what's new - affordable care act

The Affordable Care Act (ACA) brought significant change to the health insurance industry and—as we’ve all experienced over the last few years—those changes can come at any time and with little warning. This can be confusing as people try to figure out exactly how the law impacts them, their health insurance, and their income taxes.

Many of the ACA’s provisions are in effect for our members, but uncertainty remains about the timeline for other requirements of the law. Blue Cross of Idaho can help you navigate this tricky time, providing answers to all of your questions and information about the changes brought on by the ACA.

family healthcare reform brochureIf 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.

health insurance and your tax returnFor 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 have a minimum level of health insurance, file for an exemption, or pay a tax penalty.

  • In 2015 the penalty is $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 already have insurance. 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 every year from late fall through early winter.

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 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’ve experienced some major changes to my life recently. Does that allow me to buy a new health insurance plan or change my existing one?

Certain life changes trigger something called a special enrollment period (SEP). These major life events allow you and your family to change or purchase a new health insurance plan.

Below is a list of 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, such as employer-provided coverage
  • Covered dependent turns 26
  • Death of a subscriber
  • Divorce
  • New citizenship
  • Change in income that affects your ability to pay or makes you newly eligible for monthly payment assistance or a cost-sharing reduction
  • Permanent move to an area where you have access to new plans
  • Member with catastrophic coverage turns 31

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 for now.

What are my options to purchase insurance?

The ACA provided you new ways to buy health insurance. If you don’t have coverage from an employer, trade group, or union, you have a few options. First, you can speak to a local insurance agent and he or she can assist you in finding a plan that fits your health needs and your family budget. Second, you can purchase directly from Blue Cross of Idaho by calling our sales team at 888-462-7677 or visiting shoppers.bcidaho.com. Finally, you can buy a plan through Idaho’s health insurance exchange at yourhealthidaho.org.

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 from late fall through early winter.