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West Virginia Health Insurance Exchange Guide

E-guides • April 22, 2013 at 2:00 PM • Written by: PeopleKeep Team

Starting in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state health insurance marketplaces. Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased via a state health insurance exchanges. 

All states have three options for setting up a state health insurance exchange for 2014:

  1. Build a State-Based Exchange
  2. Enter into a State-Federal Partnership Exchange
  3. Default to the Federally-Facilitated Exchange

West Virginia will offer a state-federal partnership exchange that will open October 1, 2013 for coverage starting January 1, 2014.

West Virginia Health Insurance Exchange - What is it?

In 2014, West Virginians will have a new insurance marketplace that will inform consumers of their eligibility for premium tax credits and subsidies when purchasing health insurance, as well as informing them about their eligibility for public health insurance programs such as Medicaid or CHIP. West Virginia's Exchange will be a partnership between West Virginia and the federal government (CMS). The West Virginia Health Policy Unit is tasked with planning, implementing and overseeing these functions of the Marketplace.

According to healthcare.gov, 285,930 or 18% of West Virginia’s non-elderly residents are uninsured. And, 267,328 (93%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if West Virginia participates in the Medicaid expansion.

West Virginia Health Insurance Exchange - How Was it Formed?

On February 15, 2013, Governor Earl Ray Tomblin submitted a blueprint to HHS Secretary Kathleen Sebelius for West Virginia to establish a state-partnership exchange with plan management responsibilities. In 2012, Governor Tomblin signed SB 408 into law to establish the West Virginia Health Benefits Exchange, and the state began exploring implementation options for a state-based exchange. However, concerns over the sustainability of a state-run exchange led the Governor to pursue a state-federal partnership exchange instead. 

On March 5, 2013, West Virginia received conditional approval from HHS to establish a state-partnership exchange. Final approval is contingent upon the state demonstrating its ability to perform all required exchange activities on time and complying with future guidance and regulations.

West Virginia Health Insurance Exchange - What Insurance Plans Will be Available?

West Virginia's Health Insurance Exchange will act as a clearinghouse. All plans will meet federal and state certification criteria. 

West Virginia is still in the process of finalizing carriers and plans that will be available in October to individuals, families and small businesses for coverage starting January 1, 2014. On March 1, 2013 the West Virginia Offices of the Insurance Commissioner (OIC) released a Draft Qualified Health Plan Submission Guide to provide guidance to health insurance issuers regarding the certification standards for individual and SHOP Qualified Health Plans (QHPs) offered through the Exchange. OIC expects issuers to submit QHPs from April 1 through May 31, 2013. The OIC will review submissions and recommend QHPs to the Department of Health and Human Services (HHS) by July 31, 2013. OIC expects issuers to enter into certification agreements with HHS in August 2013. 

West Virginia Health Insurance Exchange - Role of Insurance Professionals

Details about the role of agents and brokers with the West Virginia Health Insurance Exchange is not confirmed at time of writing. West Virginia will follow the federal Marketplace guidelines for producers selling policies on the Exchange. HHS is expecting 85% participation of current agents in the exchanges. Producers will need to register with the Exchange and attend approximately 4 hours of training. According to HHS more details are expected in July or August 2013.

West Virginia Health Insurance Exchange - Role of Navigators

As part of the state-federal partnership, West Virginia will have the federal government administer West Virginia's health insurance navigator program, while West Virginia will administer the state's in-person assister program.

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