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Understanding Health Insurance Marketplaces: Fast Facts
Posted By Michael Zuna On October 18, 2013 @ 2:00 pm In Employment | 3 Comments
We’ve been talking about it for months and it’s finally here. October 1 has come and gone, making it open enrollment season, and your employees are officially able to enroll in the Health Insurance Marketplace if that is the direction you decided to take your benefits.
Although you might be done with the preparatory messaging and employee outreach, you’re still in the midst of answering questions as your employees work to determine if they want to obtain coverage through the marketplace. We’re willing to bet they have a lot of questions.
According to the 2013 Aflac WorkForces Report, three out of four (76 percent) are not very/not at all knowledgeable about federal and state health care marketplace. That’s why we have compiled a list of key details business leaders need to understand  about health insurance marketplaces and the impact they will have on employer-sponsored benefits in 2014.
Health insurance marketplaces (also known as an exchange) are a Web portal where individuals and businesses can shop for and buy health insurance. The two marketplaces that will impact employee benefits are:
The Marketplace coverage will go into effect on Jan. 1, 2014.
Most anyone can use the Health Insurance Marketplace operating in their state to explore health insurance options, even if they already have insurance. Individuals must be U.S. residents, U.S. citizens (or lawfully present), and not currently incarcerated.
Small businesses with 100 or fewer full-time equivalent employees  can also use the marketplaces. However, states can choose to keep the limit to those with 50 or fewer full-time equivalent employees through 2016.
Private health insurance marketplaces offer health coverage options to multiple workforce sizes. Additionally, they can sell all products and services, including voluntary insurance. Many private health insurance marketplaces can help employers to move toward a defined contribution model that can help control health care costs, while still providing employees robust benefits  (PDF) options through a defined contribution.
Individuals or small businesses may be eligible  (PDF) for tax credits or subsidies through the state or federal public health insurance marketplaces. The purpose of this is to help offset the cost of coverage and defray some costs associated with using health care services.
What does this mean?
These plans pay approximately 70 percent of covered medical expenses or actuarial value. “Silver” is one of four levels of coverage offered in the marketplace. Each level varies depending on the proportion of medical expenses the insurance plan is expected to cover:
Silver is the benchmark for calculating subsidies, though individuals can “buy-up” to other plan levels, as well as dental coverage.
Since employees are able to purchase health insurance coverage directly through the health insurance marketplaces, it is important for them to understand their coverage options and health risks.
The Affordable Care Act required businesses to tell employees about the Health Insurance Marketplace and potential eligibility  for tax credits or subsidies. But, ultimately, employees are responsible for deciding how to spend their health care dollars.
Use this open enrollment season as an opportunity to further educate your workforce about the marketplace and other health care-related changes.
Healthcare  Photo via Shutterstock
This material is intended to provide general information about an evolving topic and does not constitute legal, tax or accounting advice regarding any specific situation. Aflac cannot anticipate all the facts that a particular employer or individual will have to consider in their benefits decision-making process. We strongly encourage readers to discuss their HCR situations with their advisors to determine the actions they need to take or to visit HealthCare.gov (which may also be contacted at 1-800-318-2596) for additional information.
Article printed from Small Business Trends: http://smallbiztrends.com
URL to article: http://smallbiztrends.com/2013/10/health-insurance-marketplaces-facts.html
URLs in this post:
 key details business leaders need to understand: http://smallbiztrends.com/2013/09/employee-health-care-questions.html
 Small businesses with 100 or fewer full-time equivalent employees: http://smallbiztrends.com/2013/10/health-care-reform-small-business-owner.html
 benefits: http://www.booz.com/media/uploads/BoozCo-Emergence-Private-Health-Insurance-Exchanges.pdf
 eligible: https://www.fas.org/sgp/crs/misc/R42663.pdf
 tell employees about the Health Insurance Marketplace and potential eligibility: http://smallbiztrends.com/2013/10/health-insurance-open-enrollment-employees.html
 Healthcare: http://www.shutterstock.com/pic-43047004/stock-photo-a-pile-of-cash-being-examined-with-a-stethoscope-for-signs-of-life-image-is-good-for-medical-or.html