(100 points– each question is worth an equal amount of 4 points each)
OBJECTIVES
This exercise offers each student the opportunity to learn about eligibility and pricing for health
insurance in the state health insurance marketplaces, and to help students understand the challenges,
uncertainties, and trade–offs that households face when shopping for health insurance. The assignment
is to be completed individually.
HONOR CODE STATEMENT
This assignment is to be completed individually. You may discuss the assignment with classmates and
consult course materials and other reference materials in order to develop your individual responses to
the assignment. However, the answers you submit for the assignment must represent your own
individual work, and you may not submit answers obtained from others. By typing your name below
you are affirming that you have complied with these requirements and with the Honor Code of the
Colorado School of Public Health.
Name:__________________
INSTRUCTIONS
• Read the case description below carefully
• Visit the Health Insurance Marketplace websites for the relevant states and become familiar
with how to generate lists of health plan options with premium and cost information for the
family described in the case description.
• Jot down your answers to each of the questions below.
• Once you have completed the questions, enter your final answers into the Canvas Assignment
Module for Exercise #1.
• End by thinking through the “reflection” noted at the end of this exercise.
CASE DESCRIPTION
This case–based exercise will explore shopping for health insurance in the Health Insurance Marketplaces (formally called the Health Insurance Exchanges) that were established in each state bythe federal Patient Protection and Affordable Care Act of 2010 (ACA). In the U.S., health insurance is the dominant mechanism used to pay for health care services. The ACA contains several major features
designed to improve access to insurance, including:
1) Regulations on the private insurance industry regarding who must be offered coverage, the comprehensiveness and generosity of coverage offered, and the pricing of coverage.
2) Financial assistance through insurance subsidies offered to low and moderate–income households to help them purchase private health insurance and pay for deductibles and copayments. These subsidies include federal tax credits that households can apply toward theirmonthly premium, and cost–sharing reductions that lower deductibles and copayments. These

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subsidies are only available to individuals who purchase private insurance through their state’s
Health Insurance Marketplace. The Marketplaces serve people who need or want to purchase coverage directly from a private health insurance carrier rather than purchasing coverage
through their employer. NOTE: The American Rescue Plan Act of 2021 (COVID–19 relief law),
signed into law in August 2022, extends these subsidy expansions through the calendar year
2025.
3) The expansion of state Medicaid program eligibility criteria to allow higher household incomes
to qualify for Medicaid coverage. Due to a U.S. Supreme Court Decision in 2012, this feature
was declared optional for states, allowing individual state governments to decide whether or not
to expand Medicaid eligibility for their residents.
Note that some states have elected to allow the federal government to operate their state’s Health
Insurance Marketplace, while other states have chosen to operate their own Marketplace. There are
few substantive differences between these two different types of Health Insurance Marketplaces.
However, one logistical difference is that federally–operated Marketplaces us the federal website
“healthcare.gov” to help people shop for coverage and enroll in coverage. States that operate their
own Marketplace use their own state–created websites for shopping and enrollment. The annual open
enrollment period for the Health Insurance Marketplaces is typically closed at this time of year, except
for households who have experienced a qualifying life event that changes their insurance circumstances,
such as a job loss, change in marital status, or addition of a new child to the household.
A common rule of thumb for assessing whether a health plan will be affordable for an individual or
family is to determine whether the family’s expected spending on the monthly premium is less than 10
percent of the family’s total household income, AND the family’s expected spending on out–of–pocket
costs (excluding the premium) is less than 5 percent of the family’s total household income. This is
known as the 10/5 rule.
In this assignment, your job is to serve as an objective source of advice to households regarding which Marketplace insurance plan may offer the greatest benefit to the household based on its price, cost sharing and other plan features. By answering the questions below, you will be able to determine what advice to give each household based on the characteristics of the household and the types of plans available to each household based on their state of residence. This exercise is meant to offer each
student the opportunity to learn about eligibility and pricing for health insurance in the state
Marketplaces, and to help students understand the challenges, uncertainties, and trade–offs that
households face when shopping for health insurance. The assignment is to be completed individually.
Using the case information below, your job is to advise the household in their shop for insurance by
exploring a state–operated marketplace, Colorado, and a federally–operated marketplace, Texas.
Importantly, Colorado chose to expand Medicaid eligibility under the ACA, while Texas did not. These
two states will allow you to compare health insurance options and costs under different state policy
environments.
Here are the details of the household you will be advising:

