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Three Key Things to Know About the Health Insurance Exchange

Posted 10:45 AM by

The Health Insurance Marketplace is going live today, October 1, 2013. The exchange is designed to be a single, transparent location for individuals and families that do not currently have health insurance, to review and compare insurance plans provided by commercial health insurers. Indiana has opted to partner with the federal government to administer and operate the state insurance exchange. Hoosiers can sign up and compare plans at

Here are a few key things to know about the exchange:

  1. Who is eligible?

Most everyone living in the United State is eligible to participate and purchase a plan through the Health Insurance Marketplace. The key requirements include that an individual must 1) reside in the United States, 2) be a United States citizen (national or lawfully present within the United States), 3) cannot be currently incarcerated and 4) generally reside in the area the marketplace is servicing (e.g. the state).

Additionally, since lifetime limits and pre-existing condition exclusions have been lifted under the Affordable Care Act, individuals with pre-existing conditions and other high cost ailments will be able to purchase health plans through the exchange at market driven prices.

  1. Premium assistance tax credit and cost sharing subsidy

Individuals and families with household incomes between 100 and 400 percent of the Federal Poverty Level, who do not have access to qualifying coverage, may qualify for a premium assistance tax credit beginning in 2014. These credits are designed to make premiums more affordable and are scaled based on income and the number of individuals within a family.

Some individuals and families will also qualify for a cost-sharing-reduction subsidy to help pay deductibles and co-payments normally required by the insurance coverage. These subsidies may be available to households with income that does not exceed 250 percent of the Federal Poverty Level and enroll in silver-level qualified health plans that normally require 30 percent cost sharing.

  1. Individual mandate

During the initial year of the exchange, there will be a fee for not maintaining minimum essential health insurance coverage.  This fee will be 1 percent of an individual’s yearly income or $95 per person, whichever cost is higher.  The fee will continually increase through the end 2016, up to 2.5 percent of yearly income or $695 per person, as the law currently states.

Note: Under the Affordable Care Act, United States citizens living abroad are not required to have health insurance and will be exempt from the penalty fee.

For more information regarding the launch of the Health Insurance Exchange, visit the Department of Health and Human Services website at

About Us
Katz, Sapper & Miller’s Healthcare Resources Group serves healthcare providers, including physicians, hospitals and health systems, surgery centers, and long-term care facilities. Our team of healthcare professionals has the scope and depth to meet client needs. Learn more.

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