Health Care Reform: Health Insurance Exchange Plans

Obama Signs Health Reform

Medical insurance is about protecting yourself or your family from the unexpected. Currently, you are not required to carry health coverage, but starting in 2014, the Health Care Reform law mandates most Americans and legal residents to get medical coverage or pay a penalty. Health Reform plans are not available yet, but if you would like to have insurance protection in place now, you can obtain quotes for plans that are currently in place by entering your zip code to the right and clicking 'Go'. Otherwise, you can wait up until 2014 when the Affordable Care Act is implemented. At that time, health insurance for individuals and small businesses can be obtained either privately, or through "exchanges". Quotes for health reform plans are available starting October 1, 2013, for an effective date of January 1, 2014.

Health Insurance Exchanges

Affordable Insurance Exchanges ("exchanges") are being developed as part of the Health Care Reform mandate. They are intended to make getting health insurance more convenient and affordable. They are state-based, online markets where individuals and small businesses with less than 50 employees may:

  • Find out if they qualify for tax credits on health insurance exchange plans, or government-sponsored programs for individuals and families.
  • Comparison-shop for medical plans offered by different carriers.
  • Enroll for exchange health plans.

Health Insurance Exchange Plans

Health insurance exchange plans are medical coverage policies, similar to what we have now. Individual-Family and Small Group medical plans will still be offered by health insurance carriers. You can choose from a series of plan options that vary in premiums and out-of-pocket costs for medical services, plus preventive care visits that will be no charge. What sets apart exchange health plans is that they offer government subsidies or tax credits. For more information on the tax credits available under the Affordable Care Act, click Health Reform Tax Credits.

In compliance with the Health Care Reform law, different insurance companies are developing exchange health plan proposals to submit to the state for approval. As such, they are not yet available to preview. However, what is known is that they must meet certain state requirements, to qualify as exchange plans. These plans will be referred to as 'metallic' plans, and categorized as "platinum", "gold", "silver", or "bronze" plans, to show the graduated levels of coverage.

Benefits Covered under Health Insurance Exchange Plans

In 2014, the Affordable Care Act requires all health plans to include certain medical services, called "Essential Health Benefits", whether the policy is a health insurance exchange plan or a policy purchased outside of the Exchange. Insurance carriers are busy drafting coverage policies that meet the essential health benefits requirement, while also weighing the cost for providing coverage for the additional benefits. Following are the 10 essential health benefits:

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