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]

Quote:

Originally Posted by DFW_M5 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]

Quote:

Originally Posted by MichaelB 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]

Quote:

Originally Posted by DFW_M5 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]

Quote:

Originally Posted by DFW_M5 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]

Quote:

Originally Posted by 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.

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]

Quote:

Originally Posted by 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.

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]

Quote:

Originally Posted by ziggy29 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]

Quote:

Originally Posted by 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.

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):

Quote:

Originally Posted by 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.

[MichaelB]

Quote:

Originally Posted by FinanceDude 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]

Quote:

Originally Posted by ziggy29 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_...mary_chart.pdf

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

[FUEGO]

Quote:

Originally Posted by 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.

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/facts...index.html#hie

[MichaelB]

Quote:

Originally Posted by 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: Fact Sheets & Frequently Asked Questions (FAQs) | cciio.cms.gov

Excellent link, very useful. Thanks!