Only twenty-four states have been approved to set up their own health insurance exchanges leaving the federal government to run the other 26. We don’t know yet what they will look like but we do know there will an overwhelming range of choices for millions of people who have never had to choose their own health insurance before.
Most Americans are covered by employer-sponsored insurance or by government-provided insurance such as Medicare, Medicaid, or the Children’s Health Insurance Program. Only a small percentage buys their own individual private coverage. The Congressional Budget Office projects that 26 million people will buy health insurance on the exchanges by 2022.
Initially one of the options on the exchanges was for small groups (employers with less than 50 employees) the ability to purchase group coverage for their employees with an employee choice option. HHS recently announced a proposal to delay the employee choice portion by one year. States may still choose to offer this option but for the states that will be offering the Federal Plan, it appears there will be a delay until January 1, 2015 to allow significant time for this option to be finalized.
What to Expect From the Exchanges
They will offer choice. The Act requires four levels of coverage to be offered: bronze, silver, gold, and platinum. As the names imply, they go from bare-bones coverage to the full works.
They all have to cover a package of what are called ‘essential health benefits’. Essential health benefits include free preventive screening services for certain cancers, immunizations, and maternity and birth control benefits; they can’t turn you away because you have been sick before or are a certain age; they can’t charge you more if you are a woman, or from a certain ethnic group; and they can’t stop providing coverage just because you become expensive.
Some people who now have health insurance may end up paying more. According to Robert Zirkelbach, spokesman for America’s Health Insurance Plans, “Even some people who are eligible for subsidies may have to pay more out of pocket for their premiums.”
And new taxes on health insurance will cost each family about $350 a year starting in 2016, Zirkelbach says, citing an analysis by the nonpartisan Joint Committee on Taxation, because the insurers are certain to pass along the expense to their customers.
Insurers may only charge older people three times as much as they charge the youngest customers. “That means young people are going to pay more, just to cover older people,” Zirkelbach says.
Health insurance costs will vary by state, by age, by what coverage the policy offers, by whether a person smokes, and by which providers and hospitals take part.
