Health Insurance Exchanges under the PPACA

[MichaelB]

There are still many initiatives in the PPACA that will be implemented in 2013 and 2014. One that has been the subject of much discussion here is State Health Insurance Exchanges. The States can run their own exchanges, individually or in partnership with other States, or allow the Federal Gov’t to run them.

Each state must inform its intention by Nov 16. It might be useful to have a thread that tracks what the states are doing and note updates, and link to other useful information sites. According to Kaiser Family Foundation (Health Insurance Exchanges - Kaiser State Health Facts) the current status is:

16 Established State Exchange: California, Colorado, Connecticut, DC, Hawaii, Kentucky, Maryland, Massachusetts, Nevada, New York, Oregon, Rhode Island, Utah, Vermont, Washington, West Virginia

3 Planning for Partnership Exchange: Arkansas, Delaware, Illinois

16 Studying Options: Alabama, Arizona, Idaho, Indiana, Iowa, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Mexico, North Carolina, Pennsylvania, Tennessee, Virginia

8 No Significant Activity: Georgia, Kansas, Missouri, North Dakota, Ohio, Oklahoma, Wisconsin, Wyoming

8 Decision Not to Create State Exchange: Alaska, Florida, Louisiana, Maine, New Hampshire, South Carolina, South Dakota, Texas

 

[eytonxav]

So I assume that for states that elect not to have a state exchange, a subscriber can then select from federal level exchange? If so, I wonder how good the federal one will be.

 

[MichaelB]

So I assume that for states that elect not to have a state exchange, a subscriber can then select from federal level exchange? If so, I wonder how good the federal one will be.

There will still be state exchanges, just operated by a Federal dept.

Members of Congress are required to get their health care insurance through he exchanges beginning in 2014, so I would guess there will be at least one good option...

 

[eytonxav]

There will still be state exchanges, just operated by a Federal dept.

Members of Congress are required to get their health care insurance through he exchanges beginning in 2014, so I would guess there will be at least one good option...

The thing that strikes me a little odd, is gummit claims to be interested in reducing costs, so why can't they get over this restricting insurance to state lines.

 

[brewer12345]

The thing that strikes me a little odd, is gummit claims to be interested in reducing costs, so why can't they get over this restricting insurance to state lines.

Google "McCarran-Ferguson Act."

 

[MichaelB]

The thing that strikes me a little odd, is gummit claims to be interested in reducing costs, so why can't they get over this restricting insurance to state lines.

Not really the purpose of the thread, but it looks to me that when all 50 states have health insurance exchanges that satisfy a common set of standards, this limitation is less of an issue.

 

[easysurfer]

Now that the PPACA is definitely here to stay, I'm looking forward to say, about 6-9 months from now when the exchanges get more concrete. Who knows, by then the question might be to PPACA or HSA? That is the question.

 

[Tyro]

Now that the PPACA is definitely here to stay, I'm looking forward to say, about 6-9 months from now when the exchanges get more concrete. Who knows, by then the question might be to PPACA or HSA? That is the question.

If by HSA you mean Health Savings Account, I would think it would still make sense to have both as we do now -- using HSA to cover deductibles and items not covered by PPACA/insurance.

Tyro

 

[ziggy29]

Now that the PPACA is definitely here to stay, I'm looking forward to say, about 6-9 months from now when the exchanges get more concrete. Who knows, by then the question might be to PPACA or HSA? That is the question.

There has been some concern in the past that PPACA would eliminate HSAs entirely because no PPACA-compliant insurance plan would also be a qualifying HDHP under existing law, but I don't think that's the case. It doesn't have to an either-or, at least I don't think so. Keep in mind that some HSA-eligible plans (mine included) have had first-dollar, no deductible coverage for preventative care even before PPACA was signed into law.

 

[easysurfer]

There has been some concern in the past that PPACA would eliminate HSAs entirely because no PPACA-compliant insurance plan would also be a qualifying HDHP under existing law, but I don't think that's the case. It doesn't have to an either-or, at least I don't think so. Keep in mind that some HSA-eligible plans (mine included) have had first-dollar, no deductible coverage for preventative care even before PPACA was signed into law.

I'm waiting for a cheat-cheat, like a feature on "Good Morning America" that would say something like "under the PPACA, here are the new options.." to help us decide. Of course, the situation definitely is not concrete enough at this time.

On the PPACA, just saw a article about that on Yahoo today. The entire article might be too political, so I'm not going to link it. But an important point from the article:

"Open enrollment for exchange plans is scheduled to start Oct. 1, 2013, and coverage will be effective Jan. 1, 2014." So this time next year, folk may be enrolling or at least analyzing their options.

 

[rbmrtn]

Is the open enrollment just for "uninsured" ? What happens if your on a COBRA plan, can you move to the new plans with the open enrollment.

 

[JoeWras]

Now the election is over, and the make up of the result almost guarantees no changes, I think we'll start seeing more information and cheat sheets.

Most of it is out there, but it is so buried in thick bureaucratic lingo it is hard to digest.

 

[FinanceDude]

Wisconsin is not going to do anything until they are forced to...........

 

[ziggy29]

Is the open enrollment just for "uninsured" ? What happens if your on a COBRA plan, can you move to the new plans with the open enrollment.

