Basics of Exchanges

As part of the Affordable Care Act (ACA) or health care reform starting in 2014, all Americans must have a minimum amount of health insurance or be taxed by the government.
 People who don't get health insurance at work, or can't afford it, my be able to get it through an exchange, or Marketplace.  The exchanges do not replace buying insurance privately.  They are simple a new place to shop and buy.  In the State of Ohio, the US Department of Health and Human Services (HHS) will run the exchange, because the State choose not to create one.
There will be four levels, or tiers, of coverage on the exchanges. The tiers are named after metals: bronze, silver, gold, and platinum.  Each tier will have several plans to choose from and will include "Essential Health Benefits".  Bronze plans will have the lowest monthly premium, but cost shares will be more when health care services are provided.  Platinum plans will have the highest monthly premiums, but cost shares will be less.
The different exchange tiers are:
Platinum-90% coverage
Gold-80% coverage
Silver-70% coverage
Bronze-60% coverage


All plans must include " Essential Health Benefits" as defined by the health care reform law and the HHS.  Specifically, the plans must include items and services from at least these 10 categories of care:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

Penalties for individuals who do not have a minimum amount of health coverage will receive a penalty of $95 or 1% of their taxable income, whichever is greater.  The penalty for year #2 is the greater of $325 or 2% of taxable income, and year #3 is $695 or 2.5% of taxable income.
Penalties will increase each year through 2016.  In future years, the penalties will adjust annually.

The exchanges don't replace private health insurance.  They are simply a new place for qualified individuals and small group employers to shop for and buy it.