Who Can Use The Exchanges
All U.S. citizens and legally present residents who are not imprisoned and not enrolled in Medicare are eligible to purchase a health plan in the exchange in the state in which they live. Undocumented immigrants cannot enroll in coverage through the exchanges, even without premium subsidies.
In some states, small businesses can also purchase coverage in the exchange . Note that in states that use HealthCare.gov’s small business exchange, the exchange is no longer handling enrollment, and is having businesses enroll directly with insurers instead. Some of the state-run exchanges are also using this approach, so on-exchange availability of small group health coverage is fairly limited.
As a result of the Grassley Amendment in the ACA, Congress members and their staffers are required to obtain coverage in the exchange. To accommodate this requirement and ensure that Congress and staffers didn’t lose their employer premium contributions, the government created a workaround that lets Congress and staffers enroll in small group plans through the state-run exchange in the District of Columbia .
Universal Healthcare Defeated In Colorado In 2016 Election
Supporters of universal healthcare in Colorado worked for months to gather signatures in support of ColoradoCare, a universal coverage system that would have gone into effect in 2019 if voters had approved it in the 2016 election. But voters resoundingly rejected the measure, with just 21 percent in favor, and 79 percent opposed.
ColoradoCare would have been enacted using a 1332 waiver under the ACA, which allows states to chart their own course for healthcare reform, as long as they do so in a way that covers at least as many people as the ACA would have, keeps coverage affordable and at least as comprehensive as it would be under the ACA, and doesnt increase the federal deficit.
If those general guidelines are satisfied, the state can receive funding from the federal government equal to what would have been provided to the states residents in premium tax credits, cost-sharing subsidies, and small business tax credits. In Colorado, those funds, together with Medicaid waiver funds, were projected to total $11.6 billion in 2019. Total costs to run a zero-deductible, universal coverage program in Colorado were estimated at $35.6 billion for 2019. The $25 billion difference would have been generated through a 10% income tax. Employees would have paid only a third of the total tax, with their employers kicking in the remaining two-thirds .
Grandmothered Plans Discontinued At The End Of 2015
The Colorado Division of Insurance announced that transitional or grandmothered health plans had to be discontinued at the end of 2015. As of 2016, all individual and small-group plans in the state were either fully ACA-compliant, or grandfathered .
Despite the fact that many other states are still allowing grandmothered plans to remain in force, there was controversy in Colorado over the fact that grandmothered plans were allowed to renew at all after January 1, 2014. Lawmakers in Colorado passed a bill in 2013 that aligned Colorado healthcare law with the ACA. It required Colorado plans to be compliant with the ACA as of their issue or renewal date starting on January 1, 2014. Ultimately, the Division of Insurance used their regulatory power to allow the renewal of grandmothered plans in 2014, but there were questions as to whether or not they overstepped their bounds in doing so.
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Several States Subsidize Premiums Or Out
For millions of Americans who purchase their own health insurance through their states health insurance exchange, the monthly premiums are subsidized by the federal government in the form of a premium tax credit. And millions of enrollees also receive cost-sharing reductions. The federal government no longer pays insurers to provide this benefit, but its still available to all eligible enrollees.
The federally funded subsidies are available nationwide, but some states also offer their own state-funded subsidies that are available in addition to the federal subsidies. Some predate the Affordable Care Act which created the federal subsidies, and some have been created more recently in an effort to enhance the affordability that the ACA provides.
Heres an overview of how they work, including in states with subsidies that were instituted before the ACA, states that developed them afterward, and states that are proposing to start them.
Allowing Brokers To Charge Fees
S.B.136 was signed into law in 2018. It allows insurance brokers to charge clients a fee if the insurer doesnt pay a commission. Brokers were not previously allowed to charge any sort of fee, and have historically only been compensated via commissions from insurance carriers .
But some insurers have eliminated broker commissions, resulting in fewer brokers who are willing to work with individual market clients . S.B.136 was designed to ensure that there will continue to be brokers available to serve people who buy coverage in the individual market, although the consumers may have to pay for that assistance themselves.
The Colorado Division of Insurance proposed regulations for broker fees , which became effective August 8, 2018.
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Answer A Few Easy Questions To Calculate Your Subsidy Eligibility In Seconds
By Hal LevyHealthcare Writer
Reviewed by Charles Gaba
How do you get help paying for health insurance and health coverage? It depends on how much you earn. In 2022, youre eligible for Obamacare subsidies if the cost of the benchmark plan costs more than a given percent of your income, up to a maximum of 8.5%. The cut-off threshold increases on a sliding scale depending on your income. The discount on your monthly health insurance payment is also known as a Premium Tax Credit , also known as an Advance Premium Tax Credit .
2022 health plans are measured against your projected income for 2022 and the benchmark plan cost. You qualify for subsidies if you pay more than 8.5% of your household income toward health insurance.
In 2021, premiums for new enrollees have averaged about $30 less per person per month, or 25%. For subsidized enrollees, the median deductible has dropped by 90% from $450/yr to just $50. If you already enrolled in an ACA plan and got a subsidy, you can change your plan and get the added savings through August 15th in most states.
