Health Care MarketplaceNews & Research

Summary of the Health and Human Services Report on Obamacare

October 1st marks the beginning of new health insurance enrollment through the statewide health insurance exchanges. A recent report from the Department of Health and Human Services provides some insight about what coverage plans and premiums will look like in your state. The health insurance exchanges will provide a simply way to compare health insurance plans available in each state, leaving consumers more informed and prepared to make a decision regarding their coverage.

The most recent report details information about the health insurance plans available in the 36 states where the insurance exchanges will be partly or fully run by the Department of Health and Human Services for 2014. The report is primarily focused on plans with the lowest premiums in each state, since it’s expected that cost will be a critical factor in the decision-making process for individuals across the country.


Coverage Availability

The report research determined that most consumers (95%) will have a choice between 2 or more health insurance carriers. Additionally, 95% of consumers live within states with average premiums that are less than earlier estimates. Individuals will have an average of 53 health plan choices in states where HHS is partially or fully running the marketplace. Each rating area within various plan levels will have between 6 and 169 plans available.


Plan Costs: Silver Plans

For the purposes of identifying the cost of a plan that individuals and families are most likely to purchase, the researchers review the second lowest cost silver plan, finding that premiums are approximately 16% less than previously projected by the Congressional Budget Office.

  • In 15 states, the second lowest cost silver plan will cost less than $300 a month. This represents a savings of $1100 a year per plan enrollee.

  • 95% of insured individuals now available for the exchanges live in states where the average premiums are less than previous Congressional Budget Office estimations.

Young Adults and Health Coverage

Young adults will be paying lower premiums and benefit from the addition of a catastrophic plan that covers primary care, prevention, and high costs incurred as a result of illness or a major accident.

  • The average lowest monthly premiums for a 27-year-old individual in 36 states will be $129 for a catastrophic plan, $163 for a bronze plan, and $203 for a silver plan.

  • More than half of currently uninsured individuals live in states where a 27-year-old can purchase bronze plans for less than $165 a month before tax credits.

  • It’s estimated that there are 6.4 million uninsured Americans between the ages of 25 and 30 who will now be eligible for coverage through Medicaid or insurance exchanges in 2014

Takeaway Data From The HHS Report

There are several key aspects determined in the study that are worth noting.

  • Premiums are lower in states where there is more plan competition and higher levels of transparency.

  • For 27-year-old individuals, premiums on the lowest bronze plan range between $130 and $250 per month before the tax credits.

  • For a family of four with an income of $50,000, the lowest bronze plans range between $0 and $192.


Start comparing insurance rates for the new Marketplace today.

New Healthcare Marketplaces: Transforming Coverage For The Better

With all of the news coverage surrounding the Affordable Care Act over the past few years, one of the most heavily-discussed aspects of healthcare reform has been the state exchanges where consumers will be able to shop for coverage. Health insurance “marketplaces” will be the primary location where individuals and families across the country will be able to research and purchase health insurance coverage.

The goal of the exchanges is to function as a “one stop shop” for those seeking coverage. That doesn’t mean that consumers are left completely on their own in the process, however. Agents with experience in the health care market, in addition to nonprofit organizations at the community level, will be on hand to assist the many new purchasers throughout the process. The exchanges have opened as of October 1st, and they will open for re-enrollment at the same time next year. Those who wish to have health insurance coverage in place by January 1st, 2014, however, should visit the health insurance exchanges prior to that date.

Affordable Choices in One Location

The healthcare marketplaces will allow consumers and their families to explore healthcare plans within their budgets. Set up with a wide variety of choices, consumers will be able to compare plans side by side and determine which options represent the best plans for them. With the assistance of nonprofits and experienced agents, the process will also provide background educational information for those seeking coverage.

In the past, attempting to parse through comprehensive information on healthcare plans involved reading very dense and confusing information, which further discouraged some individuals and their families from obtaining coverage. With the new health insurance exchanges, all information about approved plans has been collected and shared in one central location, giving applicants an opportunity to learn about everything that’s available before making a commitment. You’ll be able to review information about benefits, plans, deductibles, and co-pays in your area to identify a program most appropriate for you.

