Federal Versus State Exchanges

Summary: The health insurance exchanges (marketplaces) are to begin open enrollment October 1, 2013 for coverage to become effective in 2014. Where can one find the official information for both state versus federal exchanges?

Learn more about Federal Versus State Exchanges

Health Insurance Exchanges are marketplaces for those who are uninsured to seek insurance coverage. The marketplaces are up to the individual states as to whether to establish a state-sponsored exchange or participate in the federally-sponsored exchange. Currently, 17 states have elected and begun setting up their exchanges while the remaining states have opted for the federal exchanges.

Healthcare.gov (www.healthcare.gov) is the official site for the latest information on the exchanges. As such, there is a lot of valuable information. Some things to consider/checklist when researching insurance include:

Definitions to differentiate between co-payments, deductibles, co-insurance, and maximum out-of pocket deductibles
Checklist for income related information required to purchase insurance through the exchanges
- Social security numbers
- Income information for each family member (W-2, payment stubs, etc)
- Policy numbers for current health insurance policies
- Completed employer coverage tool
- Know your budget allotted for health insurance to help choose a plan that is “affordable”
- Know different options available such as Medicaid and Medicare

Pricing information will be available on www.healthcare.gov as of October 1, 2013, but general information can be accessed prior to this date.

Federal Exchanges

United states

Following are the states which have elected not to setup state-sponsored exchanges and therefore by default will use the federally-sponsored exchanges.

Alabama	Louisiana	Ohio
Alaska	Maine	Oklahoma
Arizona	Michigan	Pennsylvania
Arkansas	Mississippi	South Carolina
Delaware	Missouri	South Dakota
Florida	Montana	Tennessee
Georgia	Nebraska	Texas
Illinois	New Hampshire	Utah
Indiana	New Jersey	Virginia
Iowa	North Carolina	West Virginia
Kansas	North Dakota	Wisconsin
		Wyoming

State Exchanges

For those states that have elected to setup state-sponsored exchanges, each state has their own official site which will contain the plans, insurance companies, premiums, out-of-pocket expenses, and other benefits. Each will also have calculators to assist you in calculating based upon many factors what plan is right for you (and your family if applicable) and identify whether or not you and your family qualify for subsidies.

State	Marketplace	Official Website
California	Covered California	http://www.coveredca.com/
Colorado	Connect for Health Colorado	http://www.connectforhealthco.com/
Connecticut	Access Health CT	http://www.accesshealthct.com/
District of Columbia	DC Health Link	http://dchealthlink.com/
Hawaii	Hawaii Health Connector	http://www.hawaiihealthconnector.com/
Idaho	Your Health Idaho	http://www.yourhealthidaho.org/
Kentucky	Kentucky Health Benefit Exchange	http://kynect.ky.gov/
Maryland	Maryland Health Connection	http://www.marylandhealthconnection.gov/
Massachusetts	Health Connector	https://www.mahealthconnector.org/portal/site/connector
Minnesota	MNsure	http://mn.gov/hix/
Nevada	Nevada Health Link	http://www.nevadahealthlink.com/
New Mexico	New Mexico Health Insurance Exchange	http://www.nmhix.com/
New York	New York State of Health	http://healthbenefitexchange.ny.gov/
Oregon	Cover Oregon	http://www.coveroregon.com/
Rhode Island	HealthSource RI	http://www.healthsourceri.com/
Vermont	Vermont Health Connect	http://healthconnect.vermont.gov/
Washington	Washington Healthplanfinder	https://www.healthcare.gov/what-is-the-marketplace-in-my-state/#state=washington

Penalties for the Uninsured

So what is the big deal with the exchanges? Do they really apply to you? Well, they do if you are currently uninsured. As of 2014, most Americans who do not have health insurance coverage will face penalties which can be quite steep depending upon your income. These penalties are slated to increase at least through 2016.

The penalty phases in over three years and becomes increasingly severe. In 2014, the penalty will be 1 percent of annual income or $95, whichever is greater. By 2016, the penalty will be 2.5 percent of income or $695. This means that if you do not have coverage in 2014, you will be required to pay a penalty when you file your taxes at the end of the year.

Health Insurance Penalty Phase-In Schedule Pay the greater of the two amounts
Year	Percentage of Income	Set Dollar Amount
2014	1%	$95
2015	2%	$325
2016	2.5%	$695

Stay tuned as we continue to bring you late-breaking news on the exchanges and how they affect you.

About BHM Healthcare Solutions – www.bhmpc.com

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development. Follow BHM Healthcare Solutions for more information about Federal Versus State Exchanges.