In order to effectively engage with payer customers around the topic of health insurance Exchanges, you’ll need to be up to date on how Exchanges work and how stakeholders are impacted. This newsletter contains a brief over

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Which Exchange Models Are States Choosing?


By the end of 2012, states had to determine whether they would establish their own state-run Exchange. If a state opted to run its own Exchange, it had to submit its proposal and obtain final approval from the HHS.

Then, in February 2013, the remaining states had to decide whether they would partner with the federal government in setting up a Marketplace. After both deadlines passed, any states that were left would have their Marketplaces run by the federal government. Here’s how things looked after the February 2013 deadline.



Who Will Buy Insurance
on the Health Insurance Exchanges?


Overall, the population using the Exchanges is projected to be slightly older, less educated, have lower income, and be more racially diverse than current privately insured populations. According to a health industry report by PricewaterhouseCooper (PwC), those who will enroll in the Exchanges break down as follows:

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How to Calculate a
Health Insurance Subsidy

According to ACA, individuals purchasing a health plan on the Exchange can receive a premium subsidy if they earn 100% to 400% of the FPL.

How Will Payers Design Health Plans for Exchanges?

Any payer designing individual or small-group health plans, whether or not they are for an Exchange, will need to adhere to the Essential Health Benefit (EHB) categories defined by ACA. Although some state-level mandates existed prior to ACA, the goal of the EHBs is to make sure all individuals throughout the country have access to a baseline level of care.

The ACA mandates that people who purchase a plan on the Exchange must be offered coverage in these 10 Essential Health Benefit categories:

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