Businesses, individuals and families are even more confused about where they can buy health insurance come 2014. Some think they have to buy inside the exchange. This is simply not the case. So what do you do? Get informed!
The exchanges were designed to offer a richer set of plans that most people in Chicago are used to through their employer. The government knew this going into it. On top of that, they created an incentive to use the exchange through subsidies for those who qualify. But only within the exchange. The family size and income will play a major roll on what and how much subsidy you will qualify for from the government inside the exchange. There are no government subsidies outside of the exchange.
Inside the exchange, there will be a Gold, Silver, Bronze and a Platinum plans. The insurance carriers who offer plans inside the exchange will not be required to offer all four plans. They are required to offer one gold and one silver plan. Each plan will have slightly different essential benefits.
There is no ruling on what will be available outside of the exchange, at the time of this writing. The understanding is there will be more flexibility in choosing a plan that meets your needs versus what is available inside the exchange. As of now, the non-grandfathered plans, will include more of the essential benefits that are required by the law. This could be a plan you currently have right now. An example of essential benefits is maternity coverage. The maternity benefit will be added to your plan, along with the associated costs, as well as new plans starting January 2014.
This can be a good or bad thing, depending... It is bad for that single 30 year old male entrepreneur that is unmarried. He will be paying for a benefit that he will not be able to use unless he gets married and they are having children. The flip side is a growing family does not have to wait a period of time until maternity kicks in. This will eventually have an impact on the premiums. But what won't?
The plans outside of the exchange, will have more flexibility for plan selections. If you want that $5,000 deductible because you are willing to take the risk to offset premiums, you can have it. If you want to keep your HSA plan, you can. At least at the time of this writing.
Having this flexibility will allow premiums to go down. There is talk going around the industry that the plans within the exchanges will cost you more than outside the exchange. This will give many the advantage of buying outside the exchanges at a much lower cost. Especially when you make more than the income required to qualify for the subsidy by the government.
Make sure you know your choices going into 2014. The media and your friends do not work in the industry and they could only provide one sided information. Be informed for 2014.