A hypothetical example of a health exchange, as described in the health reform act.
A Health Insurance Exchange essentially offers health care solutions to groups who would normally have difficulty accessing affordable or sufficient coverage, if they can get coverage at all. These exchanges offer solutions for the groups of individuals most affected by the current health insurance industry.
Uninsurable Individuals
If your pre-existing conditions prevent you from attaining health insurance coverage, the worst is over. Health insurance reform requires that, after 2014, no patient is denied insurance because of a pre-existing condition. There is a six-month waiting period, but if you have been without coverage for six months or more already, then you are eligible for immediate acceptance into the new High Risk Insurance Pool. This pool provides coverage until 2014, at which point you cannot be denied health insurance coverage.
Self-Employed or Freelancer
The health care exchange was really created for the individual. This program will begin in 2014. By that time there should be no waiting period. Individuals and families whose income is within 400% of the current poverty level are eligible for subsidies to help with the cost of health insurance. For example, a family of four with an annual income of $88,000 would be eligible for subsidies to help pay for health insurance on the Health Insurance Exchange.
Small Businesses & Others
In 2014, small businesses with fewer than 100 employees have the option of participating in the health insurance exchange. This allows the employer to offer more affordable, customized coverage to their employees. For employees of companies with more than 100 employees, the health care exchange will offer care only if the plans offered by the employer do not meet government standards of care.
In conclusion, the Health Insurance Exchange offers real solutions to individuals who previously struggled to pay extraordinarily high premiums or were denied coverage altogether. If executed properly, these exchanges will solve some of the biggest health care issues facing this country.
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