Plans Offered Under the Health Insurance Exchanges

The Affordable Care Act requires that by 2014, every state establish a health insurance exchange—an online marketplace where small business owners can purchase health insurance.

The exchange will allow small business owners to pool their buying power and drive down the cost of health insurance. The exchange will offer employers a choice of four categories of insurance packages, each with essential minimum benefits. This will allow easier comparison among plans. As an employer, you will decide what level of coverage to offer, and your employees may pick any plan offered within the exchange at your chosen coverage level.

The four coverage levels are based on the specified percentage of costs the plans will cover:

  • Bronze = 60%
  • Silver = 70%
  • Gold = 80%
  • Platinum = 90%

The Department of Health and Human Services has defined specific services that must be covered within these packages. This provision is designed to make sure everyone participating in the exchange has access to sufficient coverage. Individual and small group plans must include items and services within these 10 categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, and behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Also, if an insurer offers a qualified health plan, they must also offer a child-only plan at the same level of coverage.