One of the major changes under the Affordable Care Act (Obamacare) are the new health exchanges, which will offer another option for coverage for consumers. An exchange will provide a menu of standardized plans that have met certain government criteria and are subject to government regulation. The plans in the exchange will be eligible for federal subsidies to help lower their costs.
States are required by Obamacare to either establish exchanges (known under the acronym of HIX) of their own, or allow the federal government to create an exchange for that state,. Health insurance companies will have the option to market plans within the exchange, but don't have to.
The plans that will be offered cannot deny coverage on the basis of a preexisting condition, and all of them are required to offer an affordable basic benefit package including prevention features.
Four levels of benefits will be provided designated by "metallic" plans-platinum, gold, silver and bronze, with platinum plans having the richest benefits. The plans will pay benefits based on actuarial values. The insured will pay the rest of the amount, based on predetermined deductibles, co-insurance and co-pays,
Platinum plans will have an actuarial value of 90%, gold will have an actuarial value of 80%, silver will have an actuarial value of 70% and bronze will have an actuarial value of 60%. A catastrophic plan will be offered that has limited benefits and will only be available to individuals under the age of 30 or to those with financial hardships.
The start up date for the new exchange plans is slated to be October 1, 2013. Applications that are submitted between October 1, 2013 and December 15, 2013 will be assigned a January 1, 2014 effective date. Open enrollment will begin after December 15, 2013, and continue until March 31, 2014. Applications that are submitted between the first and fifteenth day of the month will have the first day of the following month assigned as the effective date. If the application is submitted between the sixteenth and the last day of the month during open enrollment, the coverage effective date assigned will be the first day of the second following month.
If someone buys a plan through the exchange, they will be eligible
for federal subsidies to help pay for that plan, as long as they meet
certain income qualifications. If a consumer is between 100% and 400% of
the federal poverty level (FPL), their health insurance premium cost
will be based on a percentage of their income.
Annual Premium Not To Exceed Percentage of Income
Up to 133% FPL
2% of income
133 to 150% FPL
3 to 4% of income
150% to 200% FPL
4 to 6.3% of income
200 to 250% FPL
6.3% to 8.05% of income
250 to 300% of FPL
8.05% to 9.5% of income
300% to 400% FPL
9.5% of income
Federal poverty limits vary by family size. The following table illustrates the income that falls between 100% and 400% of FPL depending on family size.
Income Between 100% and 400% FPL
$10,830 to $43,336
Family of 2
$14,470 to $58,280
Family of 3
$18,310 to $73,240
Family of 4
$22,050 to $88,200
Some assistance in sharing the cost of the insurance will be offered to those individuals who purchase health insurance through the exchange and meet income levels between 100% to 250% of the federal poverty level, the individual must enroll in at least a silver plan in order to qualify for cost sharing, in addition to meeting the FPL requirements. A 2/3 reduction in premium will be available for individuals with incomes between 100% and 200% of the FPL, . the reduction will be either 1/2 or 1/3 depending on income for the remaining individuals between 200% and 250%.
Individuals with incomes between 100% and 150% of FPL will benefit from plans with an actuarial value of 94%. . Those with income levels between 150% and 200% will be insured by plans with an actuarial value of 87%. Insurance coverage will be offered at 73% actuarial value for individuals with annual income of 200% to 250%.
Related Page: Updated
Guide to 2016 Arizona Health Exchange Options
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