About Health Care Reform
For those considering health insurance for the first time, or those who've had health insurance but want to know what health care reform means for them, here's an overview of what's involved.
Health care reform introduces cost-sharing measures and advance premium tax credits (subsidies) to help make health insurance premiums more affordable and allow individuals to upgrade to plans with more benefits.
How much cost-sharing and subsidy you may qualify for depends on your gross annual income, household size and access to affordable health insurance either through your employer or government programs such as Medicaid and Medicare. If your employer's plan does not pay 60% of average medical costs or if your share of the premium is more than 9.5% of your income, you may qualify for a subsidy.
To make comparing plans easier, the government has mandated that all qualified health plans be assigned a metallic value. These are bronze, silver, gold and platinum, with bronze providing the least amount of coverage and platinum the most. However, all plans have an out-of-pocket limit of $6350.1Some plans have an even lower OOP limit.
No matter where you buy your plan, the average amount of medical costs that are covered will be the same for each metallic value. For example, all bronze plans pay approximately 60% of your medical costs no matter where you buy them.
Essential Health Benefits
Regardless of the coverage you choose, health care reform requires that qualified health plans include essential health benefits that fall into the following ten categories:
- Ambulatory services
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse services (including behavioral health)
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive/wellness services and chronic disease management
- Pediatric services, including dental and vision
In 2014, the Affordable Care Act mandates that all taxpayers purchase health insurance or pay a penalty on their tax returns. The penalty will increase every year until 2016.2
- 2014: a minimum of $95 per year or up to 1% of annual individual income (whichever is greater)
- 2015: a minimum of $325 per year or up to 2% of annual individual income (whichever is greater)
- 2016: a minimum of $695 per year or up to 2.5% of annual individual income (whichever is greater)
You can enroll in a plan from 10/1/2013 to 3/31/2014.
Unless special circumstances apply, you will not have the opportunity to enroll again until 10/15/2014 through 12/7/2014 for coverage that starts 1/1/2015. That means you can't wait for a medical need to enroll.
More About Health Care ReformLearn more about health care reform and how it affects health insurance:
- Ready for Reform - Our website devoted completely to health care reform.
- BCBSNC Licensed Sales Agents - If you have more questions about health care reform and what it means for you, give us a call at 1-800-324-4973.
Health care reform is dedicated to making it easier for consumers to comparison shop health insurance plans. This is done by using metallic levels (bronze, silver, gold and platinum) to indicate the level of coverage and insurance benefits in a plan.3
- Bronze: Medical costs are covered at approximately 60%. Ideal for people who want lower monthly premiums and don't expect to need a lot of medical services.
- Silver: Medical costs are covered at approximately 70%. Ideal for those who want to keep their monthly premiums and out-of-pocket medical costs more balanced.
- Gold: Medical costs are covered at approximately 80%. If you receive medical services regularly, and you're okay with paying a higher monthly premium to have more of your health care costs covered, this level of plan is one to consider.
- Platinum: Medical costs are covered at approximately 90%. If you receive medical services frequently, and you're willing to pay more each month for the lowest health care costs, consider this plan level.
All health insurance plans must fall within these metallic levels in 2014, except for the catastrophic plans for people under 30 or that meet certain hardship requirements. Our catastrophic plans, however, do meet bronze level requirements.
All plans have an out-of-pocket (OOP) limit of $6,350.1 This includes costs such as prescription drugs, copayments, etc. Your OOP limit does not include premiums or costs not covered by BCBSNC. Family plans have a higher OOP limit of $12,700. (You may, however, have a plan with a lower OOP limit.)
Get answers to some of the most commonly asked questions about health care reform:
- What are advance premium tax credits?
- How do metallic values work?
- What do essential health benefits cover?
How To Enroll
Enrolling is simple and easy. You can enroll online 24/7.
When you get your free, no-obligation rate quote, we'll help you estimate any advance premium tax credit (subsidy) or cost-sharing reduction you may be eligible for through the government. We'll apply any estimated subsidy to your quote so you can see the reduced rate.
Use the tools and tips on the rate quote results page to compare prices and plan details. We also provide links to more information about our plans and assistance picking the right plan.
Once you pick a plan, you're ready to enroll.
It all starts with a free rate quote!
Note: You only have a limited time to enroll.
- The annual enrollment period is from 10/1/2013 to 3/31/2014. You can choose to have your coverage start between 1/1/2014 and 5/1/2014.
- Unless special circumstances apply, you will not have the opportunity to enroll again until 10/15/2014 through 12/7/2014 for coverage that starts 1/1/2015. That means you can't wait for a medical need to enroll.
Special circumstances for enrolling outside of the open enrollment period include:
- Loss of minimum coverage (employer coverage, government plans, etc.)
- Adding a dependent through birth, adoption or marriage
- Gaining citizenship
- Enrollment/non-enrollment errors by the federal Marketplace or the US Department of Health and Human Services
- Qualified health plan violates the material provision of its contract with the individual
- Newly eligible for a subsidy or a change in the amount of subsidy you are eligible for
- Moving to a new state
- American Indian/Alaska Native status (may change once a month)
- Other exceptional circumstances
- Out-of-pocket limits are subject to change each year according to IRS determination.
- The Henry J. Kaiser Family Foundation. "The Requirement to Buy Coverage Under the Affordable Care Act." http://kff.org/infographic/the-requirement-to-buy-coverage-under-the-affordable-care-act/. Accessed May 8, 2013.
- The Center for Consumer Information and Insurance Oversight. Centers for Medicare and Medicaid Services. "Actuarial Value and Cost-Sharing Reductions Bulletin." http://cciio.cms.gov/resources/files/Files2/02242012/Av-csr-bulletin.pdf. Accessed April 29, 2013.