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Health Insurance Exchanges: Cheap Health Insurance for Everyone? Posted: May 17th, 2010

By Maryalene LaPonsie

After all the discussion and debate, health care reform may have created just as many questions as it answered. Let's take a closer look at the promised health insurance exchanges, and answer your most pressing questions.

Do I have to get insurance now?

No. The individual mandate doesn't go into effect until 2014. The individual mandate means every legal resident of the United States must carry health insurance or face government fines.

What if I can't find health insurance?

By 2014, states must set up health insurance exchanges so that those with pre-existing conditions can find health insurance. If your state doesn't have one in place by then, the federal government will administer one for your state.

What is a health insurance exchange?

The overall operation of health exchanges isn't clear yet. The Department of Health and Human Services created an Office of Health Insurance Exchanges to develop a framework of rules and regulations. Health insurance exchanges are likely to be a competitive marketplace where consumers can shop for affordable medical insurance.

Who can run an exchange?

According to the Patient Protection and Affordable Care Act, a governmental agency or non-profit entity must run health insurance exchanges. Although the state must establish the exchange, the state can delegate the administration to a non-profit organization.

Who can purchase coverage through a health insurance exchange?

Any individual or family not covered by an employer group plan, Medicare, or Medicaid may purchase health insurance through a health insurance exchange.

Can I get free health insurance through a health exchange?

No. However, the federal reform did expand Medicaid eligibility, and many families can find free health insurance through that program.

What if I still can't afford insurance through the exchanges?

The government will provide subsidies to families whose income ranges from 133 to 400 percent of the federal poverty limit. Currently, the federal poverty level for a family of four living in the 48 contiguous states is $22,050. Limits for Hawaii and Alaska are higher. Using the current figures, a family of four earning up to $88,200 a year would be eligible for a subsidy when buying cheap medical insurance through a health insurance exchange.

What sort of coverage will I get?

One concern with any cheap health insurance is whether you will actually receive valuable benefits. To prevent insurers from selling "junk" policies, the law requires benefits meet four plan levels determined by the Secretary of Health and Human Services.

According to the Kaiser Family Foundation, those plan levels are:

  • Bronze: Provides benefits equal to 60 percent of the expected cost of claims from an average individual
  • Silver: 70 percent coverage
  • Gold: 80 percent coverage
  • Platinum: 90 percent coverage

Insurers may also offer catastrophic plans that offer limited benefits to those under the age of 30.

Do the plans include dental and vision coverage?

The law does not require all plans offer dental and vision coverage. Consumers who buy health insurance through the exchange should compare plans to determine whether vision benefits are included.

However, the act does require that exchanges allow plans with limited scope adult dental benefits if certain children's care is covered.

Can I buy coverage if I have a pre-existing condition?

Yes. Starting in 2014, the Patient Protection and Affordable Care Act prohibits all insurers from denying coverage to those with pre-existing conditions. In addition, the Kaiser Family Foundation reports plans included in the health insurance exchanges must meet certain marketing standards. These standards make sure companies don't discourage those with ongoing medical needs from enrolling.

Is anyone exempt from the health insurance mandate?

If you can't find cheap medical insurance -- insurance with premiums less than 8 percent of your income -- you do not have to purchase health insurance.