§18032 Consumer choice

Summary

Qualified individuals may sign up for any qualified health plan they are allowed to join. Small employers that choose to offer coverage through an Exchange may pick a level of benefits to make available, and each employee can choose a plan that matches that level. People who enroll can pay their premiums directly to the insurance company. Health insurers must treat all enrollees in their non-grandfathered individual plans as one risk pool, and must do the same for their non-grandfathered small-group plans. A State can decide to combine its individual and small-group markets. States cannot force grandfathered plans into those pools. Plans can be sold and chosen outside an Exchange, and people and employers may enroll in those plans. Exchanges cannot charge a fee to someone who cancels because they get minimum essential coverage (see section 5000A(f) of title 26) or the coverage becomes affordable (see section 36B(c)(2)(C) of title 26). States may allow agents or brokers to enroll people and help them apply for premium tax credits as soon as plans appear in the Exchange. Definitions: “qualified individual” = someone seeking to enroll in an Exchange plan who lives in that State (not incarcerated except pretrial); “qualified employer” = a small employer making all full-time employees eligible for 1 or more Exchange plans (from 2017 a State may let large employers be included). After the effective date of this subtitle, the Federal Government may only offer Members of Congress and congressional staff plans created under this Act or offered through an Exchange. Catastrophic plans are limited to those eligible under section 18022(e)(2).