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A Healthcare Reform Newsletter for PacificSource
Individual and Family Plan Members
July/August Idaho Issue
 Printable PDF

Welcome to Reform and You, a new newsletter to keep you informed and help you make the most of 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. Through this newsletter and other communications from PacificSource, you'll have the information you need to make important decisions about your coverage.

Reform and You will be distributed every other month through 2013.


Health Insurance is Changing: An Overview

While many of the ACA's changes have already been implemented, the biggest changes begin to take effect on October 1, 2013, when the Health Insurance Exchanges begin accepting enrollment for January 1, 2014 effective dates. Understanding these changes and how they impact you will better prepare you to make the best choices.

Since you already buy health insurance coverage on your own, you may be interested to know:

  • You'll be able to remain enrolled with PacificSource by allowing us to move you to a new plan when you renew, or you can shop for coverage through your state's exchange marketplace.
  • You may qualify for financial assistance through the exchange marketplace to help pay for your individual coverage.
  • Your plan's benefits will change when you move to a new plan in 2014 (beginning January 1, 2014, when all new individual and family health plans sold must meet new ACA requirements):
    • Plans must fit into one of four new "metal level" benefit tiers.
    • Plans will cover newly defined "essential health benefits," which will have no annual or lifetime dollar limitations.
  • The way insurers determine rates for coverage will change. Requirements of the ACA may mean higher rates for some, and lower rates for others. Rates will be based only on your age, geographic location, tobacco use, and the benefit plan you choose.

With all of the changes to health insurance, it will be difficult to compare the plan and premium rates you have today with what will be available in 2014. You'll have new plans to choose from, access to financial help for paying for coverage if you qualify, and a new way to purchase your coverage if you choose. While many things will change, our commitment to serving you with our award-winning service remains the same.

In this first issue of Reform and You we'll cover the new exchange marketplace and financial assistance.


Exchanges: A New Marketplace Option

The ACA calls for states to establish new health insurance marketplaces to help individuals and small businesses shop for coverage. They're intended to make it easy to compare health plans based on price, benefits, and quality. Idaho's exchange marketplace will open for business on October 1, 2013 and people will be able to enroll in health insurance that begins January 1, 2014 or later.

You might think of an exchange as a website similar to Amazon. You can shop for an item, compare products based on quality (consumer reviews) and price, and make a purchase. Idaho's exchange marketplace will let you compare plan benefits and costs among all the insurance companies, including PacificSource, that are participating. The exchange marketplace will also be the gateway to financial assistance if you qualify (please see "Financial Assistance for Health Insurance"). If things such as drug formularies or calls answered by a real person are important to you, you may want to do a bit more research by going to a health insurance company's website.

Will everyone need to use the exchange marketplace to enroll in coverage?

No, but if you'll qualify for financial assistance (explained in the next article) you'll need to go through Idaho's exchange marketplace to access that help. If you don't qualify for assistance or simply don't want to use the exchange marketplace, you can choose to stay with PacificSource and we'll move your coverage to a new qualified health plan (QHP) that most closely matches your current plan, unless you select one of our other new QHPs. Idaho's exchange marketplace will operate alongside, but not replace, our current direct carrier marketplace. All of the plans sold inside the exchange marketplace will also be available directly from us, at the same rates, and we'll offer more health plan choices outside the exchange marketplace.

Weighing your options: Idaho's new exchange marketplace vs. current direct marketplace

In 2014, as your benefits and rates change to comply with ACA requirements, you'll have options for maintaining individual health insurance. There are advantages to consider with each one, and your best choice depends on your personal needs.

Idaho's Exchange Marketplace: The best choice if you qualify for financial assistance

If you qualify for financial assistance, you'll only receive that assistance by enrolling in new coverage through Idaho's exchange marketplace. If there's a chance your 2014 household income might be under 400% of the federal poverty level (FPL) you should check with the exchange marketplace to see if you qualify for any financial assistance (please see "Financial Assistance for Health Insurance").

When you visit the exchange marketplace you'll answer detailed financial questions to determine if you're eligible for financial assistance. If you qualify for Medicaid, the exchange marketplace will direct you in how to enroll in that coverage. If you qualify for premium assistance, you'll be able to choose any plan available and apply your financial assistance toward that plan's premium cost. If the plan you choose costs more than your premium assistance, you'll be responsible for paying the difference.

