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The Health Benefit Exchange ------------------------------ A Tool for Transparency and Competition in Health Insurance.

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Presentation on theme: "The Health Benefit Exchange ------------------------------ A Tool for Transparency and Competition in Health Insurance."— Presentation transcript:

1 The Health Benefit Exchange A Tool for Transparency and Competition in Health Insurance

2 Welcome & Introductions Tonights speakers: Tom Bunnell, NH Voices for Health Mike Goudzwaard, Working Families Win Introductions around the room: Please state your name and briefly why you are interested in the health benefit Exchange

3 What is an Exchange? A health benefit Exchange is a health insurance supermarket that will give individuals and small businesses in New Hampshire more choice about what insurance plans they buy and how much they pay for coverage. Each state must have a fully operating Exchange by January 1, 2014.

4 Where Did the Idea Come From? Exchanges were originally endorsed by conservative think tanks like Heritage Foundation and former Massachusetts Governor Mitt Romney and were discussed during the 1994 health care reform debates. The idea was not utilized then, but became a key point in the new health law, the Affordable Care Act.

5 Exchange: One Stop Shops An Exchange could be a one-stop shop to find and compare affordable, quality health insurance options for families and small businesses. Exchanges add new transparency to the market so that consumers will be able to compare plans based on price and quality. Exchanges hold the promise of making coverage more affordable by increasing competition between insurance companies and allow individuals and small businesses to band together to purchase insurance.

6 Who Will Use It, and When? The new health law calls for each state to have a fully operational health benefit Exchange in At that time, the constituencies served by the Exchange will start to shop for and buy health insurance coverage through it, including: Individuals and families Small businesses w/ fewer than 50 / 100 employees Members of Congress and their staff Note: Undocumented immigrants will be barred from buying insurance in the Exchange.

7 The way it is now …

8 … and the way it will be. A supermarket of health insurance options!

9 Details: How It Works The law says that health insurance plans sold on the Exchange must follow certain rules: Cost should be more affordable Quality must be good Choices of insurance plans and what each plan offers must be clear

10 Details: How It Works Web-Based – Program available online for interested consumers; other options available for users who do not have access or are not computer savvy ADVOCACY POINT: Ensure walk-in centers available Comparison Tool – Different health insurance plan options, what they offer and what they cost will be posted Summary of Benefits – Each insurance company will be required to provide a summary of the benefits of the plans they are offering, using a standardized format so information is easily comparable across carriers and plans. Uniform Glossary of Terms - A uniform glossary of terms commonly used in health insurance coverage, such as "deductible" and "co-pay.

11 Summary of Benefits


13 Details: How It Works Plan Levels. To help make purchasing insurance easier and less confusing, plans will be divided into four different types, based on the level of benefits: Bronze Silver Gold Platinum Small businesses will be able to allow their employees to choose among all plans in a plan level. The Exchange may also allow employers to make just one plan available or to offer their employees choice of: All plans in the entire Exchange; or Some other combination of plans.

14 Details: How It Works

15 Customer Service Center and Navigators to help consumers understand and select coverage options ADVOCACY POINT: Ensure navigators are armed with information about other health options to promote the no wrong door approach and to ensure tax credits, etc are utilized properly.

16 Details: How It Works Medicaid. The new health law ensures people with incomes up to 133% FPL are eligible for Medicaid. In 2014, people will be able to apply for Medicaid using a simple application through the health benefit Exchange. Family SizeMaximum Income 1$14,400 3$24,352

17 Details: How It Works Families. If your income is less than 400% federal poverty level (FPL) and you dont have access to affordable coverage through your employer, you will be able to get a tax credit if you buy your health insurance through the Exchange. Family SizeMaximum Income 1$43,320 2$58,280 3$73,240 4$88,200

18 Details: How It Works Small businesses. Starting in 2010, up to 4 million small businesses that offer health care coverage to their employees became eligible for a tax credit. Starting in 2014, they will continue to access those credits by buying their health insurance through the Exchange. To qualify, a small business must: 1) Have fewer than 25 full-time equivalent employees 2) Pay average annual wages below $50,000 per FTE 3) Contribute at least 50% of each employee's premium

19 Fun Fact About Exchange Most Americans will continue to get insurance through their jobs, not via the Exchange. However, the Congressional Budget Office estimates 11.5 million people will use the health benefit Exchange in 2014 and 27.1 million in 2018.

20 Making It Happen: Exchange Advocacy Locally & Nationally States can choose to operate their own exchanges or participate in a multi-state exchange. If New Hampshire chooses not to create its own Exchange, the federal government will set one up for the state.

21 Exchange Planning Across U.S.

22 Exchange Advocacy Opportunities – Your Voice Needed! Community Education Forums Letters to Editor, etc. Weighing in on Early Decision-Making – including Senate Bill (SB 163), Federal Regulations, Listening Sessions Submitting / signing onto written statements Participating in public forums and hearings Contacting your Federal and State Officials

23 Major Challenges/ Key Advocacy Points Creating a State-Run Exchange Governance Structure of the Exchange Navigators

24 Questions and Answers Time for questions about the health benefit Exchange or the planning and implementation process. Followed by break-out groups on advocacy options.

25 Small Groups Personal Reflection (5 minutes) Please consider the following questions: What part of the health benefit Exchange most excites you? What part of the health benefit Exchange are you most concerned about protecting/advancing? Group Reflection (10-15 minutes) Please take group notes to submit to facilitator.

26 For More Information… NH Voices for Health: join our mailing lists for updates or attend our learn about the law, new provisions as they are released, and search coverage options Kaiser Health Reform Gateway: learn about the law

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