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HHS Issues Health Care Exchange Rules

By Joyce Frieden, News Editor, MedPage Today

WASHINGTON — The Department of Health and Human Services has issued the final regulations for implementing the state health insurance exchanges mandated by the Affordable Care Act (ACA).

They allow states more flexibility in determining eligibility for the exchanges than was first given, according to Chiquita Brooks-LaSure, director of coverage policy in HHS’ Office of Health Reform. That change was made after “a lot of input from states and stakeholders,” she told reporters on a Monday afternoon conference call.

The setup of the exchanges “lets consumers easily determine their eligibility for enrollment and easily enroll in coverage that’s right for them,” said Brooks-LaSure. That includes using a single streamlined application so that consumers will get a “consistent eligibility determination” without needing to submit different information for the different plans offered.

Under the ACA, nearly everyone is required to have insurance starting in 2014, and the government will provide financial assistance to those who need it. People who earn less than 133% of the federal poverty level can enroll in Medicaid, and those who are between 133% and 400% of the poverty level will be eligible for tax credits from the federal government in order to buy insurance.

People can use the tax credit to buy health insurance through an exchange in their state. The exchanges will act as “one-stop shops” where people can compare different insurance plans.

For small employers — such as small physician practices — that want to provide health insurance for their employees, the exchanges also will offer a Small Business Health Options Program (SHOP).

SHOP will let small businesses choose among different levels of coverage, depending on what works for them and their budget. SHOP will allow these employers to offer coverage from a number of insurers, but still get one bill and write only one check, according to HHS.

The SHOP program also features tax credits to help make coverage easier for small businesses to afford.

According to HHS, starting in 2014, small employers purchasing coverage through SHOP may be eligible for a tax credit of up to 50% of their premium payments if they:

  • Have no more than 25 employees
  • Pay employees an average annual wage of less than $50,000
  • Offer all full-time employees coverage
  • Pay at least 50% of the premium

To view the final regulations, visit:

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