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Subscribe to RSSHealth insurance exchanges will change the way people buy coverage and will help millions of uninsured people get a private plan. Nearly 49 million people are uninsured in the United States, but the numbers vary dramatically by state.
Exchanges will be the most visible part of President Barack Obama's health care overhaul law in everyday life. Open enrollment starts Oct. 1, less than 10 months away.
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." The plans sold in the new markets will start covering patients on Jan. 1, 2014. 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. 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: How will I know if I can get help with my health insurance premiums?
A: You'll disclose your income to the exchange at the time you apply for coverage and they'll let you know. 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 $44,700 for singles, $92,200 for a family of four. But do yourself a favor and read the fine print because the government's help gets skimpier as household income increases.
For example, a family of four headed by a 40-year-old making $35,000 will get a $10,742 tax credit toward an annual premium of $12,130. They'd have to pay $1,388, about 4 percent of their income, or about $115 a month. A similar hypothetical family making $90,000 will get a much smaller tax credit, $3,580, meaning they'd have to pay $8,550 of the same $12,130 policy. That works out to more than 9 percent of their income, or about $710 a month.
The estimates were made using the nonpartisan Kaiser Family Foundation's online calculator. Some people will also be eligible for help with their copayments.
Final note: Though it's called a "tax credit" the government assistance goes directly to the insurer. You won't see a check.
Q: What will the benefits look like?
A: The coverage will be more comprehensive than what's now typically available in the individual health insurance market, dominated by bare-bones plans. It will be more like what an established, successful small business offers its employees. Premiums are likely to be higher for some people, but government assistance should mostly compensate for that.
Related: Buying health insurance will never be the same
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 "platinum," which will cover 90 percent. "Silver" and "gold" are in between. 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.
Related stories:
- States get more time for health exchange plans
- Feds look set to run more state health insurance markets
- More Americans got health insurance in 2011
Leave a Comment:
Hah! And this will be enforced by an Administration that won't enforce immigration laws, or control our borders. Hah!
If you honestly think that the Obama administration will be sneaking in payments for illegal aliens your crazy.
The Obama administration is deporting illegals at an all-time record pace. Thank God we got the Republican infestation out of the White House.
I don't want more insurance. I want health care. The two are not the same.
It sounds like a major cluster Poop..why didnt they just put it into Medicare where there is a system already set up, From what I read about paying premiums is that it will hurt most families than not, milk or Heart Drugs The Big Goverment Sugar Daddy will take care of us...oh well lets see what we can do and maybe it will work but if not change it or get rid of it
Medicare does not have any type of premium payments like these set up. The Medicare premium for all people making below $170,000 is $104.90 a month and then it increases from there. Medicare does not have a system set up like the one in the article mentions that would need to involve number of people in the family, etc....
Though you are right the exchanges are a cluster F&$%. There are licensed insruance brokers in your area that can advise you of the available insurance plans, taking in to consideration your usage. IE: are you on a monthy prescription, how much do the different plans cover of that particular prescription, do you go the the doctor a lot, what types of dcotors, specialist vs. PCP since there is a cost difference related to each fo those, what are the finding options for your deductible, like can you have a HSA or HRA account to help you with a taxbreak when paying your $3,000 deductible, etc... etc..... Whereas the people working at the exchange do not have to be licensed at all! Meaning that guy was just working the MCDee's drive through yeaterday and today he is explaining insurance coverage options to you. Good luck with that!
Sounds too complicated. Single payer plan and better health care with integrative medicin.
what exactly would single payer solve?
The major problem is that prior to the 2010 election, members of the house and senate from both parties would get together to review and adjust the ACA as appropriate for the good of the citizens of the USA. After the 2010 elections and still today, too few congress-members care about the greater good; therefore, the citizenry is left with a law that is going into effect, but, in actuality, still needs some tweaks. God help us, cuz it doesn't have to be this way. Irregardless of whose name is attached to the ACA, it is a good start -- but to do the most good, it should not have been left as is.
Sizima,,you are correct, its a template of what hopefully can be carved into something better, it ,nor will any program be perfect, but the situation now of having health care coverage bolted firmly to employment is a cock of crap and has to end.
agreed that there will need to be a better option for individuals, but the fact that health care is "bolted" to employment can be helpful to the consumer. It's "buying power". When a company brings multiple people to the table for an insruance plan, that plan takes into account the average age and returns a premum payment for the group. It can work out in a consumers favor sometimes.
