Under the Affordable Care Act or Obamacare exchanges were created which allowed for consumers to shop for health plans online. Each state like Florida had the option of creating their own exchange or having their citizens use the federal exchange. Along with the state exchanges and federal exchange, private companies were also allowed to create exchanges. These exchanges allowed for citizens to receive health subsidies as long as they met certain financial requirements and the health plans offered met certain ACA standards. So what do exchange plans have to offer?
Plan Requirements
Exchanges can vary from state to state but they must meet certain requirements under the ACA. To be a Qualified Health Benefit Plan the exchange’s health plan must meet the following requirements:
- Meet all essential benefits
- Only include fully insured plans
- Meet certain accreditation requirements on clinical quality measures
- Grant access to all patients with pre-existing conditions
- Set no annual limits on essential health benefits
- Set no lifetime limits on essential health benefits
- Offer at least five levels of coverage
The 5 Levels of Health Coverage
One of the requirements of being an exchange and being eligible for subsidy use is having at least five levels of coverage. The government set up plan names to help simplify the shopping experience. Bronze catastrophic individual plans must cover 60 percent of costs, Silver must cover 70 percent, Gold 80 percent and Platinum must cover 90 percent. A Qualified Health Benefit Plan on an exchange must offer at least one gold or silver category.
Essential Health Benefits
These health benefits are still being defined and vary for certain individuals, but here are some examples and categories of essential health benefits:
- Ambulatory services
- Emergency services
- Hospitalization
- Laboratory work
- Maternity and newborn care
- Mental health and substance abuse treatment
- Prescription drugs
- Rehabilitative and habit treating services
- Preventive services and chronic disease management
- Oral and vision care for children
For more information about what is covered and not covered under exchange health plans talk to an agent today. You can also get your free Florida health insurance quote instantly!
We are health insurance consultants / agents with many years of experience in the health insurance field and access to multiple health insurance company’s plans and pricing. We will work with each you to find the right group or individual health insurance plan to fit your needs and budget. Serving clients in and around Greater Jacksonville, Orlando, Tampa, Miami, Florida and more. Contact us at 866-217-2873.
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