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Exchanges

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Health Care Reform: Exchanges

During the open enrollment period, individuals and small businesses with up to 50 employees can purchase health coverage through online exchanges, also called "health insurance marketplaces." Health coverage for 2015 can be purchased via the exchanges during the next open enrollment period, which starts November 15, 2014, and runs through February 15, 2015. In 2016, businesses with up to 100 employees will be able to participate.

Together with our parent company, Aetna, we created this video to tell you more about exchanges. Hit the play button to check it out:



En Español

Video transcript

What can I expect from health plans bought on an exchange?

Essential Health Benefits
Non-grandfathered plans for small groups and individuals that are sold both on and off the exchanges must cover a set of health services and benefits called the essential health benefits package. These include:

  1. 1. Ambulatory patient services
  2. 2. Emergency services
  3. 3. Hospitalization
  4. 4. Maternity and newborn care
  5. 5. Mental health and substance use disorder services, including behavioral health treatment
  6. 6. Prescription drugs
  7. 7. Rehabilitative and habilitative services and devices
  8. 8. Laboratory services
  9. 9. Preventive and wellness services and chronic disease management
  10. 10. Pediatric services, including oral and vision care

Coverage levels

The exchanges create four benefit categories of plans:

Platinum plans to pay for about 90 percent of covered health costs
Gold plans to pay for about 80 percent of covered health costs
Silver plans to pay for about 70 percent of covered health costs
Bronze plans to pay for about 60 percent of covered health costs

There is also a Catastrophic plan available to those under 30 years of age and to certain other individuals.

Out-of-pocket maximums
Out-of-pocket costs for most health plans are capped at the limits under health savings accounts (HSAs). In 2014 these out-of-pocket limits will be $6,350 for self-only coverage and $12,700 for family coverage.

Will the government help me to be able to afford health coverage sold on an exchange?

Subsidies in the form of advanced premium tax credits are available to individuals who enroll in a qualified health plan on the individual exchange if:

1. Their income is less than 400 percent of the federal poverty level AND
2. They do not have access to minimum value employer coverage





Exchanges

Essential Health Benefits
PDF 260 KB
A flyer giving an overview of essential health benefits and a map of states' benchmark plans.

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