So will Is our illustrious senate and congress exempt?
How many others were issued exemptions so the could
push this through? This looks like another well thought out
feel good / shaft the people plan...........
The ruling party thinks it's so good but they are exempt again??
BTW, Why did the courts ruling on Obama's NLRB
crap get hidden away from the front end of this site?
NLRB was Friday's news, not today's.
So making sure people have healthcare is shafting the people? Sorry but what we had up until two years ago was insurance companies shafting the people this will give actual healthcare to people instead of denying everything.
Jessie, Your a dumba$$!!!
"How can I get "help" with my premiums?"
That's so cute. It means somebody will earn the money and the government will take it from them and use it to pay your bills. That's how. It's like all the other government giveaway programs.
taxed
"Thats so cute"?LMAO
So the $10K will be a tax credit coming in the form of a tax refund? How many of those folk will put that $10K aside for insurance. They will spend it on other things (like food) and they will have to come up with $1K per month.
nope, re-read the article, just under the section you pasted, it explains that consumers won't get a check, they just won't pay the full price, and the government will send the rest to pay the insurance to the company....
You mean like a government/corporate hand holding??
I just want a plan that will pay part of my bills from my doctor who treats me with homeopathic remedies. If it would just pay a portion of the office visit, I'd be happy. I rarely get sick. When I do, he makes a $20 remedy bottle that lasts several months and cures me within hours or a few days, at most.
This is medicine that really works! Unfortunately, none of my "comprehensive" health insurance covers it!
Go figure....
I'd be worried as to what was in the little bottle. The ACA will cover more types of care than current Insurance will so there is a chance that it will be covered. Well as long as he isn't a snake oil salesman.
If any of you think you're getting of this for "free" - think again. You'll be paying through the nose and it's only going to get more expensive.
Suck it up, tea baggers - you lost!
Soon the U.S. will have a national health care system like the rest of the developed world.
Unfortunately it wont. The ACA requires health insurance not health care and they are completely different things. An example:The MA connector has approved plans designed for the low wage retail sector that have many restrictions, high deductibles and co-pays. People with these plans are still unable to afford to use them to access healthcare but technically they are insured in the eyes of the state and the connector. That is one of the reasons why medical bankruptcy is still a problem in MA and why free clinics still exist and are extremely busy.
The insurance executives at the MA connector are really raking in money working as "consultants" in other states right now so what you see in MA is what you will get elsewhere. Of course MA is a benign environment as far as the insurance industry goes. Most of the local companies are technically non-profit. It will be interesting to see what happens once the large for profit vultures that help write the ACA get involved. I am sure MA will look great in comparison.
Here starts the illusion from Dumbama-care.
This definitely is not equal distribution and cost for all of American people. One set of folks will pay 4% of their income for this Dumbama garbage insurance, why the other part, more successful by the way and most likely working harder, pays about 9% for the same sh_t.
What gives?
Here we go again. That Muslim frigging president of ours redistributes the income of the harder working folks to those that don't have. If that is not Communism I don't know.
The insurance set up is not worth the powder to blow it away to begin with, but, why does not everybody pay the same percentage towards this crap without being discriminated against?
A fine half-breed president you idiots have voted into the White House. Wait two years and see what this sh_t health care really cost this country.
Sad, very sad.
Do you even know what communism is? Go back to school and learn you racist, right-wing pig!! Luckily most of you are dying off little by little. Communism means that everybody gets the same portion or ration of food, medicines, etc. You're contradicting yourself because you wrote that President Obama is taking much more from some to give more to others. At the same time you say that this is communism! How could it be communism if only some will reap the benefits of this law?
Shipwercked. There are lots of jobs that are very hard to do and they often pay less than jobs that are not as hard to do.
Plus you don't know squat about communism or the Presidents religion.
Keep calling Obama a Muslim, clown. It lost you two elections.
And you should keep NOT calling him a muslim. Right up until your new CORAN in delivered to your home for free!!! Read the Hitler history.
Another reason to raise your taxes because it not going to pay for itself so the only winners here are those with no skin in the game.
For all you Obama fans how well is only raising tax on the 1% doing for you? That is the government taking more out of your pay check not the big bad rich business owners and going to be the same with Obamacare.
It's going great, thanks. Maybe you haven't seen but the markets are soaring; my 401K is very happy.
