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The skinny on marketplaces

By - Last modified: February 21, 2013 at 9:35 AM
Heather Stauffer
Heather Stauffer

Health insurance marketplaces are coming, so here are some basics you as business leaders should know.

Launch date: Oct. 1. There is some skepticism about whether this deadline is attainable, but officials say they will make it. (I've heard one nonofficial but well-connected person say, "Oh, it's electronic; of course they'll make it." My experiences with businesses and software make me deeply dubious of that electronic-is-easy thesis, but then I happily have no experience with government and software.)

Date coverage can start: Jan. 1, 2014.

Versions: Individual and Small Business Health Options Program. The concepts are pretty similar. Qualifying individuals can get subsidies; businesses with up to 25 full-time-equivalent employees with an average wage of less than $50,000 a year can get health care tax credits of up to 50 percent for coverage obtained through SHOP. SHOPs, the feds say, "will enable you to offer your employees a choice of qualified health plans from several insurers, much as large employers can … You choose what share of the premium cost to cover. And, depending on the marketplace in your state, you choose which qualified health plans to offer your employees."

Who can SHOP: Companies with fewer than 100 employees. Note, however, that states can set stricter limits at 50 employees, and that come 2017, companies larger than 100 employees will be allowed to participate.

How many businesses will buy coverage on the exchanges: Few. According to the Congressional Budget Office's latest predictions, only 2 million people will have employment-based coverage purchase through the exchanges in 2014. That's from a total of 155 million people with employment-based coverage. It's not expected to rise much, only to 4 million out of 167 million people with employer coverage in 2023.

Dates and details according to reporting by Kaiser Health News senior correspondent Phil Galewitz. March 28 is the date for insurers to begin submitting premium and benefit plans to Health & Human Services for the exchanges. July is when HHS says it will know what rates on the exchanges will be. HHS has said the federal marketplace will be on, which is now allowing visitors to register for text or email updates on health insurance options and benefits.

Why the individual marketplace matters: Penalty. An employee receiving a tax credit when purchasing insurance in an exchange is the trigger for the employer penalty, which applies only to companies with at least 50 full-time equivalent employees. Employees can't get tax credits on the exchange if the company's qualifying coverage does not cost more than 9.5 percent of household income for their individual policy.

Who is going to help people figure out the marketplaces: Brokers and navigators. This is a good story on the subject.

What the online application in development currently looks like. See below.

Issues to watch: Premiums and pools. Whether and how much premiums will go up and if that, in turn, leads young, healthy people to eschew insurance and if that, in turn, causes catastrophe aren't questions confined to exchanges, but they are certainly applicable to it.

Heather Stauffer covers Lancaster County, nonprofits and health care. Have a tip or question for her? Email her at You can also follow her on Twitter, @StaufferCPBJ.

Click here to download a PDF file of the online application in development.

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