Sharon Sullivan
ssullivan@gjfreepress.com

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October 24, 2013
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Affordable Care Act: The winners and losers

When Tony Scapellato of Grand Junction walked into Hilltop’s Health Access office Oct. 1, he thought he’d leave with insurance in place through the Affordable Care Act, also known as Obamacare.

However, he’s waiting to learn how much his Advanced Premium Tax Credit will be, and if he’ll receive cost-sharing assistance for his deductible and co-pays before selecting from one of four insurance providers and their various plans in Mesa County’s marketplace.

Hilltop is the certified assistant for Connect for Health Colorado where people can shop and compare insurance plans online. Trained and certified Connect for Health Colorado “guides” (in some states they’re called navigators) walk people through the process at its office at 602 Bookcliff.

“What people don’t know, who are waiting to do this, they don’t realize it’s going to take time,” Scapellato said. “So if you wait until the beginning of December you may not have it completed in time for the Jan. 1 effective date.”

Scapellato, 63, has been uninsured since leaving his job two years ago due to health problems. COBRA, a temporary health insurance program available for people who lose their employer-provided coverage, was too expensive, he said.

“It was $800 a month,” Scapellato said. “I couldn’t afford it.”

With a $1,170 monthly income, Scapellato couldn’t even pay for a less expensive $200/month premium offered by a state program, he said. Plus, it wouldn’t cover his insulin costs because his Type 2 diabetes was a pre-existing condition.

Scapellato suffered a minor heart attack a few years ago, has high blood pressure, and currently pays for his medical expenses out-of-pocket. Based on the cost of one of the plans offered at the Connect for Health Colorado marketplace, and his estimated tax credit, Scapellato expects he’ll pay a monthly premium of about $150 after he’s enrolled in Obamacare.

Scapellato said if he ends up in the hospital, he’ll be glad to have the insurance.

“That’s why I’m doing it. I think it’s good. I want insurance,” he said.

Scapellato is supposed to have his diabetes checked every three months. But because he pays for his medical expenses out-of-pocket, he’s extended the time between doctor visits to six months. When he goes to his next appointment in November, Scapellato said he hopes to convince the doctor to allow him to postpone until January a recommended $175 blood test.

“I want to get on insurance first,” he said. “Then I will go back to every three-month visits. Plus, I’ll be able to afford the blood work.”

A ‘glitch’ in the law

Many may find themselves paying more for health insurance under the new health care law.

Paul Ashcraft of Whitewater was unhappy when his insurance provider, Anthem Blue Cross, told him his $250 monthly premiums would increase to $500 a month under the Affordable Care Act. Plus, his deductible for both hospital and medical will increase.

“If I had the policy in place before the Affordable Care Act was signed into law in 2010, (his rate would have been ‘grandfathered’ in),” Ashcraft said.

However, because he purchased the policy after 2010, he was told his premium would increase. Ashcraft is self-employed and chose to buy insurance for himself rather than go on his schoolteacher wife’s plan because it was cheaper, he said.

“It’s an eye opener,” Ashcraft said, regarding the change. “It’s sticker shock. A lot of us are going to be clobbered.

“Luckily, Anthem sent me a note that said if I renew right away before December they’ll allow me to stay on at $250 a month for another year.”

Hilltop’s Health Access Manager Rhonda Lofing acknowledged there is a “glitch in the law” that negatively impacts people like Ashcraft who choose not to go on their spouse’s employer-provided insurance.

“The way the law was written and passed, if an employer offers ‘affordable’ coverage, the family can’t access the advanced premium tax credits in the (Connect for Health Colorado) marketplace,” she said.

“The law’s not perfect, but it will help a lot of people.”

CATASTROPHIC PLANS

Consumers who have been purchasing individual catastrophic insurance plans (typified by a higher deductible, and lower monthly premiums) are seeing their premiums rise.

Under the new health care law, catastrophic insurance plans will only be available for people under age 29. Individuals older than 29 who purchase catastrophic plans will be hit with tax penalties because that type of coverage has been deemed inadequate for people 30 and older.

“Individual insurance companies make their own business decisions whether to choose to grandfather in current policies,” Lofing said. “So not everyone’s happy with decisions of the insurance companies.

“On the other hand, insurance premiums have been going up for more than a decade.”

tax credits go toward insurance premiums

Individuals with household incomes less than four times (400 percent) the amount of federal poverty level will qualify for tax credits designed to lower insurance premiums to affordable rates.

For example, a family of two earning up to $62,040, or 400 percent of federal poverty level, would qualify for the subsidies.

“It’s a big deal for older people, where it’s been not unusual to pay $800 a month (insurance premium) for two people,” Lofing said.

According to a September article in the Wall Street Journal, 20 percent of people 50-64 did not have health insurance in 2012, up from 15 percent in 2005. Twenty to 29 percent of people in that age group were denied in 2008.

Individuals in that age group, many who have lost jobs and are experiencing health problems, are a lot of whom their office is seeing, Lofing said.

Under the new health care law, insurance companies will no longer be allowed to charge older Americans five times as much as they do young people, Lofing said. Tax credits available for both young and old will bring down their premiums to similar levels, she said.

Scapellato will need to purchase insurance for only 10 months, because on Nov. 1, 2014, he’ll qualify for Medicare, thus he’ll be medically covered and in compliance with the health insurance mandate.

Medicaid is also considered adequate coverage under the Affordable Care Act. If you have Medicaid or Medicare, you do not have to buy additional insurance.

Connect for Health Colorado guides help people like Grand Junction native Rae Lynn Powers to sign up for Medicaid.

“I was denied Medicaid in August — I was about $20 over,” mentioned Powers, 56, whose monthly income she said, totals $876.

Powers, who has chronic obstructive pulmonary disease, Parkinson’s Disease, rheumatoid arthritis and Crohn’s Disease is now covered under Medicaid due to the ACA expansion of Medicaid. Colorado was one of the states who agreed to the optional increase in Medicaid eligibility.

As Scapellato mentioned, applying for insurance may take several steps and more than one trip to the Health Access office for assistance. For insurance coverage starting Jan. 1, the application and enrollment process, plus payment of the first month’s premium must be completed by Dec. 15. To have coverage starting Feb. 1, the enrollment process must be completed sometime between Dec. 16 and Jan. 15.

For questions or to make an appointment with Connect for Health Colorado guides, call 970-244-0850. Drop-ins are also welcome.


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The Post Independent Updated Oct 28, 2013 09:02AM Published Oct 30, 2013 03:36PM Copyright 2013 The Post Independent. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.