Health Insurance Marketplaces (Exchanges)

Summary

The Affordable Care Act (ACA) introduced a new option for small business employers and individuals to access health insurance, Health Insurance Marketplaces, also called Exchanges. These online Marketplaces are established in each state and provide another way to research, compare and enroll in health insurance offered by health insurers.

There are also two types of Marketplaces within each state. One is the Individual Marketplace, where individuals can shop for insurance. And the other is for small business employers, called the SHOP Marketplace, short for Small Business Health Options Program. The SHOP Marketplace provides a place for eligible employers to explore health insurance plans and choose which level of coverage to offer their employees.

The next open enrollment period for plans offered through the Individual Marketplaces starts Nov. 1, 2018. Small business employers can enroll in a SHOP plan throughout the year.

Beginning 2017, states may permit employers in the large group market to participate.

Health plans offered through the Marketplaces are grouped into four "metal" levels: Bronze, Silver, Gold and Platinum. The levels do not mean the quality or how much care the plans provide.

Plan levels differ by how much an employee pays in monthly premiums and by what they pay in out-of-pocket expenses for medical services. For example, bronze plans have lower monthly premiums, but require employees to pay more out-of-pocket when they receive care. And platinum plans may cost more each month, but employees will pay less out-of-pocket when they receive care.

Bronze Plan: covers approximately 60% of the actuarial value of the covered benefits
Silver Plan: covers approximately 70% of the actuarial value of the covered benefits
Gold Plan: covers approximately 80% of the actuarial value of the covered benefits
Platinum Plan: covers approximately 90% of the actuarial value of the covered benefits

The Individual Marketplaces are where consumers can find out if they are eligible for federal subsidy assistance. To qualify for subsidies, individuals or families must:

Buy insurance through the Individual Marketplace
Meet household income requirements
Not have affordable health insurance available through an employer
Not be eligible for Medicaid or Medicare or enrolled in additional specified government programs

The subsidies can be used to lower the monthly premium costs, and for qualifying individuals, to reduce the out-of-pocket expenses. Subsidies or tax credits are not available to employees who get their health insurance through SHOP or their employer.

Small business tax credit

The small business tax credit is now only available to eligible employers who purchase health insurance through the SHOP Marketplaces, and is now worth up to 50 percent of their premium costs. Employers who qualify must have fewer than 25 full-time employees with average annual wages less than $50,000, and the employer must pay 50 percent of employees' premiums.

For information about your state's Exchange, visit HealthCare.gov.

Model Notice Available for Employers to Share with Employees on Exchanges

On May 8, 2013, the Department of Labor (DOL) issued Technical Release 2013-02(Opens a new window) which provides temporary guidance for employers regarding the requirement to notify employees of coverage options available through Exchanges. This Model Notice to Employees of Coverage Options is available for employers to use today if they wish. Employers were to provide the notice to current employees by Oct. 1, 2013, and to all new hires within 14 days of their hire date going forward.