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Amarketplace (or exchange) is awebportal where individuals andbusinesses can shop for
andbuy health insurance. Therewill be two types of marketplaces throughout theU.S. that
will impact employee benefits:
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| TheHealth InsuranceMarketplace facilitatedby the state and/or federal government
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| Privatemarketplaces facilitatedby private industry stakeholders (insurance providers,
brokers or benefits consultants)
TheHealth InsuranceMarketplace facilitatedby the state and/or federal government is
expected toprovide an onlinemarket for individuals and small employers.
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Any individual canuse theHealth InsuranceMarketplaceoperating in their state to explore
health insuranceoptions, even if they already have insurance. The requirements are:
• Youmust live in theU.S.
• Youmust be aU.S. citizenor national (or lawfully present).
• You can’t be currently incarcerated.
Generally, small businesses canuse theSmall BusinessHealthOptionsProgram (SHOP)
Marketplace toobtain insurance if they have nomore than50 full-time employees. Starting in
2016, SHOPswill beopen to thosewith100or fewer full-time employees.
In2017, stateswill have theoption tomakeprovisions for businesseswithmore than
100 employees topurchase employeebenefits plans through theSHOPMarketplace.
Privatemarketplaceswill offer health coverageoptions tomultipleworkforce segments and
sizes. Additionally, privatemarketplaces can sell all products and services, including voluntary
insurance, unlike theHealth InsuranceMarketplace, which canonly offermedical anddental
insurance.Many of theseprivatemarketplaces help employers tomove toward adefined
contributionmodel that canhelpbetter control health care costs, while still offering employees
robust benefits options throughdefined contribution.
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Tax credits for individuals and small businesses to help offset the cost of coverage are
available only for coverage purchased through a publicHealth InsuranceMarketplace.
TaxCredits andPenalties
Individual credits:
Individualswith household incomes between 100percent and
400percent of the federal poverty level may be eligible for tax subsidies if they are not
eligible for affordable, minimum value employer-provided coverage.
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Small businesscredits:
Small businessesmaybeeligible for a tax credit of up to50
percent of their premiumpayments if they have25or fewer full-timeequivalentswhose
averageannual wages are less than$50,000.While it is still tooearly to tell exactly
Important Fact 1:
Amarketplace
(or exchange) is a
webportal tobuy
and sell benefits.
Important Fact 2:
TheHealth
Insurance
Marketplace
will beopen for
small businesses
and individuals
toenroll on
October 1, 2013
for coverage to
go intoeffect
January 1, 2014.
Important Fact 3:
Private
marketplaces
generallyprovide
cost-controlling
options for
businessesof all
sizes.
Important Fact 4:
Tax subsidies are
onlyavailable
through the
Health Insurance
Marketplace.
