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A Healthcare Reform Newsletter for PacificSource Small Group Members
November/December Idaho Issue
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Information You Need

Welcome to Reform and You, a newsletter about the Affordable Care Act (ACA), also known as healthcare reform or Obamacare. In 2014, many things about health insurance will be different than they are today. This newsletter will provide you with the information you need to understand how these changes may, or may not, impact you.

In this issue:


Health Insurance is Changing: An Overview

While many of the ACA's changes have already been implemented, the biggest changes take effect on January 1, 2014. You might already be hearing about exchange marketplaces, which opened in October. In these new marketplaces, individuals and small businesses can compare insurance options. Those who qualify can also access tax credits to help pay for coverage.

The ACA will have the biggest impact on people who buy their own individual health insurance and those without any coverage today. If the law will result in changes to your employer-sponsored health plan next year, you'll receive specific information from your employer. In the meantime, you might be wondering what these changes are, and how they could impact a family member or friend who doesn't have health insurance.

Here's a summary of the major changes happening in 2014:

  • The individual coverage mandate requires that nearly all Americans have health insurance by January 1, 2014 or face a tax penalty.
  • Health underwriting and pre-existing condition limitations are eliminated. Coverage is available to everyone who applies for health insurance regardless of their health, and rates won't be affected by an individual's health.
  • Many people with low to moderate incomes qualify for financial assistance to help pay for individual coverage through the new health insurance exchange marketplaces.
  • Benefits for individual and small employer plans change to meet the new ACA requirements when coverage renews in 2014.

What is the individual mandate?

The ACA includes a requirement that all U.S. citizens and legal residents have basic 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. There are only nine categories of people that may be exempt from the requirement to pay the tax penalty:

  • Certain religious groups, federally recognized Native American tribes, individuals not lawfully present, and people who are incarcerated
  • People with incomes below the tax filing threshold
  • Those suffering hardships, as defined by the U.S. Department of Health and Human Services, that prevent them from obtaining qualified health insurance coverage
  • Members of a healthcare sharing ministry
  • Individuals who experience a short coverage gap (approx. three consecutive months)
  • Individuals who cannot afford coverage based on household income

 Who'll qualify for financial assistance?

Federal tax credits will be available to help many Americans who pay for their own individual insurance coverage. People who don't have access to coverage through an employer or a government program may qualify for help if they meet the ACA's income requirements.
Qualification is based on the Federal Poverty Level (FPL) and assistance is available to those whose household income is up to 400 percent of the FPL. As a point of reference, 400 percent of FPL includes individuals who earn up to $45,960 and families of four who earn up to $94,200 in 2013.

Online financial calculators like the one at can provide estimates of eligibility for financial assistance. To verify eligibility and access that assistance, those who qualify will need to enroll in coverage through the exchange marketplace.

What is the exchange marketplace?

The exchange marketplace is a new way for individuals who purchase their own coverage to access financial assistance (if they qualify), compare plans from different insurance companies, and enroll in coverage. Small businesses may also use the marketplace to purchase coverage for their employees. This marketplace will operate alongside the direct marketplace we have today, where people purchase coverage right from a health insurance company (often with the help of an insurance agent).

Idaho’s exchange marketplace, called Your Health Idaho (, opened in October for coverage beginning January 1, 0214.

What are essential health benefits?

The ACA ensures that all health plans sold to individuals and small employers—both inside and outside of the new exchange marketplaces—cover certain items and services, known as essential health benefits or EHBs. This requirement begins in 2014 as policies renew, so you won't see them with your coverage until your employer renews to a new ACA compliant plan.
EHBs include the following general categories:

  • Ambulatory care, which includes doctor office visits and other same-day outpatient care
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including dental and vision care for children under 19
  • Chiropractic care

What are "metal" plans?

Another change you might be hearing about is a reference to plans by "metal" level. Today, health insurance companies offer many different plans, and the choices can be very different from company to company. In 2014, plans will be categorized into "tiers" or "levels" called Bronze, Silver, Gold, and Platinum.

As you might guess from their names, the metal levels reflect the relative cost and benefit levels. Platinum plans will offer the most generous coverage in exchange for the highest monthly costs, while bronze plans have the lowest monthly costs and least generous coverage.

These metal level categories are designed to make it easier for employers and individual purchasers to compare plans from different insurance companies when they choose a new ACA-compliant plan at renewal.

Want to learn more about EHBs or metal levels?

You'll find more details on EHBs in the consumer guides on our reform website, Click on your state under
"I'm covered by a group health plan," and look for the topic you're interested in.


Know someone who'll need individual coverage
in 2014?

If your friend or loved one could use a little help understanding the changes or finding the right coverage, our Coverage Advisors are here to help.

PacificSource Coverage Advisors
Toll-free: (855) 330-2792
Hours: 7:00 a.m. to 6:00 p.m. M-F


Online resources for you: – Here you'll find information about how healthcare reform will impact you as a PacificSource member. – This site provides general information for consumers about healthcare reform changes. – Idaho’s exchange marketplace


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Last updated 11/12/2013