Health Insurance Exchanges

By October 1, 2013, Exchanges must be operational in each state to begin Open Enrollment for the 2014 plan year. The Exchange will make it easier for small businesses with fewer than 50 employees and individual consumers to compare plan offerings and buy health insurance.

A state may operate the Exchange on its own (a state-based Exchange), share operational functions with the federal government (a State Partnership Exchange) or allow the federal government to operate the Exchange within the state (a Federally-Facilitated Exchange).

There are many factors being considered in developing each Exchange. While we watch how the implementation of Exchanges unfolds, leading up to the initial Open Enrollment period beginning this October, we can count on a few rules, such as:

• A small business and individual Exchange must be established, though an Exchange could decided to establish a single Exchange that serves both markets.
• Each state must establish an individual and a small business Exchange. States may choose to establish a single Exchange that serves both markets.
• Exchange governing boards must be publicly accountable, transparent and have technically competent leadership among other rules regulated by the Department of Health and Human Services.
• Any plan offered on an Exchange must be a Qualified Health Plan (QHP) - an insurance plan certified by the Exchange through which it’s offered. And, all plans must provide essential health benefits.
• Plans will be available within a level of cost sharing that best fits the needs of those individuals and small business seeking a plan on the Exchange. The cost share levels are also referred to as the Actuarial Value, and are distinguished by metal levels.

Metal Plan level	Cost Share/Actuarial Value
Bronze	60%
Silver	70%
Gold	80%
Platinum	90%
Catastrophic (individual only)	Up to age 30 or exempt from mandate

  Exchanges Timeline

Health and Human Services expects 25 million Americans to buy health insurance through exchanges. About 19 million could qualify for a subsidy to help pay for their coverage.

Individuals Who Might Use the Exchange

Cigna supports Exchanges that focus on health care quality and costs. The required deadlines for states to determine their intent and readiness to open Exchanges provide a clearer view of which states plan to develop their own state Exchange. Many states have requested federal partnership to help operate their Exchanges.

Exchange Type By State
Forecast for 2014