Close Welcome! We've made a few changes to our site. We've refreshed the design and added great content to help you make smarter health care choices.

Changes for 2014: The Affordable Care Act

YouTube Video

Mandatory Coverage Requirements

Your health coverage rights and responsibilities

The Affordable Care Act (ACA) impacts everyone differently. It’s important to learn more about the law and how it might affect you.

Guaranteed acceptance: No denial for pre-existing conditions

The ACA makes health insurance benefits more accessible to more people. Starting January 1, 2014, no one in your family will be denied coverage or charged more because of a pre-existing condition including a disability.

Individual mandate: Your health coverage choices

The ACA requires people over the age of 18 to have health insurance by March 31, 2014.

  • If you do not receive coverage through your employer, you can buy health insurance directly from an insurance company, or through an independent broker or the Health Insurance Marketplace, a federally operated online website for buying insurance.
  • If you choose to remain uninsured the federal government will assess a tax penalty. To avoid a penalty, you must have a health insurance policy by March 31, 2014 and include proof in your 2013 tax return.
Year Per Adult Per Child Family Max   % of taxable Income
2014 $95 $47.50 $285 or 1.0%
2015 $325 $162.50 $975 or 2.0%
2016 $695 $347.50 $2,085 or 2.5%

Contact Us

Read More Show Less
null

Health Plan Benefits Are Changing

Your health coverage choices will be simplified with standardized plans in 2014. The Affordable Care Act (ACA) requires new 2014 individual and family plans to include a set of essential health benefits and provide four basic levels of coverage.

Essential health benefits*

No matter what level of coverage you buy, you are guaranteed the following services:

  1. Ambulatory patient service
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including dental and vision care

Four basic levels of coverage

The different levels are defined by the percentage each insurance company will pay toward medical expenses for an average person. Here’s how the levels break down:

  • Bronze plans: 60% of medical expenses
  • Silver plans: 70% of medical expenses
  • Gold plans: 80% of medical expenses
  • Platinum plans: 90% of medical expenses

What if you already have a plan?

If you currently have an individual and family plan with Blue Cross and Blue Shield of Arizona, you may be eligible to keep that plan. The law considers health plans that were in effect on or before March 23, 2010, the date of the new health care reform law’s enactment, a “grandfathered plan.” These plans do not need to comply with certain provisions of the ACA.

* Healthcare.gov: Essential health benefits (accessed October 2012).

Contact Us

Read More Show Less

Worried about how you’ll afford to buy health insurance? Financial support may be available

Two forms of financial subsidy are available to help those who can’t afford minimum health coverage. Eligibility for each subsidy depends on income level. Individuals with incomes below 400% of the federal poverty level (FPL), and who don’t have affordable coverage through work, may qualify for a tax credit to apply toward the cost of health insurance premiums. Individuals with incomes below 250% of the FPL may qualify for reduced cost sharing. where the federal government pays part of a member’s cost share, such as copayments and coinsurance.

If you are eligible to receive a subsidy, you must purchase a health insurance policy on the Federal Exchange by March 31, 2014 and include proof in your 2013 tax return. When you apply through the Exchange, you will provide information about your income that determines your eligibility for a subsidy.

If your income is below 400% of the federal poverty limit, you may be eligible for a tax credit, depending on your family size.

Household Size 100% - 400%
1 $11,490 - $45,960
2 $15,510 - $62,040
3 $19,530 - $78,120
4 $23,550 - $94,200
5 $27,570 - $110,280

Check our savings estimator to see how much your tax credit might be.

Contact Us

Read More Show Less
null

Ways to purchase health insurance are expanding

If you don’t have health coverage through an employer, you have three ways to buy a plan:

  1. Purchase from an insurance company
  2. Contact an independent broker
  3. Go online to the Health Insurance Marketplace, also known as the Federal Exchange

What is the Health Insurance Marketplace (Federal Exchange)?

The Health Insurance Marketplace is an online website where you can compare plans, verify subsidy eligibility and buy health insurance. If you are eligible to receive a tax credit, you must buy a health insurance policy on the Health Insurance Marketplace website by March 31, 2014. Even if you don’t qualify for a subsidy, you can still buy health insurance through the Health Insurance Marketplace.

Contact Us

Read More Show Less
null

Enrollment for 2014 plans begins October 1, 2013

Another change from the Affordable Care Act is the process for enrollment. To sign up for a 2014 health insurance plan, you will be required to buy during a set timeframe called “open enrollment.” Unless you qualify for a special enrollment exemption, you will not be able to buy coverage outside of the open enrollment period. The open enrollment period is October 2013 to March 2014. Insurance companies that offer products outside the Marketplace may choose to have longer, or additional, open enrollment periods.

