PPACA Health Exchanges


PPACA will create exchanges in every state that will begin enrolling people on October 1, 2013. These exchanges will provide coverage to individuals who do not qualify for Medicaid (all those below 138% of poverty in states that elect to adopt the Medicaid expansion) or choose to stay with their employer-provided plan. Exchanges will offer a variety of private health plans with standardized benefits to facilitate comparison. All plans must offer “essential health benefits” as defined by the federal government and must meet other federal requirements regarding limits on cost-sharing.  Plans will come in four categories: Platinum, Gold, Silver and Bronze.

The Bronze plan is the minimum health insurance plan in which individuals can enroll that will satisfy the Affordable Care Act’s individual mandate to purchase health insurance. It is designed to cover 60% of expected health expenses for plan members.

However, the exchanges will offer income-related subsidies designed to cap the percentage of income required to pay for coverage; these caps range from 2% for the lowest income individuals to 9.5% for those with the highest incomes. A parallel set of income-related caps applies to out-of-pocket spending, i.e., costs not covered by the plan.  Thus, families will qualify for subsidies to make up the difference between the caps applicable to their income category and the actual amount of spending.

Short-Form Application. This is the Obama administration’s draft of the 21-page application form to determine if a person qualifies for subsidies in the new exchanges.

Application Appendix.  This codifies what information is required about each applicant, the applicant’s family, income, job and employer, and health habits. This 61-page appendix to the short-form application shows the full decision tree of questions.

Decision Chart. This is a decision tree to determine eligibility for subsidies.

State Health Exchange Profiles (Kaiser Family Foundation). Provides in-depth, regularly updated individual state profiles detailing each state’s progress in setting up exchanges including the legislative process and the next steps.

Kaiser Family FoundationEstablishing Health Insurance Exchanges: An Overview of State Efforts. This issue brief provides an overview of states’ progress in setting up the state-based health insurance exchanges through which millions of Americans are expected to purchase coverage under The Patient Protection and Affordable Care Act (ACA) beginning in 2014.


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