My understanding is that anyone can use the exchanges starting 1/1/2014. And if you start COBRA today (or started any time after July 1 of this year), you will be able to stay on it all the way until this date. In other words, it may have just become a little safer to retire based on the health insurance considerations since I now pretty much agree with this take (any changes between now and then would likely be tinkering around the edges):

Now the election is over, and the make up of the result almost guarantees no changes, I think we'll start seeing more information and cheat sheets.

 

[MichaelB]

Wisconsin is not going to do anything until they are forced to...........

Actually, there is no forcing here, because there is a default option to a federally run exchange.

 

[winger]

Information! I need information!!

 

[rbmrtn]

My understanding is that anyone can use the exchanges starting 1/1/2014. And if you start COBRA today (or started any time after July 1 of this year), you will be able to stay on it all the way until this date. In other words, it may have just become a little safer to retire based on the health insurance considerations since I now pretty much agree with this take (any changes between now and then would likely be tinkering around the edges):

That was my understanding as well. In some of the docs I have read it mentions being a "qualified" individual to do open enrollment, so what exactly is a "qualified" individual.

I found this def.

Qualified individual means, with respect to an Exchange, an individual who has been determined
eligible to enroll in a QHP in the individual market offered through the Exchange.

From here http://www.naic.org/documents/index_health_reform_section_exchanges_reg_summary_chart.pdf

Best I can determine is "eligible" refers whether you get medicaid or choose a plan based on FPL.

 

[FUEGO]

Now the election is over, and the make up of the result almost guarantees no changes, I think we'll start seeing more information and cheat sheets.

This was my thinking as well. Many states have been sitting on their hands waiting to see the outcome of the election before they devote substantial resources to developing these exchanges and the policies and procedures surrounding them. I imagine in the next six to nine months we will have a more concrete idea of what they will look like.

 

[M Paquette]

The initial open enrollment period on the various health insurance exchanges is scheduled to start October 1, 2013, for coverage starting January 1, 2014.

A web site collecting the various fact sheets and FAQs related to the exchanges and the Affordable Care Act is at:
http://cciio.cms.gov/resources/factsheets/index.html#hie

 

[MichaelB]

The initial open enrollment period on the various health insurance exchanges is scheduled to start October 1, 2013, for coverage starting January 1, 2014.

A web site collecting the various fact sheets and FAQs related to the exchanges and the Affordable Care Act is at:
Fact Sheets & Frequently Asked Questions (FAQs) | cciio.cms.gov

Excellent link, very useful. Thanks!

 

[gerrym51]

i live in mass. we already have this. Unless your poor enough to qualify for subsidies even though you are guaranteed coverage it is not cheap.


example for 60 year old singles. 570 a month premium 2400 deductible.

there are some options lower but you have to go to certain clinics.

best way to see what i mean.

google/bing massachusettes health connector. select prompts to price a health plan without subsidies. it does not asky you who you are but will ask d.o.b
and zip code .use a zip code from different parts of mass(look up zips on web)

the connector will list all different types of plans bronze/silver/gold with and without drug. big range premiums/copays no total plan is cheap be forwarned

 

[GalaxyBoy]

Virginia will defer to a federally-run exchange.

Link to Washington Post article here.

 

[rbmrtn]

i live in mass. we already have this. Unless your poor enough to qualify for subsidies even though you are guaranteed coverage it is not cheap.


example for 60 year old singles. 570 a month premium 2400 deductible.

there are some options lower but you have to go to certain clinics.

best way to see what i mean.

google/bing massachusettes health connector. select prompts to price a health plan without subsidies. it does not asky you who you are but will ask d.o.b
and zip code .use a zip code from different parts of mass(look up zips on web)

the connector will list all different types of plans bronze/silver/gold with and without drug. big range premiums/copays no total plan is cheap be forwarned

OK, I looked. I'm not familiar with the details in MA, but they seem reasonable to me ( better than being denied coverage ), $360 for a bronze plan. Didn't see any high deductible plans. Seems to be a wide range in price for basically the same coverage, $346 - $551, different companies.

I do plan on being "poor" enough for subsidies, unless they start means testing

 

[ERhoosier]

I keep reading about how difficult it will be for states to start HI exchanges by Oct '13 and think I must be missing something. Isn't what a company like "ehealthinsurance" does essentially a form of web-based HI exchange? Why couldn't a state just use such a web-based model for "qualified" plans for their state residents?

 

[M Paquette]

I keep reading about how difficult it will be for states to start HI exchanges by Oct '13 and think I must be missing something. Isn't what a company like "ehealthinsurance" does essentially a form of web-based HI exchange? Why couldn't a state just use such a web-based model for "qualified" plans for their state residents?

The web site for an insurance exchange will functionally be a lot like ehealthinsurance.com, but the real work is under the covers.

The exchange is going to have to do some tracking and management of its own operation, insurance companies, and customers. They have to look out for adverse selection problems. They'll tie into some national "building blocks" to check eligibility for special programs like Medicaid and CHIP, as well as subsidy qualification. There are to be public outreach and accountability programs.

http://www.healthcare.gov/law/resources/regulations/guidance-to-states-on-exchanges.html