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Members & Individuals

What does it mean to me?

Information for families and individuals

The Affordable Care Act was signed into law on March 23, 2010, and many of the major provisions impact the private health insurance industry and the way you purchase coverage. The foundation of the ACA requires every American to carry health insurance or face a tax penalty.

Many of the ACA’s provisions were implemented over the last four years, while some changes will continue to go into effect through January 1, 2015. Blue Cross of Idaho implemented many of the requirements, and we will continue to provide you information about new rules and regulations that impact your coverage. We encourage you to check back to this page periodically for updated information, questions and answers.

Health Care Reform Individuals and Family

If you want a more in-depth look at the ACA, Blue Cross of Idaho created a toolkit specifically for families and individuals. Please select the image to the left to download this important resource.

Federal Tax Return Information

For a short guide that explores how your health insurance plan affects your Federal tax return, select the image to the left.

The following questions and answers are informational and not the equivalent of legal advice. Consult legal and tax experts to understand how the law will affect your individual or business circumstances.

 

I heard there’s a penalty for not carrying health insurance. Is that true?

The ACA requires individuals to hold a qualified health plan (QHP) by April 1, 2014 or pay a tax penalty.

  • In 2014, the penalty is $95 for adults and $47.50 for children, with a maximum of $285 per family or 1% of the family income, whichever is greater.
  • In 2015 the penalty increases to $325 for adults and $162.50 for children, with a maximum of $975 or 2 percent of family income, whichever is greater.
  • In 2016 the penalty increases to $695 for adults and $347.50 for children, or 2.5 percent of family income, whichever is greater.

I purchased a health insurance plan directly from Blue Cross of Idaho/I purchased a plan on the state exchange/I have coverage through my employer. Do I have to do anything right now? Will I face a fine?

No. If you currently have a health insurance plan then you will not face a fine. You will have an opportunity to buy a new plan, or make changes to your current plan during the next open enrollment period. This occurs later in 2014, from November 15, 2014 to February 15, 2015.

How does the financial assistance work under the Affordable Care Act?

There are two ways for you and your family to get a break on your health insurance costs. First is the monthly premium tax credit. This is a new kind of tax credit that helps lower your monthly premium. Your household income must be less than 400 percent of the federal poverty level, you cannot have access to health insurance through an employer and you must purchase a plan on the state exchange to qualify for the tax.

The second form of assistance is a cost-sharing reduction. This is additional financial that helps you pay for out-of-pocket costs (like a deductible, coinsurance, and copayments). Your household income must be less than 250 percent of the federal poverty level, you cannot have access to health insurance through an employer and you must purchase a plan on the state exchange to qualify for assistance.

I got married last week, and heard my spouse and I can buy a new health insurance plan. How does that work?

Marriage is considered a life event that triggers a special enrollment period (SEP). This even allows you and your family to change or purchase a new QHP. In the case of marriage, both spouses get an SEP. This means you can enroll in a new or different plan, or one spouse can add the other to their plan.

Below is a list of other qualifying events that allow you to change coverage outside of the open enrollment period:

  • Marriage
  • Birth/adoption/placement of foster child
  • Loss of minimum essential coverage
  • Covered dependent turns 26
  • Death of a subscriber
  • Divorce of a subscriber
  • Change in work hours that causes loss of employer coverage
  • Loss of employer-provided coverage
  • New citizenship
  • Change in or loss of subsidy eligibility
  • Permanent move to an area served by the state exchange
  • Member with catastrophic coverage turns 31

What is a grandfathered plan? How do I know if my health insurance is grandfathered?

If you bought your plan before March 23, 2010, your plan may be grandfathered under the ACA. This means you can keep you coverage, and avoid some of the impacts of the ACA.

However, your plan is not completely exempt from every ACA regulation. Blue Cross of Idaho implemented some additional ACA changes to your grandfathered plan to be consistent in the coverage we provide our members. These changes do not affect your plan’s grandfathered status. You do have the option to purchase a new plan during the open enrollment period from November 15, 2014 to February 15, 2015, unless you have a qualifying life event.

What about a non-grandfathered plan? Can I keep what I have?

If you bought a health plan or changed your coverage after March 23, 2010, your plan is not grandfathered. The federal government and the state of Idaho allowed you to keep your plan. However, you do have the option to choose a new plan during the next open enrollment period.

What are my options to purchase insurance?

The ACA provided you new ways to purchase a plan. First, many people get insurance through an employer, group or union. If you receive coverage this way, you do not have to purchase additional coverage. Second, you can purchase a plan directly from Blue Cross of Idaho. Third, you can purchase a plan on the state exchange at YourHealthIdaho.org. Finally, you can speak to a local insurance broker and he/she can assist you in finding a plan that fits your health needs and your family budget.

When is the next time I can purchase a plan?

Unless you had a qualifying life event, the next time you can purchase a plan is during the next open enrollment period. This occurs from November 15, 2014 to February 15, 2015.