What You Need to Know About Healthcare Reform
- You need to have health coverage or pay a penalty (in most cases) starting in 2014.
- You may qualify for tax credits to help pay for your coverage.
- You can get coverage even if you have health problems.
- There will be changes to your healthcare benefits and costs.
- You have more choices for buying health coverage.
1. You need to have health coverage or pay a penalty (in most cases) starting in 2014.
So what does that mean for you? Let’s figure it out. Here’s a look at a few different situations:
- If you have health coverage through your employer or through a government program such as Medicare or Medicaid, you've already met the requirement.
- If you are uninsured, you can meet the coverage requirement by buying health coverage directly through an insurance company or through HealthSource RI, our state's health insurance marketplace (also called an exchange). Through HealthSource RI, you can also see if you are eligible for Medicaid, which meets the coverage requirement. (See #5 below.)
- If you fall into certain categories, you don’t have to pay a penalty.
The chart below shows the penalty for not having coverage. You pay whichever amount is higher—the flat dollar amount or the percent of household income. The penalty will be applied by the Internal Revenue Service (IRS) when you file your income taxes each year.
2016 AND BEYOND
$95/adult plus $48/child, up to $285/family
1% of household income
$325/adult plus $162.50/child, up to $975/family
2% of household income
$695/adult plus $347.50/child, up to $2,085/family
2.5% of household income
2. You may qualify for tax credits to help pay for your coverage.
To help more people afford high-quality health coverage, the government is helping to pay for insurance for people at certain household income levels. To get tax credits, you must:
You can use this calculator to see if you may qualify for financial help, which is available in one or more ways:
- Tax credits – If your household income is between 100 percent and 400 percent of the federal poverty level, you may qualify for a premium tax credit. Tax credits can be applied to your premium or you can receive them when filing your taxes at the end of the year. The amount you save depends on your family size and how much money your family earns. In general, people at the income levels below will qualify to save in 2014.* The lower your income, the higher your savings will be.
- Up to $45,960 for individuals
- Up to $62,040 for a family of two
- Up to $94,200 for a family of four
- Lowered cost sharing – If your household income is between 100 percent and 250 percent of the federal poverty level (up to 300 percent for Native Americans), the government may also help pay part of your copays, coinsurance, and deductible. In general, people at the income levels below will qualify to save in 2014.*
- Up to $28,725 for individuals
- Up to $38,775 for a family of 2
- Up to $58,875 for a family of 4
*These amounts are based on 2013 numbers and are likely to be slightly higher in 2014. Amounts are different for each family size, up to eight.
3. You can get coverage even if you have health problems.
If you have asthma, heart disease, or any other pre-existing condition, you can still get health insurance. While Blue Cross has always offered coverage to anyone during open enrollment—no matter their health status—some insurers did not.
4. There will be changes to your healthcare benefits and costs.
To meet the requirements of the Affordable Care Act, your plan will change in these ways:
- Change in how premiums are calculated – In Rhode Island, your premiums will be calculated based only on your age and the age of your covered dependents. Your gender and health status are not used to determine your premium.
- Expanded benefits – Most health plans must cover 10 categories of essential health benefits without annual or lifetime dollar maximums. If you have a Blue Cross plan, many of these benefits are already included, such as hospital care and laboratory services. However, others are new, such as children’s dental and vision coverage.
- New limits on how much you pay out of pocket – For 2014, the out-of-pocket maximums cannot be more than $6,350 for individual coverage or $12,700 for family coverage. And cost sharing on all essential health benefits will apply to your out-of-pocket maximum.
- New taxes and fees – The taxes and fees required by the Affordable Care Act, along with the added benefits described above, are new costs that are included in your monthly premium.
5. You have more choices for buying coverage.
If your employer continues to offer coverage or if you have coverage through a government program such as Medicare or Medicaid, you can continue to get your coverage as you always have. And if you purchase plans directly from Blue Cross, you can keep doing that as well! However, you also have another option for buying coverage starting in October 2013: HealthSource RI. Plans from Blue Cross will be available through HealthSource RI.
If you are eligible for tax credits or cost-sharing reductions, you will only be able to take advantage of those programs by buying insurance through HealthSource RI.