Q&A with Cori Loomis
California's health exchange
offers look at how it works
Q: In February, California was the first state health exchange to announce what individuals can expect to get from the health plans offered under the Affordable Care Act. What is a health insurance exchange?
A: A health insurance exchange is a structured, online marketplace for the sale and purchase of health insurance. Individuals and small businesses will be able to shop and compare prices and benefits for insurance. They will operate similar to websites that allow individuals to find airline travel options and buy tickets.
Q: Will Oklahoma sponsor a health insurance exchange?
A: No, Oklahoma has decided not to set up a state exchange. Instead, individuals and small businesses in Oklahoma will be able to shop for insurance on an exchange established by the federal government. All exchanges, both state and federal, are required to carry out many of the same functions and adhere to many of the same standards, although there may be some differences. Open enrollment is scheduled to start on Oct. 1, with coverage offered effective Jan. 1.
Q: Will cost assistance be available for individuals who buy health insurance through the exchange?
A: Yes, to make coverage more affordable, certain individuals will receive premium assistance in the form of tax credits. In addition, some recipients of premium credits also may receive subsidies toward cost-sharing expenses. An individual is eligible for a premium credit if he/she has a household income between 100 percent and 400 percent of the federal poverty level. For 2013, that ranges from $11,490 to $45,960 for an individual and $23,550 to $90,200 for a family of four. In addition, the individual cannot be eligible for employer-sponsored insurance that is affordable as defined by the Affordable Care Act. An individual who qualifies for the premium credit and is enrolled in what is referred to as the “silver” plan through an exchange, also will be eligible for a cost-sharing subsidy.
Q: How do the insurance exchanges affect Medicaid coverage?
A: The Affordable Care Act's Medicaid and exchange provisions originally were intended to work in tandem with each other to provide a continuous source of subsidized coverage for low- to middle-income individuals and families. As originally enacted, the ACA required states to expand Medicaid eligibility to individuals under age 65 with income up to 133 percent of the federal poverty level. Currently, Oklahoma has elected not to expand Medicaid. Therefore, some low-income individuals still may not be able to afford health insurance coverage, even with the premium credits and subsidies.
PAULA BURKES, BUSINESS WRITER