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  1. What is an exchange?
  •   An exchange, as created under the Affordable Care Act (ACA), is a place where consumers can purchase subsidized health insurance coverage. Each state has an exchange, operated by either the federal government or by the state.   In Ohio, there is a federally facilitated exchange.
  • Who can purchase insurance from the exchange?
    • Qualified individuals include U.S. citizens and legal immigrants who are not incarcerated and do not have other public coverage.
    • While anyone can purchase, only certain individuals will have access to federal subsidies.  
    • The ACA also provides a separate Small Business Health Options Program (SHOP) exchange for small businesses (fewer than 50 eligible employees) to obtain health coverage for their employees.
    • It is important to note that there are no subsidies offered through the SHOP.
  • Must everyone have health insurance?
    • Yes, individuals, except for a select few, are mandated to have basic health insurance coverage, referred to by the ACA as “minimum essential coverage.” This provision is called the individual mandate.
    • There are a few select groups that are exempt.  To learn more about who is exempt, please visit https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/ or call 1-800-318-2596.
  • Must I purchase my health insurance on the exchange?
    • No.  There are a handful of ways to satisfy the individual mandate, including insurance on the regular market or from an employer, and not be penalized.
    • The exchange merely exists as a mechanism for those eligible to be able to receive subsidized health insurance. 
    • Consumers who do not qualify for subsidies may find more affordable options outside the exchange on the regular market.
  • What are the types of plans that will be offered in the exchange?
    • Every plan offered on the exchange must be certified as a Qualified Health Plan (QHP).
    • To receive the QHP certification, the plan must offer at least a uniform benefits package, called Essential Health Benefits (EHB), be licensed by the state and have a sufficient network.
    • Each exchange will offer four levels of coverage and a catastrophic plan for those under 30 or those who meet certain income levels.
    • Generally, the benefits will be the same among the plans, while the percentage of total average costs for covered benefits that a plan will pay will vary between metal tiers:

    Bronze: The plan must cover 60% of expected costs and the consumer is responsible for 40%.  This is the lowest level of coverage.

    Silver: The plan must cover 70% of expected costs and the consumer is responsible for 30%.

    Gold: The plan must cover 80% of expected costs and the consumer is responsible for 20%.

    Platinum: The plan must cover 90% of expected costs and the consumer is responsible for 10%.

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