What is an exchange?
It’s an online marketplace where individuals and small employers will be able to shop for insurance coverage. You can get information at www.healthcare.gov, which has details on the federal exchanges and links to state-run exchanges. The exchanges will also help people find out whether they are eligible for federal subsidies to help cover the cost of coverage or eligible for Medicaid, the federal-state health insurance program for the poor.
Will all states have exchanges?
Yes. Some states will run their own, and in others, they will be set up by the federal government; in several states, the exchange will be a federal-state partnership.
Who will use the exchanges?
They’re aimed at people who are uninsured, people who don’t get coverage through their employer and those whose employer-based coverage is too costly and/or lacking in benefits.
But not everyone will be allowed to buy from the exchanges, right?
Right. People who are in the country illegally will be barred. Legal immigrants are permitted to use the marketplaces and may qualify for subsidies if their income is no more than 400 percent of the federal poverty level (about $46,000 for an individual and $94,200 for a family of four).
Most workers and their families already have coverage through their jobs, and they will not be likely to buy policies on the exchanges. However, for businesses with 50 or fewer workers, the federal marketplaces and most states will have a Small Business Health Options program, or SHOP exchange, that will give employees more options than they now have. Most states and the federal marketplaces will allow only businesses with 50 or fewer workers to purchase through the exchanges initially.
How will the process work?
If you have a computer, it’s relatively straightforward. You can go online to Healthcare.gov or to your state-run exchange, if there is one, and create an account. Then you would fill out an application and provide information such as household size, location, income and citizenship status.
Then the exchange takes over. It first determines whether you are eligible for Medicaid; if so, it will refer you there. If not, it will tell you how much of a subsidy you can receive. (These subsidies will be sent directly by the government to the insurer to pay a portion of the premium.)
After that, the exchange will show you a list of health plans and their premiums and out-of-pocket costs, including deductibles and co-payments. If you decide to buy one of those plans, in most cases, you will be directed to the insurer’s Web site to make the payment. In some jurisdictions, consumers will make their first premium payment to the exchange and then further monthly payments to the insurer.