If it makes sense to shop early for Christmas, it’s just as advisable to get an early start looking for health insurance under the federal Affordable Care Act, for which enrollment opens Oct. 1, a San Juan Basin Health Department health-coverage guide says.
Enrollment is not as simple as buying a pair of socks for a second cousin, said Kevin O’Connor, health-coverage guide for the health department.
“We can help you get started or help you if you meet a stumbling block,” O’Connor said. “We encourage people to get in the decision-making process early to make sure they understand the options.”
The first benefits will be available Jan. 1, 2014.
O’Connor and his counterpart in Pagosa Springs, Renee Burch, were hired by San Juan Basin Health Department. They are part of a network to help local residents evaluate health-plan options, apply for a tax credit (if eligible) to reduce costs and sign up for health coverage as of Oct. 1.
Their services are free.
The Affordable Care Act, commonly known as Obamacare after its chief champion, is the result of national legislation that has three goals – make health care affordable to people previously shutout by cost or pre-existing condition; reduce the cost of health care and health insurance; and increase choices in health-insurance options, O’Connor said.
Vanessa Boyd, manager of care coordination services at San Juan Basin Health Department, said the cost of health care is a major barrier to getting coverage. In Southwest Colorado, transportation also is a significant obstacle, she said.
Connect for Health Colorado is the state-created “marketplace” where individuals, families and small businesses (fewer than 50 employees) can compare all aspects of about 150 competitive health plans and choose one.
Employers with fewer than 50 employees are not required to offer health coverage, O’Connor said. Employers with more than 50 employees have until 2015 to offer coverage.
Insurance carriers will offer up to four levels of services – bronze, silver, gold and platinum – depending on how much they pay and how much the customer pays, O’Connor said. The plans, respectively, will pay 60, 70, 80 and 90 percent of costs on average, with the insured person picking up the remainder.
Enrollment can be done online, by the applicant alone or with the help of O’Connor or Burch in person or by phone. Paper applications also are available, and customers can deal with an insurance carrier directly or with an insurance broker.
For the record, O’Connor said, Connect for Health Colorado is not a state agency, a new health-care system, a regulatory body, an insurance broker, a negotiator of rates with insurance carriers, an arm of Medicaid or a provider of Medicare or its supplements.
Health-care reform increases choices of insurance plans and insurances carriers for small-business owners and their employees, O’Connor said. If employees aren’t satisfied with how much employers contribute toward benefits, they can “buy up” to a higher level of benefits, he said.
If an employer offers qualified health-care coverage, an employee doesn’t qualify for a tax credit, O’Connor said. The only exception occurs if the employee’s premium is 9.5 percent or more of his or her household income.
The intent of the Affordable Care Act is to reduce health-care costs, O’Connor said. Competition should keep costs manageable. Costs already have fallen by 50 percent in New York state, but it remains to be seen what the overall trend will be, he said.
A qualified health plan must provide coverage in 10 areas – ambulatory patient care, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse, prescription drugs, rehabilitative services and devices, laboratory work, preventive and wellness programs, and pediatric care, including and vision and oral elements.
“If you have an employer’s qualified plan, you probably can’t do better in the marketplace on your own,” O’Connor said.
Health-care reform is expected to make 160,000 more Coloradans eligible for Medicaid, O’Connor said. People who earned too much to qualify for Medicaid in the past may meet new guidelines, so that will be their most affordable option.
Colorado is one of 16 states that have established their own insurance marketplace, O’Connor said. Six other states use a combination of federal and their own regulations. The remaining 28 states fall under federal guidelines.
daler@durangoherald.com
Health-care questions? There are answers
A health-coverage guide at San Juan Basin Health Department can help people enroll and answer questions about the Affordable Care Act.
The following are some common, good-to-know facts about the new law, as provided by Kevin O’Conner:
Everyone must have health insurance through the Affordable Care Act. The only exceptions are members of certain religious groups or Native American tribes.
The enrollment period opens Oct. 1 and closes March 31.
People who receive care through the Cover Colorado program will also see their coverage end March 31.
A penalty of 1 percent of adjusted gross income for each family member is imposed annually for failure to enroll in a health plan. The penalty will increase in the future.
Changing health-care plans can be done only once a year, from Oct. 15 to Dec. 7.
A husband and wife can have separate health plans.
Veterans who receive care through the Department of Veterans Affairs will see no change in benefits or out-of-pocket expenses.
People who live with a significant other or who are in a common-law marriage would be wise to check on the status of such relationships because they are complicated issues.
Anyone contemplating elective surgery should consult their carrier.
An insurance carrier can’t deny coverage because of pre-existing conditions and can’t charge more because of them. The only exception is a smoker, who will pay a premium.
A federal tax credit tied to income and number of family members can provide substantial help in meeting health-coverage premiums.
A person who loses employment can keep the employer’s plan through Cobra. If the employer’s plan is lost, the person must sign up for coverage during the annual open-enrollment period.
The marketplace is not connected with Medicare or its supplements.
The cost of medications could vary according to the health plan chosen.
Oct. 1 is the first date to enroll in a health plan. Plans will take effect Jan. 1.
daler@durangoheald.com
On the Net
The Colorado Department of Regulatory Agencies website has several links to information about the zoned rates to be charged for health-care premiums in medical and dental fields.
The information is available at: http://1.usa.gov/194vyJw
Contacts, meetings and resources
A number of health-coverage guides are available in the Durango area to provide free information about the Affordable Care Act and how to enroll.
They are Kevin O’Connor in Durango at 335-2021 and Renee Burch in Pagosa Springs at 264-2409, ext. 203, from the San Juan Basin Health Department.
O’Connor has a speaking schedule:
6 p.m. Sept. 19, 10 a.m. Sept. 26 and 10 a.m. Sept. 28 at Ignacio Public Library.
10 a.m. Oct. 14, 6 p.m. Oct. 17 and 10 a.m. Oct. 19 at Durango Public Library.
The La Plata Family Centers Coalition has three health-coverage guides. They are Eileen Mathy at 749-4533; and Bernice Lozano and Angie Dinger at 385-4747.
Help also is available at Connect for Health Colorado. The center will take calls around the clock starting Oct. 1 at (855) 752-6749. Anyone who is more comfortable in a foreign language may ask for help in that language.
Information, general and specific, also is available at:
www.ConnectforHealthCO.com
www.Healthcare.gov
kff.org
www.costcoreform.com
Colorado.gov/peak
www.dol.gov
www.sjbhd.org
www.hrblock.com/healthcare
The original version of this story included some incorrect times and dates for the Durango Public Library schedule.
