Health Benefit Exchanges
Learn about the insurance marketplace for individuals and families.
Families and individuals* are now required to have health insurance, whether through an employer, Medicare or Medicaid, or an individual plan through an exchange or on the open market outside an exchange. Exchanges have the stated purpose to provide Americans a way to shop for health coverage. At GuideStone, our goal is to meet the health care needs of pastors and those in ministry in a manner that stays true to our Biblical convictions and complies with PPACA.
*Effective 1/1/2019, the individual mandate penalty is reduced to zero dollars.
As your health care reform advocate, GuideStone developed this resource to help answer questions about the exchanges. Follow the prompts below to learn about the exchanges.
What is an exchange?
An exchange is a marketplace for Americans to shop for health insurance. It is not the only way people can buy insurance, and individuals are not required to purchase through an exchange. An exchange connects buyers (individuals and families) and sellers (insurers) of health insurance to facilitate shopping and enrollment. An exchange also provides access to premium subsidies and cost-sharing reductions (discussed later) to people of a certain income level.
There are three types of exchanges for individuals. Every state has one of the following types of exchanges:
- State-based exchange: A state will create and operate its own exchange.
- Federally facilitated exchange: A state elected the federal government to create and operate the exchange.
- Partnership exchange: A state and the federal government will create and operate the exchange together.
GuideStone has a firm foundation in offering health plans that share your Christian values and provide quality coverage. You can rely on and trust GuideStone because we are a non-profit organization that operates with a Kingdom perspective. We are committed to offering health coverage to your family and ministry, and we believe offering health plans outside of the exchange will serve in our participants' best interest at this time.
Who can purchase coverage on an exchange?
Only eligible individuals can purchase coverage on an exchange. An individual must apply and be approved. Eligible individuals must be:
- Someone who was not offered coverage by his or her employer that is either affordable or of minimum value.
- Someone who is a citizen of the U.S. or a national (lawfully present).
- Someone who is not incarcerated.
- Someone who meets applicable state residency requirements.
Approved individuals are able to purchase a qualified health plan with different benefit levels (bronze, silver, gold and platinum) on an exchange in their state.
What type of coverage is available?
Coverage offered on an exchange is standardized. There are four benefit levels based on how much of the medical cost an insurer pays.
- Platinum covers at least 90% of eligible costs.
- Gold covers 80% to 89% of eligible costs.
- Silver covers 70% to 79% of eligible costs.
- Bronze covers 60% to 69% of eligible costs.
For some, subsidies may be available through the exchanges. Subsidies have the purpose to cap premiums or reduce cost-sharing costs, but subsidies are not available to everyone, only a select group. For more information, see the “What are subsidies and who may qualify?” section of this webpage.
This provision (standardized benefits) does not apply to self-funded health plans such as GuideStone’s. However, GuideStone is committed to providing competitive, quality coverage to those we serve. Additionally, in cooperation with church benefits boards across the country, we are working with the administration and legislators to gain legislation that speaks to the structure and unique needs of church plans.
Because we are not restricted to mandated benefits, GuideStone health plans are more flexible in benefit design. Our plans are uniquely focused on the needs of pastors and those in ministry. Our plans are portable, which allows our participants to take their coverage wherever they sense God is leading them. Our plans only provide contraceptive prescriptions and services that adhere to our Biblical convictions. Our plans are family friendly, which means the plans are priced in such a way that, regardless of the number of children a family has, the family does not pay additional costs for more children. We give our participants access to nationwide networks with best-in-class doctors, hospitals and other health care providers at significant discounts.
When are the exchanges open?
Generally the re-enrollment period begins in late October/early November and ends in mid-December. Outside an open enrollment period, individuals must have a qualifying event — such as marriage or divorce, birth or adoption, loss of coverage, etc. — to apply for coverage.
GuideStone participants can expect the insurance re-enrollment process to happen every fall as usual. GuideStone will remain outside the exchanges so we can continue to focus on serving only the Southern Baptist Convention and other like-minded evangelicals in a manner consistent with our Biblical principles. For 95 years, GuideStone has served the Southern Baptist Convention and like-minded evangelicals with retirement and insurance products and will continue to do so.
Additionally, each state- or federally run exchange offers insurance plans that are different across borders and/or with limited provider networks. GuideStone has chosen to continue to offer plans that are entirely portable to existing participants (across state lines/nationwide) and don't change based on which state or network you reside. If you move to another state and have insurance purchased on the exchange, you would need to select a new plan from that state's exchange. Not only is this an inconvenience, it means your deductible would restart, no matter what time of year you make the move. Many exchanges operate within very small networks. With GuideStone, our participants have access to nationwide networks with best-in-class doctors, hospitals and other health care providers at greater discounts.
What are subsidies and who may qualify?
There are two types of subsidies: premium assistance tax credits and cost-sharing assistance.
Premium assistance tax credits' purpose is to reduce the cost of premiums, limiting the amount an individual or family must pay for coverage. The credit is based on a sliding scale for individuals with incomes of 100% to 400% of the Federal Poverty Level (FPL).
Cost-sharing assistance is intended to limit a plan’s maximum out-of-pocket costs, deductibles, co-insurance or co-payments. This subsidy may be available on a sliding scale for families with incomes at or below 250% of FPL.
Subsidies are not available to individuals who are offered affordable, employer-sponsored coverage at minimum value.
- Individuals offered an employer-sponsored health plan that is affordable and of minimum value do not have access to subsidies.
- A family member may be eligible for a subsidy if the employee must contribute more than 9.56% of household income for self-only coverage.
Only employee, not family or dependent, coverage offered by an employer has to be affordable, according to the Employer Shared Responsibility provision.
What are my considerations?
Some people are hesitant to move their coverage to the exchanges and instead are sticking with their current health insurance. If your health plan is with GuideStone, consider the financial impact of purchasing coverage through GuideStone or on an exchange. As ministers and ministry organizations have trusted GuideStone for nearly a century, you too can continue to trust GuideStone to be your health care reform advocate.
If your ministry does not offer GuideStone group health plans, talk with your employer about the options GuideStone may make available to your ministry. We want to work with your employer to find an employee health benefits solution that your ministry can afford.