You'll find a variety of PacificSource plans on Idaho's exchange marketplace, so if you qualify for financial assistance and want to stay with PacificSource, it is easy to do.

The existing direct marketplace: More choice and less complexity

If you don't qualify for financial assistance, you may find advantages to keeping coverage with PacificSource outside the exchange marketplace. Here are some helpful things to keep in mind:

  • Outside the exchange marketplace, you'll have access to all the plans available through the exchange marketplace (at the same rates), plus additional options. Health insurers are only allowed to offer a limited number of plans in Idaho's exchange marketplace, but there are no such limits outside the exchange marketplace.
  • Maintaining your coverage with PacificSource is easier to do outside the exchange marketplace. You'll be able to move to a new ACA-compliant PacificSource plan without completing a new application form. You'll also have uninterrupted access to all our member services, including InTouch, your claims history and EOBs, wellness tools, and condition support programs. And you'll have more plans to choose from outside the exchange marketplace. We'll automatically transfer you to the ACA-compliant plan that's closest to your current plan design. If that plan doesn't meet your current needs, you are welcome to choose from any of our other plans.

The ACA calls for states to establish new health insurance marketplaces to help individuals and small businesses shop for coverage. They're intended to make it easy to compare health plans based on price, benefits, and quality. Montana will use the federal exchange marketplace, It will open for business on October 1, 2013 and people will be able to enroll in health insurance that begins January 1, 2014 or later.

Do you qualify for financial assistance?





Enroll in new coverage through the exchange marketplace.
You can enroll in a new PacificSource plan through the exchange marketplace and enjoy all the extras and member services you have with us today. When you receive your new member ID number you can re-register for InTouch and re-enroll in any other PacificSource member services.



Option one (easiest path): We will send you the information to stay with PacificSource with uninterrupted service. We'll automatically move you to the closest new qualifying plan, or you can choose any other plan we offer.

You won't need to re-enroll, and you'll keep your current InTouch account, claims history, EOBs, and access to all our services. If you pay your premium by EFT or credit card you may need to complete a new payment authorization. 

Option two: Review all your new coverage options, either through Idaho's exchange marketplace, or direct with health insurance companies to find the plan that fits your needs. You can use an insurance agent to help with this or do it on your own.


Financial Assistance for Health Insurance

Although some people thought the ACA meant health insurance would be free in 2014, that's not the case. But depending on your income, you may be able to get help paying for your health insurance costs.

How will you know if you qualify?

You can use an online financial calculator like the one at to get an estimate of whether you'll qualify for financial assistance. The calculations are 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 earning up to $45,960 and families of four earning up to $94,200 in 2013. To verify your eligibility and access any assistance, you'll need to apply for insurance coverage through Idaho's state's exchange marketplace (please see “Exchanges: A New Marketplace Option”).

What financial assistance is available?

Three types of financial help are available to individuals purchasing their own coverage through an exchange.

  1. Premium assistance tax credits are intended to help lower your monthly premium costs. The credits, based on a sliding scale so that those with lower incomes receive the most help, are available to people earning between 138 and 400 percent of the FPL. This assistance could come in monthly payments or a lump sum when you file your taxes.
  2. Cost-sharing subsidies are federal payments that can reduce the out-of-pocket costs of care. These subsidies are available to individuals and families earning up to 250 percent of FPL, and American Indians and Alaska natives with income up to 300 percent of FPL. This assistance supplements the premium assistance tax credits also available at this income level. If you qualify, this subsidy will help with cost-sharing – expenses like copayments, coinsurance, and deductibles – for covered benefits by reducing the plan's out-of-pocket limits by up to two-thirds (or eliminating cost-sharing altogether for American Indians and Alaska natives). Like the premium credits, this subsidy is also applied on a sliding scale with lower income individuals receiving the most generous help.
  3. Medicaid will continue to be available to those who qualify. 

It's important to understand that this financial assistance is only available if you enroll in individual or family coverage through Idaho's exchange marketplace. The tax credit can't be used to help cover the cost of employer-sponsored coverage, or coverage you buy on your own outside the exchange marketplace.


What's next?

You'll be hearing more from us in the coming months as we make the transition as easy as possible for you. In the next issue of this newsletter you'll learn about the new standards for benefits and plan designs, and the essential health benefits all individual health plans will cover. Watch for the next Reform and You to arrive in August. Prior to your renewal, we'll send you information about your current plan ending, and new plans available to you.


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.



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