State Health Exchange Consumers Guide

Here is a list compromised of questions we have received from readers on the State Health Exchanges.

Q: State Health Exchange, What exactly is it ?

Starting on October 1, 2013 every state within the US will have in place a state health exchange, or health insurance market place. Each state made a decision on how their exchange would operate.  The State or the US Government will manage the exchange. At the bottom of this article is a list of the States Health Exchange that will be managed by the States.

State Health Exchanges will begin taking applications on October 1, 2013, with an effective benefit date of January 1, 2014.  The State Health Exchange will be a simple online market place for all state resident interested in purchasing health insurance.  Everything will be easily managed on the health exchange site. All costs will be display throughout the site to ensure you have a very precise idea of how much the various plans will cost you; additionally no insurance company can deny you coverage for any pre-existing condition.

Q: State Health Exchange What will it be like ?

Have you ever purchased a plane, train or bus ticket online? Well think of the insurance exchange the same ways, except you will be purchasing health insurance. There will be various health plans based on what you willing or want to pay. Most middle-income individuals will be able to pick from a variety of health plans by private insurers. Individuals with lower income will be provided the options of Medicaid. There are several states that have chosen not to expand Medicaid. The individuals in those states must abide by the states Medicaid eligibility rules. Use our subsidy calculator to see if you would be eligible for a subsidy based on current income standards.

Q: Who is eligible to receive a subsidy to purchase insurance?

The government will provide a subsidy for individuals within a certain income bracket, other lower income individuals will be geared toward Medicaid expansion, please use our subsidy calculator to calculate your eligible subsidy amount.


Q: State Health Exchanges, are the health plans any good?

It depends on what you are comparing the plans to. If you are comparing the plans to what is available to individuals trying to purchase private health insurance on their own because they may have lost their jobs, or are uninsurable? Then the plans will definitely be more comprehensible and reflect what you would get if you worked for a small business. Premiums may still be high, but there are various subsidies and tax credits available to help offset the costs to individuals and families.

If you are comparing it to you current health insurance through work or another provider, the State Health Exchange may provide your more options and choices with regards to plans then your employer can at costs that maybe much lower than what you pay at your employer. However middle-aged and older adults maybe charged more on the exchange than young people, which is something that is not often done at your employer.

Q: What type of service will the plans from the State Health Exchanges offer?

Every plan that is part of the State Health Exchange must offer the essentials, these essentials are referred to as “essential benefits” The essential benefits include; Wellness and Preventative services, Doctors Visit, Prescription drugs, Emergency room coverage, hospitalization, maternal and newborn coverage.


Q:  If every plan has to offer “essential benefits”, what makes the plans on the State Health Exchanges different?

While each State Health Exchange plan is required to offer the “essential benefits”, the amount of cost sharing and premiums will vary. The plans will be categories in four tiers, Bronze, Silver, Gold, and Platinum

Bronze health insurance plan:

The Bronze Health Insurance plan will cover 60% of the expected cost of care. This plan will charge the lowest annual premium, however it will also have the largest annual deductibles

Platinum health insurance plan:

The Platinum Health Insurance plan will cover 90% of the expected cost of care. This plan will charge the highest annual premium, however it will have the small out of pocket cost for medical care.

Silver & Gold Health Insurance plan

Silver & Gold Health Insurance plan will cover 60%-90% of the expected cost of care, and fall somewhere between the Bronze and Platinum plans in regards to annual out pocket cost-sharing

Q.  What states will have their own State Health Exchange 

In October 2013 the following state as of February 21, 2013 will run their own State Health Exchange, click the link to open the State Health Exchange information site for each state.



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