Easy Application Procedures

Once you’ve explored the healthcare plans approved in your state, you can move forward with the application process to get your healthcare set up quickly. Marketplaces provide information about applying online, by mail, or in person. Part of the implementation of the Affordable Care Act includes assistance from qualified helpers and individuals known as Navigators, who can provide more information and help in choosing a final plan. Plans are set up in three categories known as bronze, silver, gold, and platinum, making it even easier to break down the application process.


Subsidies For Low Income Patients

Individuals and families with lower incomes will have subsidies to help them afford the coverage offered through the health insurance marketplaces. Maximum monthly premiums are set at $57 for an individual with a yearly income of $17,235. Those with limited income may be eligible for expanded Medicaid benefits, too, depending on the state. To learn more about what you may be able to receive to support your healthcare, check out the tax credit calculator or call our customer service help line.


Health Care Marketplaces: They Work Overseas

As states across the nation prepare for their health care marketplaces to go live, it’s worth recognizing that some other countries already provide interesting examples of exchanges in action. Although the state exchanges have received a lot of media attention in the U.S. as far as potential impact and organization, the idea isn’t entirely new.In fact, exchanges are not completely fresh in the U.S., either. The eHealthInsurance website has been in operation since 1997, a living example of an electronic health insurance products sold in the individual market. Utah and Massachusetts also already operate their own forms of health insurance exchanges.
The drive to get all states on board with current health insurance exchange goals of operation by October 1, however, has been a challenge for some. There are several aspects of the existing and impending changes in health care reform that are similar to programs in other countries, which helps provide a window into the experiences and a basic guideline of what implementation might look like here. Two such examples are the Netherlands and Switzerland.
Mandating Universal Coverage With Basic Insurance Plans 
The Netherlands implemented this universal coverage mandate in 2006, built on their prior system of social and private insurance. The Swiss, too, have a mandate that has been in place even longer, since 1996. As a result, the numbers of uninsured individuals are low, and the government helps to subsidize about 40% of the population through premium assistance.
Regulation of Markets, Including Open Enrollment and Community Rating 
Guaranteed offer and renewal are both part of the systems in Switzerland and the Netherlands. The two countries each have their own approach, however, to setting premiums, risk equalization, and market oversight. The exchange program in Switzerland is region-based, much like how the U.S. system will operate.
  • In the Netherlands, plans operate on either a for-profit or non-profit basis. The top five plans make up 82% of enrollment. Children are provided full coverage through public funds. Plans generally offer coverage all over the country
  • The Swiss system is more decentralized, and only nonprofit insurers are allowed into the marketplace. The 10 largest carriers cover 80% of the population. 


National Standards For Coverage 

Benefits in both the Netherlands and Switzerland are comprehensive, with insurance systems combining working age and elderly populations into one pool. Switzerland has higher rates of cost-sharing. Individuals in both countries are highly likely to get supplemental coverage, which isn’t regulated by the same level of restrictions.


Successes Of Health Insurance Exchanges

Both the Swiss and the Dutch can lay claim to some success with their health insurance exchanges. Universal health coverage in both places has extended options to everyone, allowing a broad range of access and patient choice. Both countries also are connected with some of the longest life expectancies around the world, and the citizens in Switzerland and the Netherlands are also extremely positive about the health insurance exchange programs. The other benefit for the citizens in each country is that the government has taken an evolving approach to care, constantly seeking opportunities to improve the coverage and maintenance of the exchanges.

Best Ways to Maximize Tax Credits In the New Health Care Marketplace

The main reason that so many people don’t currently have health insurance stems from the fact that most middle class families simply can’t afford the high cost of monthly premiums. The new Affordable Care Act will make health insurance as affordable as possible for families. To offset the high cost of premiums, the government has created tax credits to help the average family pay for coverage. There are some tricks you can use to ensure that you’ll get the maximum amount of tax credits that you deserve.


#1  Don’t Assume Your Ineligible for the Subsidies

Just because you and your spouse make a decent wage, it doesn’t mean you won’t qualify for any of the tax credits that have been created to off set the cost of health insurance. Based on the current government standards, a family of four that has an average household income of $94,200 will qualify for some tax credits.