Ya know if the government wanted to get more people on board for this stuff they should go through the social programs we already have and cut out all the fraud. Disablility for instance. I know people who can go out and play basketball all day, but are "disabled" and unable to get a job. To get on disablility all you have to do is know the ropes and be relentless about it and you will get there. Don't tell me it's not done. I see it all the time. I have know problem helping people who need help, but our system is over flowing with people who are just unwilling to work. My favorite is drug dealers rolling in thier BMW getting disablity. Nice
Your comment makes lot of sense! I agree 100%. I'm all for helping my fellow human beings but refuse to help lazy bastards who spend all day watching T.V. and playing sports while collecting a disability check. Our government needs to come up with stricter laws to punish these criminals. I hate to say it but that's one thing I agree with Republicans, reform welfare system and punish the people taking advantage of it. It is not fair that millions of us go to work everyday to support these parasites of society!!
Thank God and Obama that they at least don't have to look for a job or quit taking their drugs!!!
Even with all the money thrown at education in this country, the ignorance is stunning!! For just once in your life check some actual facts before posting or screaming at your neighbor.
The vast majority of disability applications is turned down in this country, there are narrow limits to be considered disabled. There are limits on how much you must have actually worked before you can even be eligible for it .
On appeal of a denied claim there is a tiny amount of them reversed on the decision to deny it ,
The people you see as lazy are disabled , you just dont see them without limbs, cancer is not visible, luekemea is not visible, copd is not visible . The list goes on , most disabilities are not visible.
The ones you see playing sports are trying to stay alive by doing it , that still doesnt make cancer go away, but it might prolong their lives a bit as long as they are able to do it .
Good grief. You are stupid!!
Here is the problem with healthcare today and why this won't help. Insurance is not a direct form of payment for care. Doctors hospitals and other health care businesses will still see it as not the people paying for it. Why would a Doctor care if they charge 3 times to much for something. If they can say well the insurance company is paying it so who cares. Other companies say the same thing and then you see the difference in pet care and human care with the same tool from the same company. One cost about $500 total for a mri the other cost thousands and use the same machine. But because the people have insurance and the dog don't the dog won't be able to pay it. CEOs will make a killing off this plan and medical business of all kind will come out ok. But care won't change much as companies absorb all they can with no regard to waste. No improvement just more money thrown on the stack.
I have spoke of a plan I had before but no one cares to talk about it. But my Doctor, he liked it. Medical groups are set up already. Why not say you are a med club now. Insurance payment will be made directly to you. In return you are responsible for all their health care needs.You may set rules and people may move their membership at any time. But no one can be removed because of or during a heath issue. More work would be needed of course but it would give them reason to cut waste and stop price gauging. More important it would give them all a reason to make you as healthy as possible.
The plan irritates me because it's designed to make private insurance companies larger and more powerful by requiring people to purchase their services.
I wanted socialized medicine, not mandatory privatized medicine. :(
ModeratePhil
Sizima,,you are correct, its a template of what hopefully can be carved into something better, it ,nor will any program be perfect, but the situation now of having health care coverage bolted firmly to employment is a cock of crap and has to end.
WHOA! Cock was not filtered!? On a more serious note, all this will do is make insurance companies wealthy, i seriously doubt people will get better access to health care. The only way for people to get better health care is to eliminate the profit/greed motive via a single payer system.
The rest of the world!There not developed.Its lazyness and irresponsible and were just catching up to them.
Several healthcare features linked to public exchanges may impact how health insurance plans conduct business. http://www.healthcaretownhall.com/?p=6362
"You'll disclose your income to the exchange." Ha! bye bye...
How come I have to pay $1054 a month for my health care insurance premium? I could try going without but if I have a heart attack and survive, I won't have any money left. So which is better, being bankrupt and living on the street after surviving a heart attack, or spending $1054 a month for my health care insurance premium every month? Oh yeah, if I go to the doctor, I pay out of pocket the first $400 and twenty percent of the next $6000 for a max out of pocket of $1600. Oh yeah, I also have to pay for my prescriptions. This was the best and only deal I could get after developing Diabetes at 52. My $1300/month pension barely covers the cost. Without any savings, I wouldn't be able to eat, pay my utilities, property tax, maintain my home, and everything else that one normally needs to do. And most of you think that this is ok? I hope you all loose your current coverage and have to come live in my world! We will then see how you like it!