the state by state guide to health insurance marketplaces · this guide outlines how each state...
TRANSCRIPT
The STATE BY STATE GUIDE
TO HEALTH INSURANCE
MARKETPLACES Prepare for the Opening of Health Insurance Marketplaces
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STATE BY STATE GUIDE TO HEALTH INSURANCE MARKETPLACES
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DISCLAIMER
The information provided herein by Zane Benefits is general in nature and should not be relied on for commercial decisions without conducting independent review and analysis and discussing alternatives with legal, accounting, and insurance advisors. Furthermore, health insurance regulations differ in each state; information provided does not apply to any specific U.S. state except where noted. See a licensed agent for detailed information on your state. www.zanebenefits.com
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INTRODUCTION
Starting in 2014, health insurance coverage for individuals and small businesses will become available through new state health insurance marketplaces (also known as health insurance exchanges). Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state health insurance marketplace. Under the Patient Protection and Affordable Care Act (PPACA), states are required to provide a health insurance marketplace for individuals, families, and small businesses.
Three Options for Marketplaces
States have three options for setting up a state health insurance marketplace for 2014:
1. Build a State-Based Exchange, 2. Enter into a State-Federal Partnership Exchange, or 3. Default to the Federally-Facilitated Exchange.
Under federal law, the marketplaces must be state-regulated, standardized, and fully certified and operational by January 1, 2014.
How to Use this Guide
This guide outlines how each state plans to offer health insurance marketplaces.
Individuals, employers, insurance professionals and CPAs should use this guide as a reference for the new public health insurance marketplaces opening on October 1, 2013 (for coverage beginning January 1, 2014).
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TABLE OF CONTENTS
Chapter 1: Overview of Public Health Insurance Marketplaces
Individual Health Insurance Marketplaces (pg. 6)
Small Business Health Options Program “SHOP” (pg. 6)
Frequently Asked Questions (pg. 7)
Chapter 2: State by State Overview of Marketplaces
Summary of State Decisions (pg. 12)
State Marketplaces, Alphabetically (pg. 13)
Chapter 3: Conclusion
Conclusion (pg. 22)
Additional Resources (pg. 23)
Note: The information in this guide is current as of June 17, 2013.
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“The Affordable Care Act will reduce the number of people without health insurance by
expanding eligibility for Medicaid and providing tax credits that make insurance more affordable
for people buying coverage on their own through the new health insurance exchanges.
##
The Congressional Budget Office projects that 32 million
more people will have insurance by 2019.”
- The Henry J Kaiser Family Foundation Website
CHAPTER 1: OVERVIEW OF HEALTH INSURANCE MARKETPLACES
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Individual Health Insurance Marketplaces
Starting in 2014, the public health insurance marketplaces will make it simple and more affordable for individuals and families to purchase health insurance that can't be canceled or denied because of a pre-existing medical condition.
As a key part of health care reform, federal law requires states to offer a health insurance marketplace designed to help individuals find health insurance and access tax subsidies.
The marketplace that’s available to you or your clients will depend on what state you live in.
Marketplaces will open October 1st, 2013, for coverage starting January 1, 2014.
Individuals will be able to shop online, in person, or by phone for health insurance in every state.
A special website will provide a variety of online tools to learn more about the range of health plans that will be offered through the state health insurance marketplace.
Purchasing insurance through the state health insurance marketplace will have several advantages including:
1. The ability to make "apples-to-apples" comparisons of health insurance based on levels of coverage (“Bronze,” “Silver,” “Gold,” and “Platinum” -- known as the “metal levels”).
2. The ability to receive federal financial assistance that can help lower your health insurance costs.
Small Business “SHOP” Marketplaces
Health care reform laws also require states to create a Group Market Health Insurance Exchange (called the Small Business Health Options Program or "SHOP").
Initially, SHOP exchanges will limit eligibility to only businesses with up to 100 employees. This is a new program designed to simplify the process of finding health insurance for small businesses, and applying any applicable small business tax credits.
source: healthcare.gov Eligibility details will vary by state. For example, some states are limiting SHOP to employers with less than 50 employees.
source: healthcare.gov
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Frequently Asked Questions
To best understand your state’s health insurance marketplace, it is important to understand what the health insurance marketplaces are and how the subsidies for individual health insurance will work in 2014 and beyond. Below is a list of FAQs about health insurance marketplaces.
