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Business Q&A: Health exchanges explained

Cori Loomis, a health care attorney with Crowe & Dunlevy in Oklahoma, talks about California's announced health care exchange and what's coming for Oklahoma.
by Paula Burkes Modified: March 12, 2013 at 7:20 pm •  Published: March 13, 2013
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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.

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by Paula Burkes
Reporter
A 1981 journalism graduate of Oklahoma State University, Paula Burkes has more than 30 years experience writing and editing award-winning material for newspapers and healthcare, educational and telecommunications institutions in Tulsa, Oklahoma...
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