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Assignment 9 - Health Insurance Exchanges

Terms in this set (30)

Exchanges must offer four tiers of coverage, "the medal levels," plus a catastrophic plan; each tier benefits is to cover all the services included nit he essential benefit package; differences between the plans come in two dimensions:
1. Plans in each tier cover an increasing share of the actuarial cost of the essential benefit packages; Silver plans must cover 70% of the cost of the covered services; Gold and Platinum plans cover larger percentages with correspondingly higher premiums; Bronze plans cover a smaller share
2. The plans within a tier may differ by how the consumer satisfies his/her share of the actuarial cost; one approach may be a plan that offers a relatively large deductible but has low copays once the deductible is satisfied; another plan in the same tier may have a modest deductible but copays for some services and a coinsurance rate for others; the only requirement in the legislation is that the cost sharing for each plan in a tier is actuarially expected to cover the remaining share of the costs of care; in the Silver tier the out-of-pocket cost sharing for each plan covers 30% of the cost services; Insurers are required to offer one silver and one gold plan in every exchange in which they participate
3. Catastrophic plan is somewhat different from the others. It is only available in the individual exchange, and it is may only be sold to people under age 30 and to those who would otherwise be exempt from buying coverage because the premiums would be greater than 8% of their income; plans need not to meet actuarial cost percentages, but the size of the deductible and out-of-pocket maximum must meet the current requirements for a health savings account (HSA) plan