Why should I buy health insurance?
Everybody uses the health care system at some point in life. You never know when an accident might happen or your family member will get sick and need to see a doctor. When that day comes, the expenses could be financially devastating.
Do I have to buy health insurance?
Starting in January 2014, most individuals will be required to have health insurance or pay a tax penalty if they don't. Coverage can include employer-provided insurance, individual health insurance, Medicare or Medicaid.
The tax penalty phases in over three years and becomes increasingly severe. In 2014, the penalty will be 1 percent of annual income or $95, whichever is greater. By 2016, the penalty will be 2.5 percent of income or $695. This means that if you do not have coverage in 2014, you will be required to pay a tax penalty when you file your taxes at the end of the year.
Health Insurance Penalty Phase-In Schedule Pay the greater of the two amounts
Year % of Income Set Dollar Amount
2014 1% $95
2015 2% $325
2016 2.5% $695
The total penalty for the taxable year cannot exceed the national average of the annual premiums of a bronze-level health insurance plan offered through the health insurance marketplaces. Health insurance plans will provide proof of coverage for their customers.
Several groups are exempt from the requirement to obtain coverage or pay the penalty, including:
People who would have to pay more than 8 percent of their income for health insurance
People with incomes below the threshold required for filing taxes (in 2012, $9,750 for a single person and $27,100 for a married couple with two children)
People who qualify for religious exemptions
Undocumented immigrants
People who are incarcerated
Members of Native American tribes
If you do not have insurance and do not fit into one of these categories, then you will likely pay a tax penalty.
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How will the health insurance marketplaces help me find health insurance I can afford?
Each state will have a health insurance marketplace that will allow you to shop online, over the phone or in person to find the right insurance option for your health needs and budget. This guide will go into detail about the specifics in your state. You will be able to compare different health insurance plans and learn if you qualify for federal financial assistance such as tax credits that will reduce how much you have to pay each month on a sliding scale based on your income.
Who can buy health insurance through the state health insurance marketplaces?
Generally, legal residents of your state who do not have access to affordable health insurance through their employer or another government program will be eligible to purchase health coverage from the state health insurance marketplace.
When can I purchase coverage through the health insurance marketplaces? The health insurance marketplaces will open October 1st, 2013 and continue enrollment until March 31, 2014. You must purchase health insurance during this open-enrollment period to obtain coverage in 2014. If you have a life-changing event such as the loss of a job, death of a spouse or birth of a child, you would be eligible for special enrollment within 60 days of the event. If you do not enroll during this period, you will not be guaranteed a health plan will cover you – either through the health insurance marketplace or in the private market.
The next open-enrollment period begins in October 2014 for coverage in 2015.
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How much will it cost to purchase health insurance through the health insurance marketplaces?
Generally, the cost of health insurance depends on:
1. Your age, 2. How much coverage you choose to purchase, and 3. Whether you qualify for financial assistance such as tax credits.
Tip: A cost-estimate calculator will help you estimate about how much you will pay per year for insurance coverage.
Am I eligible for cost-sharing subsidies?
In addition to the tax credits that reduce your monthly premium payments, you may be eligible for cost-sharing subsidies that reduce the amount you pay when you get care.
Eligibility for subsidies is based on income level and family size. You may be eligible for cost-sharing subsidies if your income is less than about $27,936 for a single person and less than about $57,636 for a family of four in 2012, which represents ~250% of the federal poverty level.
Cost-sharing subsidies are offered by the federal government to reduce the amount of money you have to pay for health care expenses such as copayments or coinsurance.
The public health insurance marketplaces are the only place where you can use these tax credits to make insurance more affordable.
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What if I have a pre-existing health condition?
You can still purchase health insurance regardless of any current or past health conditions.
Starting in 2014, insurance companies will be required to sell policies to everyone regardless of current or past health issues, and they will be prohibited from using your health status to determine how much your health insurance will cost.
This requirement means whether you buy insurance through a health insurance marketplace or somewhere else, you cannot be denied coverage or even screened based on a pre-existing medical condition.
Tip: It is important to remember that this requirement only applies during the open-enrollment periods.
Do I have to wait until January 1, 2014 to get health insurance?
If you do not have health insurance, you do not have to wait until the health insurance marketplaces open to get covered. You may be able to purchase private insurance for yourself by contacting an insurance company directly or working with an agent.
