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What is a health insurance exchange?

What is a health insurance exchange?. A health insurance exchange is an organized marketplace for customers to shop for health insurance based on price and quality. Like a. or. for health insurance. The cereal aisle. Why do we need to organize this marketplace?.

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What is a health insurance exchange?

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  1. What is a health insurance exchange? A health insurance exchange is an organized marketplace for customers to shop for health insurance based on price and quality. Like a or for health insurance.

  2. The cereal aisle Why do we need to organize this marketplace?

  3. Income Eligibility for Medicaid or Exchange Subsidies Family Income as % of Federal Poverty Line (FPL) People in this income bracket will receive help with premiums. People in this income bracket, enrolled in the Exchange, will receive help with premiums and out-of-pocket expenses.

  4. Who qualifies for aid? • An individual earning up to $43,560 a year or a family of four earning up to $89,400 • Lower earners may also be eligible for additional aid for out-of-pocket expenses. a year will be eligible for subsidies to help pay premiums. *2011 Federal Poverty Level as determined by annual income; will change when Exchange opens in late 2013

  5. How the Tax Credits Work Tax credits can be used by individuals and families making between 100% and 400% of the federal poverty level (a family of 4 earning $22,350 to $89,400 a year) Eligible individuals and families who use the Exchange will pay a percentage of their income for insurance, ranging from 2% to 9.5%(contribution goes up as income goes up) Older Americans who face higher premium costs will receive higher tax credit Individuals and families who choose a less expensive plan will pay less Tax credit is paid up-front to insurers – so Americans benefit right away

  6. Tax Credit Examples * 1. Family of Four with Income of $50,000, Purchases Benchmark Plan • Income as a Percentage of FPL 224% • Premium Cost for Benchmark Plan: $9,000 • Tax Credit: $5,430 • Premium Cost for Plan Family Chooses: $9,000 • What Family Pays: $3,570 2. Family of Four with Income of $50,000, Purchases Less Expensive Plan • Income as a Percentage of FPL 224% • Premium Cost for Benchmark Plan: $9,000 • Tax Credit: $5,430 • Premium Cost for Plan Family Chooses: $7,500 • What Family Pays: $2,070 * Source: U.S. Department of Treasury Aug. 12 2011 announcement

  7. Tax Credit Examples * 3. Family of Four with Income of $50,000, Parents are between ages 55 and 64 • Income as a Percentage of FPL 224% • Premium Cost for Benchmark Plan: $14,000 • Tax Credit: $10,430 • Premium Cost for Plan Family Chooses: $14,000 • What Family Pays: $3,570 * Source: U.S. Department of Treasury Aug. 12 2011 announcement

  8. Helping Small Businesses Qualifying small businesses with up to 25 full-time employees can receive tax credits to help pay employee premiums. The tax credit will be up to 50 percent of the premium cost in 2014.

  9. Exchange will provide world-class customer experience 1 2 3 Web portal to shop and compare choices Call center for assistance with eligibility and subsidies Navigators for face-to-face customer support

  10. Wisconsin’s Exchange Website

  11. Massachusetts and Utah have active Exchanges

  12. SB200: The Colorado Health Benefit Exchange Act of 2011 • The Colorado General Assembly passed Senate Bill 200 in May 2011. • SB 200 establishes the framework for the Colorado Health Benefit Exchange. • The Exchange will be governed by a Board of Directors. • A legislative implementation review committee will also monitor Exchange operations. 

  13. 2011 Exchange Milestones

  14. 2011 Workgroups EVE MEOW Eligibility, Verification, and Enrollment How can we create a “no wrong door” approach in the exchange? Marketing Education and Outreach Work Group How do we find and enroll our customers into the exchange? DAWG SEWG Data Advisory Work Group How do we use data and economic modeling to determine who are the potential customers in the exchange? Small Employer Work Group How can we best serve small businesses in the exchange?

  15. Develop web portal and customer service functions • Create policies for finance, audit, and prevention of fraud • Test all systems 2012-2014 Exchange Timeline • Develop Navigator program • Certify benefits and health plans 2014 Launch 2012 2013

  16. Contact Information Colorado Health Insurance Exchange henneberryj@coloradohealthinstitute.org www.coloradohealthinstitute.org/cohiex www.colorado.gov/healthreform Live in November: www.getcoveredco.org @JoanHenneberry #COHBE 720.382.7074

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