Health Benefit Exchanges: More Questions Than Answers

Anyone that knows me knows that I’ve been on a mission since February 2010.  THE law was passed.  Since then, wave after wave of reform requirements have been implemented.  Some of the reforms have been posititive for our clients.  Other aspects of the reform have left our clients scratching their heads and asking if the government can truly define “affordable.”  While I’ve invested hours upon hours educating myself and our clients with what we know to be true regarding the law and getting certified to comply with the law, we’re still waiting for the bulk of the information to be passed down from the Department of Health & Human Services.

The biggest issue for individuals and employers is the establishment and operation of the Health Benefit Exchanges, the portal for individual persons to purchase health insurance.  While Kentucky has opted to operate their own benefit exchange rather than allow the federal government to operate one for it, there is yet to be a lot of information gained.  At this point, we do not know which networks will be available, which insurance companies will participate, how much it’s going to cost, or the details of any plan information.  To date, we know that open enrollment for the health benefit exchange starts on October 1, 2013.  We just don’t know on what we’ll be educating the public or what choices will be available.

I expect the federal governement is working as fast as the federal government works, but for those of us that crave knowledge and have a deep desire to properly understand, educate, and treat our clients, it’s a bit frustrating to not be able to answer their questions.  I know they are tired of hearing me say repeatedly, “We don’t know, yet.”  That isn’t to say things aren’t happening.  The Department of Health & Human Services issued 474 pages of guidance and clarification concerning the medicaid appeals process two weeks ago  (Yes, I read all 474 pages).  While important to clarify, it certainly doesn’t help my employer and individual clients right now.

There are some things that we know to be reality concerning the law.  Employers that have over 50 full time equivalent employees must offer health insurance that meets a minimum value standard, is affordable (there’s that word again), and meets the definition of a qualified health plan or they will pay a tax.  This tax is $2000 per employee per year.  (The first 30 full time employees are exempt, so you’re only paying tax on employees 31 and beyond).  If an employer offers a health plan that is not affordable (again with that word), does not meet the minimum value standard, and is not considered to be a qualified health plan, the employer may be subject to a $3000 tax if they have an employee that purchases health insurance through the exchange and qualifies for a subsidy or credit to help them pay for their health insurance.  Employers have A LOT of responsibility to report to the federal government, to communicate with their employees, and to really comply with the law.  I’ll be happy to share what I know to date if you just contact me at

In terms of individual health insurance clients, we know there is going to be a health benefit exchange.  We know if you’re income falls within 100 to 400% of the federal poverty level, you’ll receive some sort of subsidy to help you pay for your family’s health insurance coverage.  I promise to update you as more information comes from each state and from the federal government.  In the meantime, please enjoy some of the reading material I review on an almost daily basis concerning who, what, where, and when with health care reform.

–Kelly (committed to being your health care reform expert)


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