Health Care Exchange Explained

A Health Care Exchange is a New York State marketplace where small business employers, sole proprietors and individuals may shop for health insurance plans.

The Exchange is an addition to your current health insurance options. There are two parts to the Exchange:

  1. the Small Business Health Option Program (SHOP)
  2. the sole proprietors and individuals program (Individual Exchange)

The Exchange is a means of shopping for health insurance plans offered through New York State in compliance with the Federal Affordable Care Act which takes effect January 1, 2014. Carriers, in each region, have submitted their applications and plan offerings to the State for approval. The Exchange will be available October 1, 2013, and we will be prepared to advise our clients accordingly.

You will have the option to continue with the usual insurance carriers or shop in the Exchange. All plans (private or in the exchange) will be in “metal tiers” as set forth by the Federal Government, according to the average cost-share members will pay for covered services. The percentages shown below are the average of what the insured will pay out-of-pocket.
Platinum (10%); Gold (20%); Silver (30%); Bronze (40%)

At this time, the Merriam Agency is preparing to certify with the State of New York in order to assist all of our clients with the upcoming changes. With this certification, we will be offering health plans for small businesses and sole proprietors both on the Exchange and through our current private insurance carriers.

Whether an exchange or private health insurance carrier is better for you depends on your circumstances. No matter which option you choose, you will have applications to complete, documents to organize, and coverage nuances to understand.

Pros & Cons


Brian’s Perspective

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Based on my 30+ years of understanding the insurance industry, I believe that the Affordable Care Act (aka “Obamacare”) is fatally flawed legislation that will bring great harm to businesses and individuals as it becomes fully implemented. Many of the problems with it were the impetus that caused the current Administration to delay its implementation for larger employers for an additional year.

Brian H. Merriam
CPCU, ARM, AAI
President, Merriam Agency
(877)MERRIAM, extension 201

Shannon McMeel

About Shannon McMeel

TPA Services Representative 376 Broadway Schenectady, NY 12301-1038 Toll-Free: (877) MERRIAM x 203 (877) 637-7426 x 203 Send Email