State Health Insurance Marketplaces

As of January 1, 2014, there is a new way for individuals, families, and small businesses to get health insurance: the Health Insurance Marketplace. These Marketplaces also are referred to as Exchanges. Marketplaces are a location where you can go to find health insurance coverage.

Whether an individual is uninsured or just wants to explore new options, the Marketplace is designed to give consumers more choice and control over shopping for health insurance coverage, by helping them find health insurance that fits their budget, with less confusion and hassle.

Most people who do not have insurance through an employer can use the Health Insurance Marketplace to explore their health insurance options. There are only three requirements to get insurance through the Marketplace:

• Individuals must live in the United States
• Individuals must be a U.S. Citizen or or lawfully present
• Individuals cannot be currently incarcerated

Consumers have a choice between purchasing several different plans in these Marketplaces. However, all health insurance companies that want to sell their plans through the must offer the following standardized plan levels: platinum, gold, silver, bronze, and catastrophic. The difference between these plan levels is the amount of money that your health insurance plan pays for your medical costs (cost-sharing).

• Platinum: plan pays 90%; you pay 10%
• Gold: plan pays 80%; you pay 20%
• Silver: plan pays 70%; you pay 30%
• Bronze: plan pays 60%; you pay 40%
• Catastrophic plans are only to individuals under thirty years old and those exempt from the individual mandate.

For more information, visit HealthCare.gov

Every state has a Marketplace, but each state’s Marketplace operates a little differently. States can create and run their own Marketplace, or have a Marketplace run by the U.S. Department of Health and Human Services (HHS). States also may choose to partner with HHS to run their Marketplace. The following chart show where states are today.

Definitions:

State Marketplace: States are responsible for all Marketplace functions.  Therefore, in these states, individuals as well as small employers and their employees in these states apply for and enroll in coverage through Marketplace websites maintained by the states.

Federally-Facilitated Marketplace: Health and Human Services (HHS) responsible for all Marketplace functions. Therefore, in these states, individuals as well as small employers and their employees apply for and enroll in coverage through healthcare.gov.

State-based Marketplace-Federal Platform: States are responsible for most Marketplace functions, except for the technology aspects. Therefore, in these states, individuals as well as small employers and their employees apply for and enroll in coverage through healthcare.gov.