#2  Don’t Mention the Possibility of Wage Increases

When applying for the tax credits it’s important to remember that the government wants an estimate of your 2014 earnings. Be very careful about how you report this. If you work at a salaried job, you can use the amount of money that you earned in 2013 to calculate your anticipated earnings in 2014. Unless a yearly wage increase has been mentioned in your work contract, don’t anticipate one, and don’t mention the possibility of your getting a wage increase, even one to cover increased cost of living, until the additional money starts to show up on your weekly paychecks.


#3  Wait Until after January 1, 2014 to Apply for a Second Job

If you’re considering the possibility of taking on freelancing work or an additional part time job, you should put these plans on hold until after the first of the year. The government can’t expect you to consider any earnings you haven’t begun to earn.


#4   Check Other Benefit Programs

You or your child may get free or low-cost coverage through Medicaid or the Children’s Health Insurance Program CHIP.


#5  If You’re Considering the Possibility of Having a Child in 2014, You Need to Report it

The more people you have in your family, the higher the tax credit you receive will be. If a baby is on the way, or if you fully intend to try to have a baby during 2014, you will want to include this information when you apply for your tax credits. Since having a child means additional medical expenses, you want to make sure you have the proper coverage.


#6  Consider Catostrophic Insurance

If you’re under 30 you’re eligible for this special, low cost insurance. Don’t expect to get much coverage, but you won’t get the tax penalty at the end of the year and you’ll be covered in case you have a traumatic injury.


You want to get the best possible tax credit, but be careful, you shouldn’t try to cheat the system. At the end of 2014, the IRS will look at the amount of money you made, and determine if the tax credit you received was much higher than you deserved. If they determine that you were credited too much, you could have to make up the difference.


Those Who Will Benefit Most From the Affordable Care Act

Although there are many benefits available through the Affordable Care Act, such as greater access to numerous preventive health care services, a wide range of choices through the state health insurance exchanges, and coverage opportunities for everyone, there are certain customers who will reap the most benefits from the implementation of the various pieces of the act. The underlying premise of the health care reform is to provide all Americans with access to high-quality medical care. Below are those that will benefit most and be sure to check the latest rates here.


Patients With Pre-Existing Conditions

In the past, insurance companies have denied coverage as a result of pre-existing conditions. Under the healthcare reform program, insurance companies are forbidden from denying coverage on application for pre-existing conditions. The goal of this stipulation is to ensure that even those individuals with a health history or medical condition will be able to get the coverage and assistance they need.


Those Who Want Preventive Care

Previously, it might have been too expensive for individuals to get preventive care and tests that could help promote overall wellness to catch medical issues before they developed into bigger problems. Now that a wide battery of preventive services and tests must be covered in health insurance plans, it will be much easier to get the regular appointments and treatments that can help you live a healthier and longer life. This is one way in which the new healthcare reform will likely have the biggest impact. A better understand of preventive care and greater affordability for obtaining these services will benefit a broad range of patients across the country.


Those With No Existing Health Coverage

The greatest push for the Affordable Care Act was drawn out of statistics about how many Americans were unable to afford coverage of their own. When coverage was simply out of reach, many individuals were not able to access regular and affordable care. Unfortunately, for some of these individuals, without consistent physicals and routine care, serious medical conditions developed and grew worse over time. As part of the Affordable Care Act, Americans and their family members will be able to shop through a wide range of healthcare plans that will align with their individual needs and budgets. Those who may have gone without health care coverage in the past will reap the benefits of access to health care plans ideal for them.


Low-Income Individuals and Families

Since the Affordable Care Act is intended to make coverage affordable for everyone, there are subsidies for families that quality. If your income falls a certain threshold under the poverty line, you may also be eligible for expanded coverage in the Medicaid program. At this time, not every state is participating in this Medicaid expansion, so you can learn more about where your state comes down on the issue by checking out this site. The Kaiser Family Foundation has conducted research determining that as many as 48% of Americans purchasing individual insurance may be eligible for subsidies from the government. If you earn up to 40% of the federal poverty line, you’ll be eligible for a subsidy (in real dollars, that’s about $45,960 for an individual and $94,200 for a family of four.)

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