NASE News

Health Care Exchange Details Trickling Out

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By Katie Vlietstra


California, home to the largest state-operated individual health care exchange, recently announced premium rates for 2014. Thirteen insurers will offer a wide range of plans in four categories: platinum, gold, silver, and bronze, for the anticipated 5.3 million Californians who will enroll in the exchange market.

However, the issue of cost remains for the self-employed. While the plans offered in the exchange are comprehensive and provide significant protections for the consumer, they will be more expensive. One cost-containing measure included in the Affordable Care Act set a maximum limit on out-of-pocket expenditures at $6,350 for an individual and $12,700 for a family for most plans. 

Officials running the state’s exchange divided California into 19 regions for rate-setting purposes. Aside from where a person lives, insurers are limited in their ability to charge consumers different prices for health care. On average, there will be five plans to choose from in each region of the state. Rural areas will have two or three.

The NASE recommends that California members take time to thoroughly review the information available on the Covered California website and begin making preliminary decisions regarding your health insurance options for 2014. Unfortunately, rate information is still unavailable for members in most other states. Currently only three other states—Maryland, Vermont, and Washington—have released rates for their state-based exchanges. Fourteen additional states and the District of Columbia have yet to release premium rates for their markets. 

For the remaining 33 states that opted for the federal government to operate the exchange market, no information or deadline has been set for when the federal government will publish insurance rates for 2014. Enrollment for both state and federal exchanges is expected to go “live” on October 1, 2013. We expect that rates will be released for all markets well in advance of the enrollment date. In order to prepare, experts encourage individuals and families to plan for an increase in the cost of health coverage benefits of 10 to 15 percent. In 2014, every American will be required to have a qualified health insurance plan either in the individual market or an employee-sponsored plan, and failure to do so will result in a penalty. In 2014, the penalty will be 1 percent of income or $95, whichever is greater.

Katie Vlietstra is Director of Government Affairs of the NASE and provides critical insight to policymakers on issues affecting our nation’s self-employed. You can contact her at advocacy@NASE.org.

Read this article in PDF form here.