What Individuals Need to Know
Health care reform requires that starting January 1, 2014:
- You will need to buy health insurance or pay a fine.
- You can’t be denied coverage if you have a serious health condition.
- Your insurance rates won’t be based on your health status anymore. Rates will be based on your age and may be adjusted based for tobacco use.
How much is the fine?
The Internal Revenue Service will fine people who don’t have insurance:
- 2014: $95 or 1 percent of income, whichever is greater
- 2015: $325 or 2 percent of income, whichever is greater
- 2016: $695 or 2.5 percent of income, whichever is greater
Is anyone excluded from paying a fine?
There are a few exceptions to the penalty, including:
- Religious reasons
- Not present in the United States
- In prison
- Not able to pay for coverage that is more than 8 percent of the household income
- An income that is below 100 percent of the poverty level
- Having a hardship waiver
- Not covered for less than three months during the year
Learn more at healthcare.gov.
If you buy health insurance on your own
We’ll help you choose a plan that complies with health care reform and fits your health needs and budget. You’ll have the option to:
- Come straight to us. If you already have HMSA, we’ll modify your plan to meet health care reform standards. Or, you can contact us and we can help you choose a health plan that better fits your health and budget situation. We know you and we’re here to help.
- Use the marketplace. Starting October 1, 2013, you can buy an HMSA health plan in the Hawai‘i Health Connector, an online health insurance marketplace. Depending on your income, you may qualify for financial help in the marketplace to pay for your health insurance premiums and out-of-pocket costs.
Benefits are changing
Starting in 2014, your health plan will offer these 10 essential health benefits:
- Prescription drugs
- Ambulance service
- Emergency care
- Laboratory services
- Maternity and newborn care
- Mental health and substance use services
- Pediatric oral and vision services
- Rehabilitation and habilitative services
- Services for preventive care, wellness, and chronic disease management
Changes to Health Plans Already in Place?
Keiki. Kids can’t be turned down for coverage even if they have medical conditions like asthma.
Young adults. If you haven’t turned 26 yet, you can be covered under your parent’s family health plan if their plan offers dependent coverage.
Women. You can get some preventive health care services at no charge to you, including:
- Well-woman exams
- Breast-feeding support and counseling
All adults. You can get preventive screenings and immunizations at no charge to you, including:
- Blood pressure screenings
- Cholesterol screenings
- HIV screening and counseling
See a complete list of screenings and immunizations that HMSA covers: Health Care Reform Coverage for Preventive Health Benefits. Some exceptions may apply to you. Check with your doctor or us for details.
This information is based on HMSA’s review of the Affordable Care Act (ACA). This overview is intended for educational purposes only and should not be used as tax, legal, or compliance advice.