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• The household lives in zip code 80045, Adams County. Later, we will consider a scenario where
the household moves to Houston, Texas (Harris County, zip code 77081).
• The household includes 2 adults and 2 children.
• The primary applicant is female, with date of birth January 1987. The other adult is male, with
date of birth April 1985.
• The 2 children include one female with date of birth January 2011, and one male with date of
birth January 2005.
• All members of the household are nonsmokers and are “medium” users of healthcare services.
• The household does not have any strong preferences for specific medical providers nor are they
currently receiving treatment with prescription drugs.
• The household desires coverage immediately or as soon as possible.
• As a baseline, we will assume that the household earns a combined income of $32,000 per year.
For some questions below, we will assume that the household income is higher than this
baseline due to a job change.
NOTE: you do NOT need to create an account on the Marketplace websites in order to complete this
exercise. If you come to any question where you feel like you need to create an account, you have
probably overlooked something or just need to look somewhere else to find the information.
USEFUL WEBSITES FOR THIS EXERCISE:
• Overview of ACA Insurance Marketplaces
https://www.kff.org/health–reform/state–indicator/state–health–insurance–
marketplacetypes/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22so
rt%22:%22a sc%22%7D
• Colorado Marketplace
http://connectforhealthco.com/
• Texas Marketplace (via the Federal Marketplace) https://www.healthcare.gov/
https://www.healthcare.gov/see–plans/
• ACA Health Insurance Subsidy Calculator
https://www.healthcare.gov/lower–costs/

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• Federal Poverty Guidelines
https://aspe.hhs.gov/poverty–guidelines
• State Medicaid and CHIP Eligibility https://www.kff.org/state–category/medicaid–
chip/medicaidchip–eligibility–limits/
QUESTIONS FOR YOU TO ANSWER
Using the above information about this household, navigate to the Connect for Health Colorado website.
Find the section on the website that allows you to compare plans and prices, and enter information
about the household in order to answer the following questions.
1. Is this family or any of its members likely to qualify for Medicaid coverage in Colorado (called
Health First Colorado) or another type of public coverage such as the Children’s Health Insurance
Program?
a. Yes
b. No
2. Briefly explain why or why not?
3. If the family chooses to enroll in a private health insurance plan offered through Colorado’s
Health Insurance Marketplace, how much is the monthly premium for the plan with the lowest
premium, after taking into account any subsidy they may be eligible for (e.g. premium tax
credit)?
$
4. Referencing the plan with the lowest premium, what type of ownership structure best describes
the insurer that sells this plan? (Hint: this may require some investigation on the insurer’s
website)
a. Private, for–profit organization
b. Private, nonprofit organization
c. Government organization
5. Referencing the plan with the lowest premium, is this plan likely to be the least expensive option
available in Colorado’s Health Insurance Marketplace for this household when considering the

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total cost to be incurred by the family, including both the premium and the expected out–of–
pocket costs?
a. Yes
b. No
6. Referencing the plan with the lowest premium, is this family expected to reach the annual out of
pocket maximum for this plan?
a. Yes
b. No
7. A common rule of thumb for assessing whether a health plan will be affordable for a family is to
determine whether the family’s expected spending on the monthly premium is less than 10
percent of the family’s total household income, AND the family’s expected spending on out– of
pocket costs (excluding the premium) is less than 5 percent of the family’s total household
income. This is known as the 10/5 rule. Using this rule, is the plan with the lowest premium likely
to be affordable for this family?
a. Yes
b. No
8. Briefly explain why or why not.
9. The health plans offered on the Marketplace are classified as either Gold, Silver, or Bronze.
Individuals under age 30 have a fourth option, known as a Catastrophic Health Plan. Which type
of plan offers the lowest premiums for this family?
a. Gold
b. Silver
c. Bronze
d. Catastrophic
10. Which type of plan offers the lowest total expected costs for this family when considering both
premiums and out–of–pocket costs?
a. Gold
b. Silver
c. Bronze
d. Catastrophic
11. Assume that the family chooses the plan with the lowest total expected costs including both
premiums and out–of–pocket costs. What is the total expected monthly cost for this family
including both premiums and out–of–pocket costs?

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$
12. Assume that due to a new job offer, the household now estimates their total household income
to be $65,000 annually. With this new income level, how much is the monthly premium for the
plan with the lowest premium, after taking into account any subsidy they may be eligible for
(e.g. premium tax credit)? In determining this amount, assume that any household members
who are eligible for Medicaid or another public program will enroll in that program.
$
13. Using the 10/5 rule, is the plan with the lowest premium likely to be affordable for this family
when earning $65,000 annually?
a. Yes
b. No
14. Looking at the plan with the lowest premium, is this family expected to reach the annual out of
pocket maximum for this plan?
a. Yes
b. No
15. Which type of plan offers the lowest total expected costs for this family when considering both
premiums and out–of–pocket costs, assuming their annual household income is $65,000?
a. Gold
b. Silver
c. Bronze
d. Catastrophic
16. Assume that the family chooses the plan with the lowest total expected costs including both
premiums and out–of–pocket costs. What is the total expected monthly cost for this family
including both premiums and out–of–pocket costs, assuming annual household income of
$65,000?
$
17. Assume that due to a new job offer, the household now estimates their total household income
to be $130,000 annually. With this new income level, how much is the monthly premium for the
plan with the lowest premium, after taking into account any subsidy they may be eligible for
(e.g. premium tax credit)? In determining this amount, assume that any household members
who are eligible for Medicaid or another public program will enroll in that program.
$