The basic idea is that Colorado’s Health Insurance Exchange will be website where people can see if they qualify for Federal government subsidized insurance plan or a government run program like Medicaid. If the person does qualify they’ll then be able to compare plans and apply online.
The goal for Colorado’s new health insurance exchange is to create a marketplace that makes it easier for consumers and businesses reviewing and purchasing health care coverage. Currently, Americans who work for small employers or who purchase health insurance on their own do not have access to the same negotiated economies of scale of administration, marketing and risk pooling that are available to employees working in large firms.
It is estimated that Colorado’s Health Insurance Exchange will provide insurance to at least 300,000 uninsured individuals.
Under the Affordable Care Act, states can create two types of health insurance exchanges; they will organize the health insurance marketplace so individuals and businesses have clear and understandable choices. Sliding scale federal subsidies will help make health insurance more affordable for eligible individuals.
The Affordable Care Act (ACA) creates state-based health insurance exchanges. Individuals and families and businesses with fewer than 100 employees can buy insurance through the state based exchanges. Beginning in 2017, states may allow businesses with more than 100 employees to get insurance through exchanges.
Colorado’s Health Insurance Exchange’s five basic functions:
- Certification of health plans to ensure they meet minimum benefits standards.
- Customer Service via a toll-free phone line and a website with standardized information on plans, and help for individuals and employers to purchase and enroll in certified plans.
- Quality assurance using a standardized rating system.
- Assistance for eligible individuals and small businesses in accessing premium and cost sharing subsidies.
- Streamlining access to subsidized health insurance programs including Medicaid, Medicare, and Child Health Plan Plus.
There will be four categories of plans plus a separate catastrophic plan offered through the exchanges. Plans will cover 60 to 90 percent of medical expenses, depending on which plan an enrollee selects. Plan benefits, premiums, and out-of-pocket expenses will vary depending on the plan chosen.
The products will be named based on their levels of coverage. “Bronze” is the minimum coverage package, followed by “Silver,” “Gold,” and “Platinum,” which will offer the highest level of coverage. The Bronze package will cover roughly 60 percent of the costs of services it covers. Silver will cover roughly 70 percent, Gold will cover roughly 80 percent of costs and Platinum will cover roughly 90 percent of the costs of the benefits provided. The fifth product offered in the exchange is a “Catastrophic Plan” which is primarily intended for people 30 years and younger or those who 35 would otherwise be exempt from the requirement to purchase coverage because the premium exceeds eight percent of their income. Catastrophic Plans must provide first-dollar coverage (no cost-sharing) for at least three primary care visits.