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Health Care Reform:

Health Insurance & Affordable Care Act

Your Guide to the New Insurance Marketplaces

WebMD News from Kaiser Health News

By Mary Agnes Carey

Mon, Sep 16 2013

By Julie Appleby

The health law's online marketplaces, also known as exchanges, will be open for enrollment Oct. 1.  They will allow individuals and consumers to comparison shop for health insurance, much like they do now online for an airline ticket or a hotel room, and apply for subsidies, if they are eligible.

If done well, proponents say, the marketplaces could make it easier to buy health insurance and possibly lead to lower prices because of increased competition. But, if designed or marketed poorly, the exchanges will not attract healthy people and will instead be left with a higher percentage of sicker people that will cause premiums to rise.

Here are some answers to common questions about the exchanges:

What is an exchange?

It's an online marketplace where individuals and small employers will be able to shop for insurance coverage. Enrollment begins Oct. 1 for policies that will go into effect on Jan. 1. The exchanges will also help people find out if they are eligible for federal subsidies to help cover the cost of coverage or if they are eligible for Medicaid, the federal-state health insurance program for the poor.

Will all states have exchanges?

Yes. Sixteen states and the District of Columbia are running their own exchanges and the federal government is setting them up in 27 states. In seven states, federal and state officials are partnering to run the exchanges. You can get information about the exchange at https://www.healthcare.gov/, which has details on the federal exchanges and links to state-run exchanges.

Who will use the exchanges?

Most people will be able to purchase coverage on the exchanges. But many workers and their families already have coverage through their jobs, and they will not be likely to buy policies on the exchanges. The marketplaces are primarily aimed at people who are uninsured and those whose employer-based coverage is too costly and/or lacking in benefits.

Most states and the federal marketplace also will offer a Small Business Health Options program, or SHOP exchange,  that will give employees more options than they have now. Initially, these SHOP exchanges will be open only for businesses with 50 or fewer workers. 

Who cannot buy coverage there?

Immigrants who are in the country illegally will be barred from buying insurance on the exchanges. Legal immigrants are permitted to use the marketplaces and may qualify for subsidies if their income is no more than 400 percent of the federal poverty level (about $46,000 for an individual and $94,200 for a family of four.)

If my employer offers me insurance, can I shop on the exchange to get a better deal?

Even if your employer offers coverage, you can opt to buy a plan on the exchange. However, you may not be eligible for a subsidy unless you make less than 400 percent of the federal poverty level and your employer's plan covered less than 60 percent of allowed medical expenses or cost more than 9.5 percent of your household income.

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