There are certain personal life events that may give you special rights to buy a plan outside of the open enrollment window including:

  • Marriage or divorce
    • For example, if you are covered under your spouse’s policy and you get divorced and lose your coverage
  • Change in dependent eligibility status
    • For example, if you are covered under your parent’s policy but lose eligibility because of your age
  • Change in Medicare or Medicaid status
    • For example, you were covered under Medicaid, but find a higher paying job and lose your Medicaid eligibility
  • Change in your employment status or that of your spouse or dependent from either full-time to part-time, or the reverse
  • Start of your spouse’s employment/eligibility for benefits

Contact Us

Read More Show Less
null

Top 10 questions about Individual coverage under the Affordable Care Act

1. What is the Affordable Care Act (ACA)?
The ACA is the federal health care reform law that was passed in March 2010. Since its passage, many federal regulations have also been enacted to implement the details and requirements. These laws are intended to make health insurance benefits more accessible to more people. The ACA requires most people over the age of 18 to have health coverage (through private insurance, employer coverage or a government program) no later than March 31, 2014. Starting October 1, 2013, new qualified health insurance plans for individuals, families, and small groups will be available for purchase for effective dates beginning January of 2013. 

2. Do I have to do anything now?
No, you don’t have to do anything now. However, you may need to act when the Health Insurance Marketplace (Federal Exchange) opens for enrollment in October of 2013. If you don’t have coverage through employment or a government program, you will need to buy insurance during the open enrollment period - October 1, 2013 to March 31, 2014. The ACA requires most people over the age of 18 to have health insurance by March 31, 2014. Those who do not have coverage may be assessed a tax penalty by the federal government. Now is a good time to educate yourself about your healthcare options.

3. Who has to buy health insurance?
Beginning January 1, 2014, most U.S. citizens and legal immigrants will be required by the federal government to have some form of health insurance or coverage. Some exceptions will be made for members of Native American tribes, undocumented immigrants, individuals with certain religious beliefs, individuals in prison, and individuals whose income is below a certain level.

4. What will happen if I don’t buy insurance?
If you are required to have coverage but choose to remain uninsured, the federal government will assess a tax penalty. To avoid a penalty, you must have a health insurance policy by March 31, 2014 and include proof in your 2013 tax return.

Tax penalties for uninsured individuals

Year Per Adult Per Child Family Max % of taxable income
2014 $95 $47.50 $285 or 1.0%
2015 $325 $162.50 $975 or 2.0%
2016 $695 $347.50 $2,085 or 2.5%

5. Can I be denied healthcare coverage?
Not for new individual and family policies issued on and after January 1, 2014. The ACA makes health insurance benefits more accessible to more people. Starting January 1, 2014, no one in your family will be denied coverage or charged more because of a pre-existing condition including a disability.

6. What is the Health Insurance Marketplace?
The Health Insurance Marketplace is an online website where you can compare plans, verify subsidy eligibility and buy health insurance. If you are eligible to receive a tax credit, you must buy a health insurance policy on the Health Insurance Marketplace website by March 31, 2014. Even if you don’t qualify for a subsidy, you can still buy health insurance through the Health Insurance Marketplace. There is one marketplace for individuals and families, and a different marketplace called “The SHOP” for small group businesses.

7. Do I have to buy from the Health Insurance Marketplace (Federal Exchange)?
No. You only have to buy from the Marketplace if you want to buy individual coverage and apply for a federal subsidy. You can also acquire health insurance coverage from your employer, directly from an insurance company, or indirectly through an independent broker.

8. What if I can’t afford individual insurance?
Two forms of financial subsidy are available to help those who don’t have coverage through work and can’t afford to buy minimum individual health coverage. Eligibility for each subsidy depends on income level. Individuals with incomes below 400% of the federal poverty level (FPL), and who don’t have affordable coverage through work, may qualify for a tax credit to apply toward the cost of health insurance premiums. Individuals with incomes below 250% of the FPL may qualify for reduced cost sharing, where the federal government pays part of a member’s cost share, such as copayments and coinsurance.

Household Size Household Income at 100% - 400% FPL
1 $11,490 – $45,960
2 $15,510 - $62,040
3 $19,530 - $78,120
4 $23,550 - $94,200
5 $27,570 - $110,280

9. What services will be covered?
All new individual and small group plans will include certain essential health benefits. No matter what level of coverage you buy, your plan will include the following services:

  1. Ambulatory patient service 
  2. Emergency services 
  3. Hospitalization 
  4. Maternity and newborn care 
  5. Mental health and substance use disorder services, including behavioral health treatment 
  6. Prescription drugs 
  7. Rehabilitative and habilitative services and devices 
  8. Laboratory services 
  9. Preventive and wellness services and chronic disease management 
  10. Pediatric services, including dental and vision care (As with any insurance plan, coverage is subject to limitations, exclusions, and member cost share requirements.)

10. What is a “grandfathered” plan?
If you have an individual health insurance plan that was purchased on or before March 23, 2010, then it’s likely a grandfathered plan. As a result, it may be exempt from many changes ushered in by the ACA.

Contact Us

Read More Show Less