Health Care Exchanges: A Look at Phase II of the Affordable Care Act, and the Maryland Market Place

Thursday, October 3rd, 2013

Tuesday, October 1st 2013 marked a momentous day in the history of the Affordable Care Act (ACA). It was on this day that the ACA (colloquially known as Obamacare) officially entered Phase II by launching the online insurance exchanges, or, the Marketplace.

Over the last year, the staff of M&L has published a number of different blogs that focus on the ACA and the ways in which the regulations and rules can affect your family with special needs. One of our articles, titled Back to Basics: Obamacare for Individuals with Disabilities  took a look at the Act as a whole, and examined the ways in which the legislation pledged to meet its goal of making health care insurance accessible and affordable for all Americans. Another article, titled Obamacare: Changes to Expect in 2013, focused on the parts of Phase I that were implemented, or scheduled to be implemented, in 2013. Yet another article, titled Obamacare and the Money Follows the Person Program took a look at a program which is very beneficial to individuals with disabilities, and the ways in which the ACA affects the services offered under this program. For any of you who are unfamiliar with the ACA, and the ways that it can affect your family, all of our blogs that focus on the ACA can be accessed by visiting our blog archives.

Today, however, we will be examining Phase II of the ACA and the launch of the Marketplace.

Phase II – What is it?

As we mentioned, the primary goal of the ACA is to ensure that healthcare insurance was accessible and affordable to all Americans. According to recent press releases and literature, the ACA was designed to roll out in two phases – phase one tackled ensuring that healthcare insurance was accessible. This meant enacting a number of different regulations, such as the elimination of the pre-existing condition clause, extending the age of coverage on parental insurance plans to 26, and eliminating the insurance coverage cap that many insurance companies put in place, among others. To summarize, Phase I targeted individuals who already had insurance, but who lost it (for a variety of reasons).

Phase II is focused on ensuring that insurance is affordable – it also focuses on expanding access to the millions of Americans who are presently without any form of healthcare insurance. The ACA proposes to achieve – and, in fact, is implementing methods to achieve – that goal by launching the Healthcare Insurance Exchanges, commonly known as the marketplace.

What is the Marketplace?

The marketplace is, essentially, online shopping for healthcare insurance plans. As President Obama explained in his speech on September 26th, many Americans do not currently have insurance because they are unemployed, employed by small businesses who could not afford the premiums, or self-employed. For individuals who shop for insurance privately, the premiums are much higher as the risk is determined on the basis of the individual, and not spread out amongst a larger group. The marketplace will change that, as the companies who are signed on will be spreading the risk among all residents of a particular state, thus reducing the premiums for everyone. The Marketplace has been described as “a place where individuals, families and small businesses can compare and enroll in health insurance, as well as determine eligibility for Medicaid and other assistance programs, federal tax credits and cost-sharing reductions.” As President Obama put it, “It’s a website where you can compare and purchase affordable health insurance plans, side-by-side, the same way you shop for a plane ticket on Kayak — same way you shop for a TV on Amazon. You just go on and you start looking, and here are all the options.”

As aforementioned, the marketplace officially launched on October 1st, and President Obama declared that it will proceed as planned, regardless of the current government shutdown. If you currently have health insurance, you don’t need to participate in the marketplace. If you don’t, it is important to enroll, as beginning in 2014 most individuals without healthcare insurance are subject to a fee.

How do I use/enroll in the Marketplace?

The easiest way to figure out how to use the marketplace is to visit the www.healthcare.gov website, and read through the various “how-to guides” that currently are in place to keep Americans informed about the new regulations under the ACA, and advise them on how to enroll in health insurance plans through the marketplace.

For those of you who are interested, however, here is a brief rundown:

Each state has its own marketplace. It is important to note that due to the Supreme Court ruling on the ACA, state participation in creating their marketplace is voluntary. 17 states volunteered to design their own, 7 formed a partnership with the federal government and shared the creation of the marketplace, and 27 declined to enroll, meaning that their marketplaces were designed solely by the federal government.

In order to find your state’s marketplace, visit the healthcare.gov/marketplace/individual website, and enter your state. You will then be directed via a link to that state’s marketplace, where you can create a username and password and fill out an application. Based on the information contained in your application, you will be advised if you qualify for private insurance plans, or Medicaid and Children’s Health Insurance Plan (CHIP).

If you qualify for private insurance plans, you will be directed to browse through the plans offered in that marketplace – these plans are categorized by premium, co-pay, and coverage. All plans offered under the marketplace have to cover these essential services:

  • Ambulatory Patient Services
  • Emergency Services
  • Hospitalization (surgery)
  • Mental Health and substance use disorder services, including behaviour health treatment
  • Prescription Drugs
  • Rehabilitative & habilitative services /devices (that help with injuries, disabilities, or chronic conditions)
  • Laboratory Services
  • Preventative and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

All plans are categorized under four levels of coverage, and you will be able to compare these plans side by side. According to President Obama, many of these plans are available for a monthly fee that will be less than a monthly cell phone bill.

For more information on the marketplace, how to enroll, and the plans you may qualify for, please click here.

Maryland’s Marketplace

Maryland was one of the 17 states that voluntarily designed their own marketplace. The Maryland Health Connection will offer residents of MD the opportunity to enroll in 40 commercial, qualified health plans, which are categorized into the four levels, in ascending order: bronze, silver, gold and platinum.

The bronze level, which contains plans with lower premiums and higher co-pays, offers 11 options. The platinum level (higher premiums and lower co-pays) offers 3, while the middle levels, silver and gold, offer 16 and 12 respectively. As you may have noted, the plans are categorized according to premiums and co-pay; deductibles and other costs that consumers have to pick up are also considered.

The plans offered under the Maryland Health Connection all cover the essential services as outlined above and are provided by six insurance carriers in the state, including CareFirst Blue Choice of Maryland, Kaiser Foundation Health Plan, All Savers, and Evergreen Health Cooperative.

It is important to note that unlike other state marketplaces, the Maryland Health Connection will not be available for small businesses (up to 50 employees) to shop for plans for their workers until January.

For more information on the Maryland Health Connection, you can contact the central consumer support center by calling the toll free line: 855-642-8572 Monday to Friday, 8:00 a.m. to 6:00 p.m. You can also visit the Maryland Health Connection website, www.marylandhealthconnection.gov.

Need Help? Contact Us!

If you have any questions regarding the Marketplace and how it can help you and your family with special needs gain or improve your healthcare insurance coverage, please contact us! We are able to advise families as to the insurance plans that best suit the needs of all family members, and can provide guidance concerning the various government programs available to individuals with disabilities.

Thank you so much for dropping by our blog today – we hope this information on the Marketplace helps you to better understand and utilize the newest component of the Affordable Care Act. Have a great Thursday!

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