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Uninsured

Q. I don't have insurance now, how and when will the new law help me get coverage?

A. It depends on your situation. If you haven't had insurance for six months, and you can't afford or don't qualify for coverage because of a pre-existing condition, you may be eligible for coverage under the federal Pre-Existing Condition Insurance Plan (PCIP) beginning July 1. For more information and how to apply for this plan, please go to www.healthcare.gov.

Q. I don't have insurance. Will I have to get it and what happens if I don't?

A. All individuals will be required to have health insurance, with some exceptions, beginning in 2014. Those who don't will have to pay an annual penalty based on their income.

Exceptions will be given for:

  • financial hardship
  • religious objections
  • American Indians
  • individuals without coverage for less than three months
  • undocumented immigrants
  • incarcerated individuals
  • individuals for whom the lowest cost plan option exceeds 8% of an individual's income
  • individuals with incomes below the tax filing threshold

Q. How will the new law affect the kind of insurance I can buy? Will it make it easier for me to get coverage, even if I have health problems?

A. Yes. The new law creates a temporary high-risk pool for people with medical conditions who have been denied insurance and who have been uninsured for at least six months.

Beginning in 2014, health plans cannot deny you coverage because of your health status.

Q. Why does the law require me to purchase health insurance coverage?

A. The key goal of the health care reform law is to ensure that nobody can be denied coverage or be priced out of coverage due to a health problem. If you allow people to wait until they have a health problem to purchase insurance, the health insurance market simply will not work. There would be a small number of very expensive choices for everyone. So, the law requires that everyone have minimum coverage, creating a larger pool of both sick and healthy individuals.

Q. I am single, have no children and earn less than $10,000 per year. What coverage choices will be available to me?

A. Beginning in 2014, single adults earning between $10,830 and $14,400 will be able to choose whether to enroll in Medicaid or to purchase coverage through the Exchange with a generous federal subsidy. Those earning less than $10,830 will be eligible for their state’s Medicaid program, but not for subsidies in the Exchange.

Q. I have been denied coverage because I have a pre-existing condition. What will this law do for me?

A. Beginning June 14, 2010, coverage will be available to individuals with pre-existing conditions who have been uninsured for at least six months through the Pre-Existing Condition Insurance Plan (PCIP) in every state. These programs will provide coverage that immediately covers pre-existing conditions at premiums that are capped at the average cost of private coverage in your state's individual market. In 2014, when the Exchanges open for business, insurers will be prohibited from discriminating against individuals with pre-existing conditions in offering or pricing health insurance policies. In addition, for those with qualifying incomes, subsidies will be available to reduce premiums and cost-sharing for plans purchased through the Exchange. For more information and how to apply for this plan, please go to www.healthcare.gov.

Q. My family income is about $45,000, but my employer does not subsidize our health insurance and we cannot afford it on our own. What will the new law do to make coverage more affordable?

A. Low- and moderate-income individuals and families whose employers do not subsidize health insurance coverage will be eligible for subsidies that enable them to purchase coverage through the Exchange in their state. The amount of these subsidies, which will reduce premiums and out-of-pocket costs for deductibles, co-payments and coinsurance, will depend upon the size of your family and your household income.

Q. What are “Exchanges”? Can I still purchase coverage through my agent?

A. Exchanges are the central mechanisms created by the health reform bill to help individuals and small businesses purchase health insurance coverage. Beginning in 2014, an Exchange will be established in each state to help consumers make valid comparisons between plans that are certified to have met benchmarks for quality and affordability. The Exchanges will also administer the new health insurance subsidies and facilitate enrollment in private health insurance, Medicaid and the Children's Health Insurance Program (CHIP). Nobody will be required to purchase health insurance through the Exchange, though subsidies will only be available for plans sold through the Exchange. If you would rather buy your insurance through an insurance agent or broker, you will be free to do so. If not, you will be able to purchase insurance in a matter of minutes on the Exchange's website.

Q. When will the federally mandated Pre-Existing Condition Insurance Plan be available in Idaho?

A. The state of Idaho has decided to allow the Federal government to manage the Pre-Existing Condition Insurance Plan. In a letter dated April 30, 2010 to U.S. Secretary of Health and Human Services Kathleen Sebelius, Governor Otter wrote, “Put simply, Idaho cannot afford to subsidize a second high-risk pool program, especially during these difficult economic times.” As soon as we have more information from the federal program on how the program will be set up in Idaho we will post it on our website. See press release.  For more information and how to apply for this plan, please go to www.healthcare.gov.