Where do I find more information on calculating my tax credit?
This guide will walk you through the specifics of how to calculate your tax credit, and what you will be eligible for:
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Won’t my employer be required to provide health insurance?
Not necessarily. The Affordable Care Act (ACA) requires certain employers to purchase health insurance or else pay a tax penalty. Specifically, starting January 1, 2015 employers with 50 or more full time equivalent (FTE) employees are required to provide health coverage to full-time employees or else pay a tax penalty.
Even with the tax penalty, many employers with more than 50 FTE will calculate the cost of not providing health insurance and find it is more cost-effective to send employees to the public health insurance exchanges. Employers may then provide a Health Reimbursement Arrangement to reimburse employees for a portion of their policy.
Are you an employer? See this free guide on this guide on calculating health reform’s tax penalties:
How do insurance agents and brokers fit into the marketplaces?
It will depend by how the state sets up their marketplace. At the time of writing, many of the details (such as commissions and how agents can register with the state as an authorized provider) have not yet been decided or released.
If you are an insurance agent, broker or agency, subscribe to our blog (www.zanebenefits.com/blog) and we’ll provide information there as soon as it’s available.
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CHAPTER 2: HEALTH INSURANCE EXCHANGES BY STATE
Summary
As mentioned previously, states have three options for setting up a state health insurance marketplace for 2014. At the time of writing, states are planning to offer marketplaces (exchanges) in the following ways*:
1. State-Based Marketplace (17)
2. State-Federal Partnership Marketplace (7)
3. Default to the Federally-Facilitated Marketplace (26)
*Note: The federal government approves or rejects all state-based or partnership proposals. At time of writing, some state proposals (“blueprints”) are still pending approval. If rejected (or not approved in time), the state will default to the federal exchange. This guide is current as of June 17, 2013.
Source: www.kff.org May 2, 2013
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State Health Insurance Marketplaces, Alphabetically
Alabama │Federal Exchange
Alabama will offer a health insurance exchange through the federally-run exchange. Originally, Alabama explored implementation of a state-based health insurance exchange, but Governor Robert Bentley announced on November 13, 2012 that the state will default to a federally-facilitated exchange.
Alaska │Federal Exchange
Alaska will offer a health insurance exchange through the federally-run exchange.
Arizona │Federal Exchange
Arizona will offer a health insurance exchange through the federally-run exchange. For more information on Arizona’s health insurance exchange planning, visit: http://www.azgovernor.gov/hix/.
Arkansas │Partnership Exchange
Arkansas will offer a health insurance exchange through a Partnership Exchange. On January 3, 2013, Arkansas received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a state-federal partnership exchange. Arkansas Health Benefit Exchange planning information: http://www.hbe.arkansas.gov/.
California │State-Based Exchange
California will offer a state-based health insurance exchange under the name Covered California (www.coveredca.com). On January 3, 2013, California received conditional approval from the U.S. Department of Health and Human Services (HHS) for its state-based exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time and complying with future guidance and regulations. Additional information about the California Health Benefit Exchange can be found on the Exchange’s website: http://www.healthexchange.ca.gov/.
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Colorado │State-Based Exchange
Colorado will offer a state-based exchange under the name Connect for Health Colorado (www.getcoveredco.org). The Exchange is run as a non-profit public organization operating outside of state government.
Connecticut │State-Based Exchange
Connecticut will offer a state-based exchange under the name Access Health CT (www.ct.gov/hix). The Connecticut Health Insurance Exchange was established as a quasi-public agency.
Delaware │Partnership Exchange
Delaware will offer a health insurance exchange through a Partnership Exchange. Delaware will retain plan management and consumer assistance functions, and defer other exchange management functionality to the federal government. More information provided at http://dhss.delaware.gov/dhss/dhcc/.
District of Columbia │State-Based Exchange
Washington D.C. will offer a state-based exchange, governed by the Health Benefit Exchange Authority (http://hbx.dc.gov).
Florida │Federal Exchange
Florida will offer a health insurance exchange through the federally-run exchange.
Georgia │Federal Exchange
Georgia will offer a health insurance exchange through the federally-run exchange.
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Hawaii │State-Based Exchange
Hawaii will offer a state-based exchange under the name Hawaii Health Connector (http://www.hawaiihealthconnector.com/). Hawaii was the first state to declare intent of a state-based exchange on June 7, 2012.
