Health Insurance Exchanges/Marketplaces
Public Health Insurance Marketplaces are available in every state in the U.S. Also known as public exchanges, these government-run online “shopping” hubs are available for individual consumers and small businesses, with fewer than 50 full-time employees, to compare plan offerings and buy health insurance.
The Marketplaces are governed by individual states, the federal government, or a partnership between the two. Health plan options and legal standards vary by state. Read the Marketplace fact sheet to learn more about the federal rules shared by all Marketplaces.
Read the most recent Marketplace guidance:
- Final 2015 Notice of Benefit and Payment Parameters - 3/10/2014
- Hardship Exemption and Catastrophic Plans for Certain Individuals - 12/20/2013
- Aligning Individual Mandate Penalties With the Open Enrollment Period - 10/29/2013
- General Questions for Agent/Broker Federally Facilitated Marketplaces Registration - 10/2/2013
- Health Insurance Marketplace Applications Published - 9/27/2013
- Temporary Guidance on the Employee Notice of Exchange Options - 5/10/13
- Exchange Navigator Requirements Defined and "Employee Choice" Delayed for SHOP Exchanges - 4/9/13
Plan Requirements – updates and/or impacts
All Marketplace plans are certified Qualified Health Plans (QHPs) providing essential health benefits. This means each plan sold on a Marketplace must meet all the legal requirements established in the health care reform law, the Patient Protection and Affordable Care Act (PPACA). However, state-run Marketplaces may have their own health plan rules and regulations in addition to those mandated by the federal law. As a result, plans vary from one Marketplace to another; this includes coverage requirements and costs.
Individual and small group plans sold in the private market must also cover the essential health benefits required by the federal law, as well as any state requirements for any given state in which they are sold. Insurers may offer additional plans in the private market, however, these private plans cannot be purchased with federal subsidies.
Insights for Individuals
All Americans are now required to purchase health insurance as further explained on the Individual Mandate page. Health coverage can be purchased just as it always has – either through group plans, such as employer-sponsored plans, or through individual private insurance. The new option for Americans is Health Insurance Marketplaces.
Every Marketplace is required to have a website, toll-free call center, and people trained and certified to help in-person. Health and Human Services has developed a central online resource that connects Americans to their state-specific Marketplace, healthcare.gov.
Plans available on marketplaces are not free. However, they could be subsidized by tax credits based on total household income. Eligible people with lowest income levels can choose less robust plans to not owe premium payments. However, individuals offered employer-sponsored individual coverage – that meets all the federal requirements of employers – will not be eligible for a subsidized Marketplace plan.
Insights for Brokers
Brokers and agents may seek the same training and certification as Navigators and non-navigator personnel for any given Marketplace.
Certification is required to help individuals enroll in any Marketplace plan. While Navigators and non-navigator personnel are funded through the Marketplace, brokers and agents are compensated as stated in their selling agreements with respective insurance companies – unless regulated differently by the state.
There is general information about the role of agents and brokers in the Federally Facilitated Marketplace on the CMS website.
We highly recommend agents and brokers interested in becoming certified in Federally Facilitated Marketplaces review the FAQs posted by the Centers for Medicaid and Medicare Services (CMS). There are many clearly laid out details to help ensure training and certification are completed successfully.
Insights for Employers
The Small Business Health Options Program (SHOP) exchanges are established in every state to assist small employers in sponsoring health coverage for their employees. All states currently define small employers as having 1-50 full-time employees. In 2016, all states must raise the participation threshold to include employers with 1-100 full-time employees. And in 2017, states may choose to offer large group coverage through the SHOP.
There are additional impacts to large employers, with more than 50 full-time employees, to help support administration of Marketplace coverage, specifically providing a one-time Notice of Coverage Options to all employees, annual Form W-2 reporting and new annual IRS reporting of large employers and insurers of group plans. Employers will receive notification when any employee is certified eligible for subsidized Marketplace coverage – and have time to appeal such eligibility if a compliant employer-sponsored plan was offered. Employers who do not appeal subsidy certification of any full-time employee will be subject to tax penalties.
Additional Resources and Tools
Created out of the Health Care Reform law, Health Insurance Marketplaces are a new way to find and buy health coverage.
OUR MARKETPLACE PRINCIPLES
Cigna supports the development of a Health Insurance Marketplace that facilitates access to high quality and cost-effective care.
MARKETPLACES WEB MEETING
Listen to Cigna experts discuss important information and insights about Health Insurance Marketplaces.
See which states Cigna is selling individual and family health plans both on the Marketplaces and in the private market.
INDIVIDUAL MANDATE IN REFORM
Under the health care reform law, all people must have minimum essential coverage beginning January 1, 2014.
EMPLOYER MANDATE IN REFORM
Businesses must offer affordable medical insurance that provides “minimum value” to employees and their dependents.
HEALTH CARE REFORM FEES & TAXES
New fees and taxes will help fund expanded programs and services. Employers will pay some of these fees while others will be paid by insurers and individuals.
ESSENTIAL HEALTH BENEFITS
These new standards are required for individual and small group plans and may also affect large group plans.