent. Bronze plans will charge the lowest premiums, but they'll have the highest annual deductibles. Platinum plans will have the highest premiums and the lowest out-of-pocket cost sharing.
Here's a wrinkle: The government's subsidy will be tied to the premium for the second-lowest-cost plan at the silver coverage level that's available in your area. You could take it and buy a lower cost bronze plan, saving money on premiums. But you'd have to be prepared for the higher annual deductible and copayments.
Q: Where can I go to find IRS resources related to Tax Reporting and the ACA?
A: Here are some helpful links to IRS resources:
http://www.irs.gov/Affordable-Care-Act/Employers
Online:
Your Health Idaho: www.yourhealthidaho.org
Federal government health care site: www.healthcare.gov