Idaho │ State-Based Exchange
Idaho will offer a state-based exchange under Idaho Health Insurance Exchange (www.healthexchange.idaho.gov).
Illinois │Partnership Exchange
Illinois will offer a health insurance marketplace through a partnership exchange. Final approval was received on February 13, 2013 by Health and Human Services (HHS). Illinois will continue its planning efforts to transition to a fully state-based exchange in 2015. For more information see: http://www.insurance.illinois.gov/hiric/hie.asp.
Indiana │Federal Exchange
Indiana will offer a health insurance exchange through the federally-run exchange. Originally, Indiana explored implementation of a state-based health insurance exchange, but Governor-elect Mike Pence announced in November 2012 that he would not move forward with setting up a state-based health insurance exchange. For more information on Indiana’s exchange planning see: http://www.nationalhealthcare.in.gov
Iowa │Partnership Exchange
Iowa plans to offer a health insurance marketplace through a partnership exchange. On March 5, 2013, Iowa received conditional approval from HHS to establish a partnership exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time, complying with future regulations, and achieving expected milestones. For more information on Iowa’s health insurance exchange planning see: http://www.idph.state.ia.us/hcr_committees/health_benefit_exchange.asp.
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Kansas │Federal Exchange
Kansas will offer a health insurance exchange through the federally-run exchange. For additional information on the Kansas health insurance exchange planning visit: http://www.ksinsurance.org/hbexplan.
Kentucky │State-Based Exchange
Kentucky will offer a state-based exchange under Kentucky Health Benefit Exchange (http://healthbenefitexchange.ky.gov).
Louisiana │Federal Exchange
Louisiana will offer a health insurance exchange through the federally-run exchange.
Maine │Federal Exchange
Maine will offer a health insurance exchange through the federally-run exchange. For more information on Maine’s exchange planning efforts, see: http://www.dirigohealth.maine.gov/Pages/exchange_planning.html.
Maryland │State-Based Exchange
Maryland will offer a state-based exchange under the name Maryland Health Connection (http://marylandhbe.com).
Massachusetts │State-Based Exchange
Massachusetts will offer a state-based exchange under the name Massachusetts Connector (https://www.mahealthconnector.org).
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Michigan │ Federal Exchange
Michigan will offer a health insurance exchange through the federally-run exchange. Michigan originally planned for a partnership exchange, however they did not meet the deadline for approval and defaulted to the federal exchange.
Minnesota │State-Based Exchange
Minnesota will offer a state-based marketplace under the name MNsure (www.mn.gov/hix/).
Mississippi │ Federal Exchange
Mississippi will most likely offer a health insurance exchange through the federally-run exchange. Mississippi originally planned for a state-based exchange, however HHS rejected their blueprint application. For more information see http://www.mshie.org/index.php and http://www.onemississippi.com/index.php.
Missouri │ Federal Exchange
Missouri will offer a health insurance exchange through the federally-run exchange.
Montana │ Federal Exchange
Montana will offer a health insurance exchange through the federally-run exchange.
Nevada │State-Based Exchange
Nevada will offer a state-based marketplace under the name Silver State Health Insurance Exchange (http://exchange.nv.gov/).
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New Hampshire │Partnership Exchange
New Hampshire plans to offer a health insurance marketplace through a partnership exchange. On March 7, 2013, New Hampshire received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a partnership exchange. For more information see: http://www.nh.gov/insurance/consumers/fedhealthref.htm
New Jersey │ Federal Exchange
New Jersey will offer a health insurance exchange through the federally-run exchange.
New Mexico │State-Based and Federal Exchange
New Mexico will run the small business "SHOP" exchange, and the federal government will run the individual health insurance exchange. For more information see: http://www.nmhia.com/nmhix/.
New York │State-Based Exchange
New York will offer a state-based marketplace under the name New York Health Benefit Exchange (http://healthbenefitexchange.ny.gov/).
North Carolina │ Federal Exchange
North Carolina will offer a health insurance exchange through the federally-run exchange.
North Dakota │ Federal Exchange
North Dakota will offer a health insurance exchange through the federally-run exchange.
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Ohio │ Federal Exchange
Ohio will offer a health insurance exchange through the federally-run exchange. For more information see: www.ohioexchange.ohio.gov.
