Insurance Exchanges

While states differ in their approaches to the education and outreach campaigns for their Marketplaces, they have a common mission of educating consumers about their coverage options. Many of the campaigns utilize creative and innovative strategies that move beyond typical government outreach efforts and target populations that are hard-to-reach and/or have high rates of uninsurance. While not exhaustive, this analysis reflects examples of state marketing efforts based on publicly available information as of September 2013. 

Advanced Premium Tax Credits (APTCs) are part of a financial assistance program established by the Affordable Care Act that can be used to help lower the costs of premiums for individuals with incomes between 100-400 percent of the federal poverty level. Outreach and education on this complex benefit will be crucial to the success of the program. The following are a collection of resources that states have released to inform consumers about APTCs.

Survey data show that the largest barrier to health coverage is difficulty finding a plan that families can afford. Beginning in 2014, the Affordable Care Act (ACA) introduces major reforms, including the start of a new advance payment Premium Tax Credit designed to lower the cost of coverage for qualified families purchasing in the new Health Insurance Marketplaces (exchanges). These advanceable and refundable features of the new tax credits introduce new elements that most consumers haven’t previously encountered. These facts raise the possibility that consumer confusion might be a barrier to using this new program to enroll in affordable coverage.

Beginning in 2014, millions of Americans will become eligible for a new premium tax credit that will help them pay for health coverage. This collection of frequently asked questions explains who will be eligible for this tax credit, how the size of an individual or family’s credit will be calculated, how midyear changes in income and household size will affect tax credit eligibility, and how the reconciliation between the tax credit amount a person receives and the amount for which he or she was eligible will be handled.

These templates were released as part of the Paper Work Reduction Act notice, and represent the metrics that the Department of Health and Human services propose state-based marketplaces collect in order to monitor and evaluate their operations.

This set of Frequently Asked Questions (FAQ) provides guidance on how health insurance Marketplaces will verify incomes of applicants that qualify for premium tax credits or cost-sharing reductions. CMS has determined that they will have sufficient resources to request and process additional income documentation such that the sample size is 100 percent. However, state-based Marketplaces are allowed to determine their own sample size percentage for this group, as long as it is statistically significant.

Starting January 1, 2014, new federal subsidies will be available for lower- to middle-income people to purchase private, nongroup coverage through new health insurance exchanges. A key issue for the exchanges is whether enough younger and healthier people will sign up for coverage to avoid significant adverse selection in which only older and sicker uninsured adults enroll, thus driving up premiums. This brief examines which uninsured adults ages 18 to 64 are most likely to purchase insurance through the exchanges.

With open enrollment in new insurance marketplaces set to begin October 1, this analysis provides an early look at insurance premiums in 17 states and DC that have publicly released comprehensive data about their rates and the impact of tax credits that will offset part of the costs for low- and moderate-income families. The analysis compares the premiums in the largest cities in each of the 17 states plus DC for individuals and families in different circumstances to illustrate the insurance rates they might pay, with and without the tax credits.

This summary provides an overview of several key statutory functions addressed in the final rule regarding eligibilty and minimum essential coverage.