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What is a health insurance exchange?
A health insurance exchange is an organized marketplace for customers to shop for health
insurance based on price and quality.
Like a or for health insurance.
The cereal aisle
Why do we need to organize this marketplace?
Income Eligibility for Medicaid or Exchange Subsidies
People in this income bracket will receive help with premiums.
People in this income bracket, enrolled in the Exchange, will receive help with premiums and out-of-pocket expenses.
Fam
ily In
com
e as
% o
f Fed
eral
Pov
erty
Lin
e (F
PL)
Who qualifies for aid?
Persons in Family 100% FPL* 133% FPL 250% FPL 400% FPL
1 $10,890 $14,484 $27,225 $43,560
2 $14,710 $19,564 $36,775 $58,840
3 $18,530 $24,645 $46,325 $74,120
4 $22,350 $29,726 $55,875 $89,400
5 $26,170 $34,806 $65,425 $104,680
6 $29,990 $39,887 $74,975 $119,960
7 $33,810 $44,967 $84,525 $135,240
8 $37,630 $50,048 $94,075 $150,520
• An individual earning up to $43,560 a year or a family of four earning up to $89,400
• Lower earners may also be eligible for additional aid for out-of-pocket expenses.a year will be eligible for subsidies to help pay premiums.
*2011 Federal Poverty Level as determined by annual income; will change when Exchange opens in late 2013
How the Tax Credits WorkTax credits can be used by individuals and families making between 100% and 400% of the federal poverty level (a family of 4 earning $22,350 to $89,400 a year)
Eligible individuals and families who use the Exchange will pay a percentage of their income for insurance, ranging from 2% to 9.5% (contribution goes up as income goes up)
Older Americans who face higher premium costs will receive higher tax credit
Individuals and families who choose a less expensive plan will pay less
Tax credit is paid up-front to insurers – so Americans benefit right away
Tax Credit Examples *
1. Family of Four with Income of $50,000, Purchases Benchmark Plan
• Income as a Percentage of FPL 224%• Premium Cost for Benchmark Plan: $9,000• Tax Credit: $5,430• Premium Cost for Plan Family Chooses: $9,000• What Family Pays: $3,570
2. Family of Four with Income of $50,000, Purchases Less Expensive Plan
• Income as a Percentage of FPL 224%• Premium Cost for Benchmark Plan: $9,000• Tax Credit: $5,430• Premium Cost for Plan Family Chooses: $7,500• What Family Pays: $2,070
* Source: U.S. Department of Treasury Aug. 12 2011 announcement
Tax Credit Examples *
3. Family of Four with Income of $50,000, Parents are between ages 55 and 64
• Income as a Percentage of FPL 224%• Premium Cost for Benchmark Plan: $14,000• Tax Credit: $10,430• Premium Cost for Plan Family Chooses: $14,000• What Family Pays: $3,570
* Source: U.S. Department of Treasury Aug. 12 2011 announcement
Helping Small Businesses
Qualifying small businesses with up to 25 full-time employees can receive tax credits to help pay employee premiums.
The tax credit will be up to 50 percent of the premium cost in 2014.
Exchange will provide world-class customer experience
1Web portal to shop and compare choices
2Call center for assistance with eligibility and subsidies
3Navigators for face-to-face customer support
Wisconsin’s Exchange Website
Massachusetts and Utah have active Exchanges
SB200: The Colorado Health Benefit Exchange Act of 2011
• The Colorado General Assembly passed Senate Bill 200 in May 2011.
• SB 200 establishes the framework for the Colorado Health Benefit Exchange.
• The Exchange will be governed by a Board of Directors.
• A legislative implementation review committee will also monitor Exchange operations.
2011 Exchange Milestones
Colorado receives planning grant
Enabling legislation passed (SB200)
Operations grant proposal submitted
2011 Workgroups
EVEEligibility,
Verification, and Enrollment
How can we create a “no wrong door” approach in the
exchange?
DAWGData Advisory Work Group
How do we use data and economic modeling to
determine who are the potential
customers in the exchange?
MEOWMarketing
Education and Outreach Work
Group
How do we find and enroll our customers into the exchange?
SEWGSmall
Employer Work Group
How can we best serve small
businesses in the exchange?
2012-2014 Exchange Timeline
Create policies for finance, audit,
and prevention of fraud
Certify benefits and health plans
Develop web portal and customer
service functions
Develop Navigator program
Test all systems
2014Launch
2012 2013
Contact Information
Colorado Health Insurance Exchange
www.coloradohealthinstitute.org/cohiex www.colorado.gov/healthreform
Live in November: www.getcoveredco.org
@JoanHenneberry 720.382.7074#COHBE