If you decide to keep your current plan, you will receive a refund for the subsidy difference at tax time next year for the first 8 months of the year for September December, those enrolled via the federal exchange will see their additional subsidies automatically subtracted from their premium due amount.
Tip #: Get Trustworthy Professional Help For Free
Still feeling overwhelmed with all the ACA choices? You’re in luck. There is free, impartial professional help available to help you choose and enroll in a plan. Just put in your zip code at Healthcare.gov/localhelp and look for an “assister” a person also referred to as a health care navigator on some state websites.”
Aaron DeLaO is one such navigator, and notes that he and his fellow guides don’t work on commission they’re paid by the government. “We’re not contracted with insurance agencies,” he says. “We do it completely autonomously, impartially. It’s about what’s best for the consumer.”
In 2021, the Biden administration quadrupled the number of navigators ahead of open enrollment.
Insurance brokers can be helpful, too, says Corlette. “Brokers do get commissions, but in my experience, the good brokers want repeat customers and that means happy customers,” she says. To find a good broker, she advises, “go through either Healthcare.gov or your local state department of insurance to find somebody that’s licensed and in good standing.”
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Health Care For Undocumented Immigrants
Undocumented immigrants are not eligible to purchase insurance or receive tax credits or subsidies through the Health Insurance Marketplace. They generally are not eligible for federal health insurance programs such as Medicaid and CHIP either, but there are exceptions. For example, some states have extended prenatal care to undocumented pregnant women. Also, five statesCalifornia, Illinois, Massachusetts, New York and Washingtonand Washington, D.C., offer health insurance coverage to undocumented children younger than 18. Unauthorized immigrants can also buy health insurance directly from brokers, but the cost may be prohibitive without the subsidies and other protections provided under the Affordable Care Act.
Households of mixed immigration status can apply for Marketplace coverage, Medicaid and CHIP for those family members who are eligible.
Undocumented immigrants can receive emergency medical care under Medicaid, and may be able to obtain other medical services through public health programs, including federally qualified health centers. These low-cost community health centers, located in both urban and rural areas, charge based on income for services including general primary care, womens care, prenatal care, oral health care, substance abuse services and referrals to specialized care. Health center employees do not ask for proof of immigration status. Find a health center near you.
What Is An Aca Silver Plan
In the exchanges, insurers offer Bronze, Silver, Gold andin a few areasPlatinum plans. . All must cover the ACAs essential health benefits, and cannot refuse to cover you or charge you more because you have a pre-existing condition.
The difference between the four tiers is their actuarial value. Bronze and Silver plans tend to have lower premiums, with higher co-pays and deductiblesup to a maximum of $8,700 in out-of-pocket costs in 2022 After an enrollee hits the out-of-pocket limit, the insurer pays for all essential benefits, as long as the patient stays in-network.
Gold and Platinum plans premiums are higher, but deductibles, copays, and total out-of-pocket exposure on those plans are often lower. Silver plans pay roughly 70% of enrollees expected healthcare costs, and generally have premiums that are higher than Bronze plans, but lower than Gold plans.
Its important to understand, however, that because the cost of cost-sharing reductions has been added to Silver plan rates in many states, you may find that there are Gold plans in your area that are less expensive than silver plans. And if youre eligible for cost-sharing reductions, youll essentially get a free upgrade on your coverage, as long as you pick a Silver plan. Shop carefully!
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Learn The Ways To Minimize What You Have To Pay
The Health Insurance Marketplace may be the best place for getting health insurance if you’re not covered by an employer, a spouse’s or parent’s plan, or some other source.
And if you’re getting by on a low income, browsing the Marketplace for a plan is a must. You may be eligible for extra savings that lower the amount you pay for your monthly health insurance bill, deductibles, copayments, and coinsurance.
Health Insurance Coverage Reforms
Through a series of provisions that create premium and cost-sharing subsidies, establish new rules for the health insurance industry, and create a new market for health insurance purchasing, the Affordable Care Act makes health insurance coverage a legal expectation on the part of U.S. citizens and those who are legally present. The Act both strengthens existing forms of health insurance coverage while building a new, affordable health insurance market for individuals and families who do not have affordable employer coverage or another form of minimum essential coverage such as Medicare or Medicaid. In expanding existing coverage, the Act fundamentally restructures Medicaid to cover all citizens and legal U.S. residents with family incomes less than 133% of the federal poverty level and to streamline enrollment.,
In addition to establishing universal coverage and shared responsibility, the Affordable Care Act sets federal standards for health insurers offering products in both the individual and small-group markets, as well as employer-sponsored health benefit plans., These requirements considerably expand on federal standards first introduced as part of the Health Insurance Portability and Accountability Act of 1996. Some of the requirements become effective prior to 2014. The broadest reformsprohibitions against pricing and coverage discrimination against adultsbecome effective in 2014, when the mandate and subsidies go into effect.
