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A Healthcare Reform Newsletter for PacificSource
Individual and Family Plan Members
November/December Montana Issue
Printable PDF


Information You Need

In the last issue, we covered some of the health insurance changes coming in 2014 through the Affordable Care Act (ACA). You read about the new state exchange marketplaces and new sources for financial assistance. If you missed it, you can read previous issues online.

In this issue, we’ll share answers to some questions you might have, and provide information about next steps to make sure you have the coverage you need in place by January 1, 2014. Topics include:


 

Explore Your Options: Answers to Your Questions

If you haven’t already heard, Healthcare.gov, the federal exchange marketplace, is now open. Are you wondering what this means for you? Here are answers to some questions we’ve received from other members that might help as you explore your options for new coverage in 2014.

Q: Why do I need a new plan?

A: Does “If you like your healthcare plan, you can keep your healthcare plan” sound familiar? In the days when the ACA was being hotly debated by Congress, that was a message we heard. But by the time the act was signed into law, it was clear that the individual health plans available in 2013 would not meet the ACA’s many requirements for benefits and coverage. Your current plan doesn’t comply with the new law’s essential health benefits and other key provisions that are required starting in 2014.

Q: When should I start exploring my options?

A: Just because the new exchange marketplace is open, there’s no rush. You don’t need to choose a new ACA-compliant plan until your current plan renews.

Q: Will PacificSource send me information about my options?

A: Yes. About 90 days prior to your renewal date, you’ll receive a renewal kit from us telling you about your plan options for new ACA-compliant coverage. If you renew in January, you should already have received your kit.

Q: Should I enroll through Healthcare.gov?

A: If you qualify for tax credits, you’ll only receive that assistance by purchasing an individual health insurance policy through Healthcare.gov. Tax credits are available for individuals and families whose household income is up to 400 percent of the Federal Poverty Level (FPL). FPL is a measure of income level issued every year by the Department of Health and Human Services. It varies by state and by the number of people in the household, and it’s adjusted annually to reflect changes in the cost of living. For example, 400 percent of FPL includes individuals earning up to $45,960 and families of four earning up to $94,200 in 2013. Online financial calculators can help you determine if you meet the criteria.

You can choose to shop for health insurance through the exchange marketplace, even if you don’t qualify for tax credits, but you’ll find more options available when you shop direct from PacificSource.

Q: Are plans offered through Healthcare.gov government plans?

A: While plans offered through Healthcare.gov do meet the requirements of the Affordable Care Act, they are not government plans. They are private health insurance plans offered and serviced by health insurance companies including PacificSource.

Q: I’m hesitant to take advantage of financial assistance. Is it a government handout?

A: You might think of the tax subsidies available through Healthcare.gov as a means to help offset the cost of coverage. The health insurance tax credit is similar to other income tax credits many people claim today, such as the mortgage interest credit or earned income credit. It differs in that you have the ability claim the credit in advance and use it toward your health insurance premium each month. The tax subsidies are a way to make coverage more affordable for many middle-class Americans.

Q: I’m really confused about my options. Where can I get help?

A: Don’t worry, there are many ways to get help at no cost to you. If you have an insurance agent, they can help you review PacificSource and other plans available direct from insurance companies and through Healthcare.gov. Healthcare.gov also offers trained community partners, called application assistors, who can help you review plans and enroll. And of course, we’re here to help. Our Coverage Advisors can help you understand your options and renew your coverage with us. If you don’t have an insurance agent and want to talk with one, we can help you with that as well. Our goal is to help you make informed decisions to get the coverage you need.

Q: What happens if I don’t have health insurance in 2014?

A: The ACA includes a requirement that all U.S. citizens and legal residents, with very few exceptions, purchase health insurance or be subject to a tax penalty. People who aren’t already insured through an employer, Medicare, Medicaid, TRICARE, Veteran’s health program, or an individual policy will need to buy health insurance during the 2014 open enrollment period. The only people exempt from the requirement to have health insurance are:

  • Certain religious groups, Native American tribes, undocumented immigrants, and people who are incarcerated
  • People with incomes below the tax filing threshold
  • People for whom the lowest-cost plan option exceeds 8 percent of income
  • Those suffering hardships, as defined by the U.S. Department of Health and Human Services, that prevent them from obtaining qualified health insurance coverage

If you don’t have coverage in 2014, you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income (whichever is higher). The fee increases every year.

Questions? We’re here to help.

PacificSource Coverage Advisors
855.330.2792 or reform@pacificsource.com


 

Watch Out for Fraud

We’re already hearing about scams connected to healthcare reform and officials are predicting more now that the exchange marketplaces are open. Criminals, often posing as government or health insurance company employees, are selling fake health policies and asking consumers to give out bank account information.

Fraud.org provides these tips:

  • If someone claiming to be with Obamacare or another federal program asks you to wire money, give out your bank account number, or load funds onto a prepaid card, it’s a scam.
  • If you receive an unsolicited phone call, email, or fax claiming that you need to purchase a new plan or update your personal information (such as your social security number, date of birth, or other sensitive information) because “it’s the law,” simply hang up, and report the event to Fraud.org.   

You’ll find other helpful tips on Fraud.org. The federal government’s Centers for Medicare and Medicaid Services also offers a flier titled, “Protect Yourself from Fraud in the Health Insurance Marketplace.” While it’s written for Medicare and Medicaid participants, the information may be helpful for all consumers looking for health insurance coverage. 


   

We're here to help.

The good news is, you won't have to navigate all of this change on your own. We're ready to answer your questions now, and we'll help you explore coverage options at renewal time. We look forward to talking with you.

PacificSource Coverage Advisors
(855) 330-2792 or reform@pacificsource.com


 

Online resources for you:

PacificSource.com/reform – Here you'll find information about how healthcare reform will impact you as a PacificSource member.

HealthcareLawGuide.com – This site provides general information for consumers about healthcare reform changes.

 Healthcare.gov – The federal exchange marketplace


Insurance Agents: A No-Cost Resource

Independent health insurance agents can be a great resource for sorting through health insurance options, and their services won't cost you a dime. If you already have a health insurance agent, he or she can help you understand your choices and enroll in a 2014 plan. If you don't have an agent but would like to find one, let us know and we'll be happy to refer you to a top-notch agent in your area.

 

Learn More about Reform

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Last updated 10/31/2013