Oklahoma │ Federal Exchange
Ohio will offer a health insurance exchange through the federally-run exchange. For more information see: http://www.okhealthcare.info/.
Oregon │State-Based Exchange
Oregon will offer a state-based marketplace under the name Cover Oregon (http://www.coveroregon.com).
Pennsylvania │ Federal Exchange
Pennsylvania will offer a health insurance exchange through the federally-run exchange.
Rhode Island │State-Based Exchange
Rhode Island will offer a state-based marketplace under the name Rhode Island Health Benefits Exchange (http://www.healthcare.ri.gov/).
South Carolina │ Federal Exchange
South Carolina will offer a health insurance exchange through the federally-run exchange. For more information see: http://www.healthplanning.sc.gov.
South Dakota │ Federal Exchange
South Dakota will offer a health insurance exchange through the federally-run exchange.
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Tennessee │ Federal Exchange
Tennessee will offer a health insurance exchange through the federally-run exchange. For more information see: http://www.tn.gov/nationalhealthreform/exchange.html.
Texas │ Federal Exchange
Texas will offer a health insurance exchange through the federally-run exchange.
Utah │ State-Based & Federal Exchange
Utah will enter into a unique state-federal partnership. Utah will run the small business "SHOP" exchange, and the federal government will run the individual health insurance exchange. The SHOP Exchange will be run through AvenueH (http://www.avenueh.com/). For more information, see http://www.utah.gov/governor/.
Vermont │ State-Based Exchange
Vermont will offer a health insurance marketplace through a state-based exchange under the name Vermont Health Connect (http://healthconnect.vermont.gov/).
Virginia │ Federal Exchange
Virginia will offer a health insurance exchange through the federally-run exchange. For more information see: http://www.hhr.virginia.gov/Initiatives/HealthReform/index.cfm.
Washington │ State-Based Exchange
Washington will offer a health insurance marketplace through a state-based exchange through Washington Health Benefit Exchange, under the name Washington Health Plan Finder (http://wahbexchange.org/).
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West Virginia │Partnership Exchange
West Virginia plans to offer a health insurance marketplace through a partnership exchange. On March 5, 2013, West Virginia received conditional approval on their partnership blueprint. More information available at: http://healthbenefitexchangewv.com.
Wisconsin │ Federal Exchange
Wisconsin will offer a health insurance exchange through the federally-run exchange.
Wyoming │ Federal Exchange
Wyoming will offer a health insurance exchange through the federally-run exchange.
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CHAPTER 3: CONCLUSION 2014 will bring one of the biggest changes in how employers offer health benefits and how individuals purchase health insurance. Rather than paying the costs to provide a specific group health plan (a "defined benefit"), many employers will instead fix their costs by establishing a monthly dollar amount (a “defined contribution”) that employees choose how to spend. For individuals, both the expansion of Medicaid and the creation of state health insurance marketplaces will mean that approximately 32 million more people will have insurance by 2019. We hope this guide has given you a better understanding of how the states will offer health insurance marketplaces in 2014.
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ADDITIONAL RESOURCES
View our full library of free health benefits tools, on-demand webinars, and eBooks at: www.zanebenefits.com/health-benefits-resources
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The #1 Online Health Benefits Solution
Successfully transition to a health benefits solution that creates happier employees, reduces costs, and frees up time for meaningful work. Request a Demo.
Zane Benefits' Partner Program is an opportunity for insurance professionals to provide clients with custom Zane Benefits solutions. Request a Partner Evaluation.
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DISCLAIMER The information provided herein by Zane Benefits is general in nature and should not be relied on for commercial decisions without conducting independent review and analysis and discussing alternatives with legal, accounting, and insurance advisors. Furthermore, health insurance regulations differ in each state; information provided does not apply to any specific U.S. state except where noted. See a licensed agent for detailed information on your state. www.ZaneBenefits.com.
Happier Employees
With Zane’s solution, employees choose the health plan that best fits
their families' needs. Learn more.
Controllable Costs
Employers fix their costs by utilizing a
defined contribution approach.
Learn more.
More Time for Meaningful Work
Once implemented, Zane’s solution
takes less than 5 minutes per month
to administer online. Learn more.
Easy Transition
Zane Benefits’ implementation
team will ensure a smooth and fast transition for you
and your employees. Learn more.