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State health insurance marketplaces provide us unparalleled opportunity

August 14, 2013
by Ron Manderscheid, PhD
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Knowing the ABCs of the State Marketplaces can benefit persons with behavioral health and ID/DD conditions.

This week, fewer than 90 days remain until the launch of the state Health Insurance Marketplaces. These insurance bazaars will represent an essential Affordable Care Act (ACA) tool for providing insurance coverage to an estimated 20 million Americans, including about 5 million persons with behavioral health conditions. Hence, we need to have a clear understanding of their structure and operation. A federal site is available to keep you informed about these Marketplaces: www.marketplace.cms.gov.

Health Insurance Marketplaces

Types of Marketplaces. Under the ACA, each state is mandated to have a Health Insurance Marketplace. A state can choose to have a State Operated Marketplace, a State Partnership Marketplace operated jointly with the US Department of Health and Human Services (HHS), or a Federally Facilitated Marketplace operated entirely by HHS. If a state does not choose one of these options, it then defaults to a Federally Facilitated Marketplace. You can learn more about what your state has elected by going to: http://statehealthfacts.kff.org/comparemaptable.jsp?ind=962&cat=17.

Marketplace Functions. The Marketplaces have several core functions: to operate a health insurance bazaar for prospective insurance enrollees; to organize and monitor the Qualified Health Plans that will be offered through the bazaar; and to engage in Consumer Outreach so that all state citizens are aware of the opportunity being provided. The type of Marketplace chosen by a state will determine whether the state or HHS will be undertaking these specific functions.

Qualified Health Plans. The Qualified Health Plans offered through the Marketplace must include ten Essential Health Benefits. One of these benefits is mental health and substance use care, which must be offered at parity with medical and surgical benefits. Four levels of health insurance must be made available: bronze, silver, gold, and platinum. These insurance levels will be equivalent to 60, 70, 80, or 90 %, respectively, of the actuarial value of the ten Essential Health Benefits. To learn more about the Essential Health Benefit in your state go to: http://kff.org/health-reform/state-indicator/ehb-benchmark-plans/

Eligible Persons and Federal Subsidies.  The Marketplaces will offer insurance to persons at or above 133 % of the Federal Poverty Level (FPL), currently about $15,200 for a single person. All persons between 133 and 400 % FPL will receive a federal tax subsidy on a decreasing sliding scale. On average, the federal tax subsidy is estimated to be slightly more than $5,500 in 2014. Those between 133 and 250 % FPL also will receive reduced co-pays and deductibles. The federal tax subsidy will be based on the silver level of insurance and will be paid directly to the Qualified Health Plan in which a person is enrolled.

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Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid

@DrRonM

www.nacbhdd.org

Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...