The Health Insurance Marketplace: Helping some Americans pay for health care

If you are one of millions of Americans under age 65 who will purchase a health plan this fall through the Health Insurance Marketplace (exchange), you may be eligible for a $0 premium plan or a new kind of tax credit that lowers your monthly premiums.

The Health Insurance Marketplace is a website designed to determine if you are eligible for financial help to cover your health insurance costs. It also will help you and your family shop for and purchase health insurance. Americans may also contact the Health Insurance Marketplace by telephone.

A Health Insurance Marketplace is being set up in each state, either by the state itself, by the federal government, or in Arkansas' case, in partnership with the federal government. Each marketplace will be responsible for:

  • Creating and maintaining a consumer shopping website.
  • Providing access to all information necessary to determine if you are eligible for help paying for your premium or if you qualify for free coverage.
  • Helping consumers shop for and purchase health plans.
  • Making sure all health plans offered on the marketplace meet all the new regulations.

The Health Insurance Marketplace will be open October 1 for people to purchase coverage that begins January 1.

Why buy on the marketplace?

Many Americans will be eligible to receive advance premium tax credits (subsidies) if they purchase a health plan through the marketplace. An advance premium tax credit is a new tax credit that you can use to lower your monthly premium costs beginning January 1, 2014. (see chart below to see if you might qualify.)

The amount of the advance premium tax credit that each household will receive is calculated by using their income, the size of their family and other factors. This new tax credit helps lower- and middle-income families. Some households, based on their income, will receive additional financial assistance when they receive medical care.

Essential health benefits

Every health plan sold to small employer groups and individuals on the Health Insurance Marketplace must include a core set of benefits established by the law. Many of these services are covered today by health plans sold by Arkansas Blue Cross. Others, such as preventive care and mental health services, are available to purchase as options, but going forward, those will be required.

The essential health benefits are included in the following 10 categories:

  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

In addition, these essential health benefits must be covered with no annual or lifetime dollar limits. Preventive services, including women's preventive care and birth control must be paid 100 percent by the health plan.

Metallic plans

People often found that it was difficult to compare what their total cost would be from one plan to the next. It was easy to compare the monthly payments (premiums) but it was difficult to compare how much you would pay out of pocket for medical services. In an effort to make it easier for people to determine what they will pay for medical services, the health care law standardized the health plans on and off the Health Insurance Marketplace. Because these health plans are called Bronze, Silver, Gold and Platinum, they are referred to as Metallic Plans.

For instance, the lowest level of coverage, called the Bronze plan, is designed to cover 60 percent of your total health care costs. A person purchasing a Bronze plan will pay more when they receive health care but less month to month (their premium). A person purchasing a Platinum plan will pay more month to month, but pay less at the doctor’s office. (See chart below.)

Because the law requires that insurance companies offer plans that only fit these levels, they are no longer allowed to offer plans that don’t fit the requirements. For instance, you won’t be able to purchase a plan to cover 75 percent of your medical costs. As a result of this regulation, health insurance companies will have to reduce the options available to small employers and individuals.

Arkansas Blue Cross can estimate any advance premium tax credits you may be eligible to receive and can help you select a health plan. You can buy an Arkansas Blue Cross plan on and off the marketplace. Call us at 1-800-310-3778 or come in for a health insurance review.

Metallic Coverage Levels