1. Purchasing ACA Insurance
Webinar

2. Individual Marketplace
Health Insurance Purchasing Options
Traditional
Market
Individual Marketplace
SHOP
Continue to do business as you do today- purchasing insurance through a Medical Mutual Sales Representative, a broker or other insurer
Online System
The Open Enrollment period for coverage is November 15, 2014 through February 15, 2015
Special Enrollment Period if have a Qualifying Life Event
Online System
Online enrollment begins Nov – enrollment via broker or insurer
Ability to choose a plan (Medical Mutual allows employer to offer two plans)
Employer tax credits available

3. ACA Metal Plans
Have you ever wondered what is meant by metal plans? It can be complicated with a lot of things to consider. Such as:
Plan Category - There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic. Plans in these categories differ based on how you and the plan share the costs of your care. The categories have nothing to do with the amount or quality of care you get.
Benefits - All plans sold through the Marketplace provide the same essential health benefits (EHB), cover pre-existing conditions and offer enhanced preventative services. But some plans offer additional benefits.
Provider Network - Some types of plans allow you to see almost any doctor or health care facility. Others limit your choices to a network of doctors and facilities, or require you to pay more if you use providers outside the network. (Medical Mutual offers their entire provider network regardless of how you purchase coverage)

4. Individual and Group Metal Plans
ACA-compliant plans are required to offer Metal-level products that include all the required essential health benefits.
Metal-level plans are based upon the percentage of the total allowed cost of benefits paid by a health plan on average (Actuarial Value):
Platinum 90%
Gold 80%
Silver 70% (includes subsidy variations)
Bronze 60% of Actuarial Value (Each can vary +/- 2%)
Catastrophic less than 60% (only available if under 30 years old or have a hardship exemption.

5. The Individual Health Insurance Marketplace
Metallic levels and actuarial values
Target + or –2%
Applies in small group market in and out of Marketplace
Exchanges must offer a silver/ subsidized silver and gold plan
90%
actuarial value
80%
actuarial value
70%
actuarial value
60%
actuarial value
Plans falling between the defined levels are NOT permitted
Actuarial value is the percent of total spending on EHB that is paid by the health plan
Except for bronze (63/50)

6. Choosing a Plan Category
When choosing a category of Marketplace plans, choose a plan that fits your budget and meets your expected health care needs.
Expecting heavy plan usage - You may want to consider a Gold plan or Platinum plan. These plans generally have higher monthly premiums but pay more of your costs when you need care.
Infrequent plan usage - You may want a Silver, Bronze, or Catastrophic plan. These plans cost you less per month, but pay less of your costs when you need care.
Save on out-of-pocket costs - You may qualify for lower out-of-pocket costs based on your household size and income. If you do, you can get these out-of-pocket savings only if you enroll in a Silver plan. If you make this choice you'll basically get the lower out-of-pocket costs of a Gold or Platinum plan while paying a Silver plan premium.
Under 30 or have a hardship exemption –You may want to take advantage of lower monthly premiums by choosing a catastrophic plan designed to protect you from worst-case scenarios, like serious accidents or diseases.

7. Health Insurance Marketplace
Online information resource portal where individuals and small businesses can purchase insurance
Compare plans and metal levels side by side
Tax credits and subsidies for individuals available only via the Marketplace
Shop enrollment is through the carrier

8. Purchasing from an Insurance Carrier
Insurance carriers provide access to ACA plans for individuals and small groups
Many insurance carriers have developed online portals that allow individuals and small businesses to shop their plans by metal level
To purchase insurance directly from a carrier, visit their website or call them to inquire
Medical Mutual can be reached at

9. Purchasing via the SHOP Exchange
Small Business Health Options Program (SHOP)
Online resource for small businesses with fewer than 50 employees to purchase insurance
Tax credits and subsidies available for small businesses that:
Pay at least 50% of the employee premiums
Have fewer than 25 employees
Have an average annual wage of less than $50k (not including the owner)
Online enrollment unavailable until November 2014
Employers able to choose one plan for their employees at this time

10. Resources
COSE Medical Mutual Small Business Resource Center: (440)
COSE Member Services Department: (216) (non- health insurance questions)
COSE Health Care Reform home page: cose.org/healthcarereform