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How Obamacare Subsidies Work
There are two kinds of ACAsubsidies.
The more common kind is called Advanced Premium Credits, which can help pay ACA health insurance premiums purchased on the Marketplace through the year. If you qualify based on your projected income for the current year, you can either:
If you take the advance tax crediteach month and you underestimate your actual householdincome, you will owe some of this advanced money back at the end of the year.On the other hand, if you overestimate your income, you will receive anadjusted tax credit refund when you file your income tax return. To avoid thisissue, report changes to your income by updating your Marketplace applicationonline or contacting the Marketplace call center.
Its important to know tax-credit subsidies apply to ACA plans you can purchase on the Marketplace. They are not available to ACA-compliant plans offered outside the Marketplace, catastrophic coverage plans, short-term health insurance, standalone prescription drug plans, or insurance supplements for such care as dental, vision, and critical illness. These alternative insurance plans may cost less, but provide fewer benefits than Marketplace plans offer, generally.
How To Shop For Health Insurance
Note: Some parts of the Affordable Care Act are being changed or eliminated via government policies and laws. It is likely that some of the rules and regulations affecting the health insurance marketplace will continue to change over time. To stay up to date on Obamacare and other health insurance issues, visit healthcare.gov and the website of the health commissioner’s office in your state.
In America today, we all need health insurance. You do. Your kids do. It’s not a “nice to have” anymore it’s a “must-have.” And that’s the law. In most cases, parents who aren’t covered by health insurance might have to pay a fine each year. Going without also means that if someone gets sick or is injured, a family might have to pay all the bills for care received. That can cost a whole lot more than paying for coverage.
To help people get health insurance, the federal and state governments set up a health insurance marketplace . This makes it easier than ever to get coverage, but the process can seem a bit confusing.
Here’s what to do to get health insurance.
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Health Insurance Exchanges: State Roles In Selecting Health Plans And Avoiding Adverse Selection
By Sharon Silow-Carroll, Diana Rodin, Tom Dehner, and Jaimie Bern1
A central feature of the federal health reform legislation is its creation of “health insurance exchanges.” The exchanges, to be operational in 2014, are envisioned as insurance marketplaces in which individuals and small businesses can compare and purchase health plans, and determine and receive premium subsidies for which they are eligible. States have the option to develop and host their own exchanges, or let the federal government establish and run exchanges for them. States that choose to implement exchanges will be able to tailor the exchanges to their states’ particular strengths and circumstances. Yet, they will face a multitude of decisions regarding their governance, design, marketing, administration, technology, and other factors.
What Is an Insurance Exchange? According to the November 2010 Initial Guidance to States on Exchanges from the Department of Health and Human Services:
“An Exchange is a mechanism for organizing the health insurance marketplace to help consumers and small businesses shop for coverage in a way that permits easy comparison of available plan options based on price, benefits and services, and quality. By pooling people together, reducing transaction costs, and increasing transparency, Exchanges create more efficient and competitive markets for individuals and small employers.”
Exhibit 2: Resources for States in Developing Health Insurance Exchanges
Applying For Obamacare Subsidies
You can apply for Obamacare subsidies through the government-run health insurance Marketplace in your state or through qualifying licensed agents, and private online Marketplaces that cooperate with the government marketplace. A good source for meeting all your insurance coverage needs is eHealth. We offer you online tools to help you determine if you are eligible for Obamacare subsidies and Marketplace plans available where you live. We also have licensed agents to help you find insurance plans that meet your needs and budget. With 24//7 support and a wide selection of plans available, you can rest assured eHealth is here to help you find and maintain the best plans for you and your family.
Keep in mind the government makes the final determination on your eligibility for a subsidy. While you can shop through eHealth to select a plan, the subsidy comes through the government-run marketplace. If you are ready to begin comparing plans, check out all of your individual and family health insurance options with eHealth.
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How Health Insurance Exchanges Work
Exchanges are designed to increase competition and ease comparison shopping. Insurance companies compete for your business in the exchange. This direct competition is meant to keep the cost of health insurance premiums down. Exchanges/marketplaces ease the comparison of plans by using an “apples to apples” approach:
All health insurance policies offered through the exchanges provide a minimum set of essential health benefits, although the specific coverage that’s offered will vary from one state to another, depending on the benchmark plan that the state uses. :
- Ambulatory care
- Mental health care, including treatment for substance use disorders)
- Prescription drugs
- Rehabilitation services and habilitative services, including devices
- Laboratory services
- Pediatric vision and dental care .
Standardized plans are available in the exchanges in some states. In California’s exchange, all of the plans are standardized.
All health insurance policies offered in the exchange must conform to one of five benefit tiers: catastrophic, bronze, silver, gold, or platinum. Both on- and off-exchange, a policys benefit tier describes the percentage of average covered healthcare expenses the plan will pay, otherwise known as the actuarial value of the plan. You can learn more about how these benefit tiers work in, ” Bronze, Silver, Gold, and PlatinumUnderstanding the Metal-tier System.”