Public Health Insurance Marketplaces are available in every state in the U.S., and open for enrollment for plans beginning January 1, 2014. Also known as public exchanges, these government-run online “shopping” hubs are expected to make it easier for individual consumers and small businesses, with fewer than 50 employees, to compare plan offerings and buy health insurance.
The Marketplaces are being developed by individual states, the federal government, or a partnership between the two. While we watch their implementation unfold we can better understand how the legal standards will play out. Read the Marketplace fact sheet to learn more about these rules.
Map of Marketplace Type by State
Read the most recent Marketplace guidance:
- 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
- Proposed Rule on Exchanges, Health Insurance & More - 1/23/13
Plan Requirements – updates and/or impacts
All Marketplace plans will be 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 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 may vary from one Marketplace to another; this could affect the costs of the Marketplace plans, as different coverage requirements can increase or decrease rates.
Individual and small group plans sold in the private market must also cover the essential health benefits required by PPACA, 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 plans cannot be purchased with federal subsidies.
Insights for Individuals
To date, most Americans are unclear about what is required of them and available to them with regard to the purchase of health insurance starting January 1, 2014. Details of these requirements can be found on the Individual Mandate page. What is certain is 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 the marketplace will not be free. The purchase of these plans 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 shared responsibilities required of employers –will not be eligible for a subsidized Marketplace plan.
Insights for Brokers
Certification programs are expected to be up and running for all Marketplaces. While Navigators and non-navigator personnel will be trained and certified within each Marketplace, brokers and agents may also seek training and certification.
Certification is required to help individuals enroll in any Marketplace plan. While Navigators and non-navigator personnel will be funded through the Marketplace, brokers and agents will be 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 recent FAQ 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. Until 2016, states have the option of defining a small employer as having 1-50 or 1-100 employees. All states currently define small employers as having 1-50 employees. In 2016, all states must raise the threshold to include employers with 1-100 employees for participation. And in 2017, states may choose to offer large group coverage through the SHOP.
There are indirect impacts to large employers, with more than 50 full-time employees, to help support individuals who choose to apply for Marketplace coverage, specifically the Form W-2 reporting and providing a Notice of Coverage Options to all employees. Employers will also 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 to that same employee.