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Exchanges

Will Exchanges Improve the Healthcare System?

If you have not heard much about the Exchanges there is a reason. Both the Conservatives and the Liberals like them. The exchanges are expected to improve the current system in a number of ways:

  1. Standardization – Plans sold through the exchange by different insurance companies must be a like in benefits at specific tiers of coverage so people can make “apples-to-apples” comparisons between the plans.
  2. Increased Choice – there will be 4 choices of plans
  3. Consumer Protection – Each plan must cover “essential health benefits” this will bring confidence that they are not being sold an inferior policy
  4. Economics – Because the exchanges will be places where hundreds of thousands of consumers shop, they will foster healthy, competition among insurance companies. And this should bring prices down as quality goes up in the future.(this is the hope)

Four Standardized Plans: Bronze, Silver, Gold and Platinum.

All four plans will be required to include “Essential health benefits” What exactly are “essential health benefits”?

After this minimum level of benefits is met the tiers of insurance coverage will differ based on their “actuarial value.” This is the amount of financial coverage that the plan offers, on average to its participants. The Bronze plan will offer the lowest amount of coverage, with 60% of medical cost covered on average, followed by the Silver plan at 70, the Gold plan at 80% and the Platinum plan at 90%. The Bronze plan will cost the least and the Platinum the most.

A Range of Exchange Subsidies

Financial assistance from

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the federal government will be offered through the exchanges to all Americans who qualify. It will come in two forms both of which will lower the price of the health insurance plan that a person buys.

  • Lower PremiumsLower
  • Out-of-Pocket Limits

Lower premiums
Subsidies will be provided based on where a person’s income level falls on the sliding scale. Those whose income falls in the bottom of the scale or 133% of the federal poverty line will receive the most government assistance and those whose income reaches the top of the scale (the ceiling is 400% of the poverty line) will receive the least. Those whose income exceeds the ceiling level will not receive and subsidies.

Lower Out of Pocket Limits

Government assistance on the exchanges is also provided in the form of lower out of pocket limits, which are the levels, that an individual or family must pay before their insurance plan begins to cover their medical expenses. The baseline

out of pocket limit on each exchange is equal to the out of pocket limit for Health Savings Accounts (currently $5,950 for individuals and $11,900 for families)

A dis lowered from that ceiling level according to where an income level falls in the range. In 2010 dollars this means that a family with an income that falls in the lowest range(100 to

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199 % of the federal poverty level) will reach its out of pocket limit at $3,967- or 33% of the amount for a Health Savings Account($11,900) used by a high income family.

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