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Taking confusion out of Obamacare

HILLTOP’S HEALTH ACCESS OFFICE

602 Bookcliff Ave.

970-244-0836

The office is open Monday through Friday from 9 a.m. to 5 p.m. and Saturday, 9 a.m. to noon. Walk-ins or appointments are available during daytime hours. Evening hours until 7 p.m. are available by appointment only.

With open enrollment for state-run health insurance kicking off this month, it’s no secret there’s plenty of confusion regarding how the Affordable Care Act (ACA) — nicknamed Obamacare — will impact Grand Valley residents heading into 2014.

And with approximately 22,000 folks thought to be currently uninsured in Mesa County, lots of people will be considering their healthcare options in the coming months. (Only 40 or so have stopped in to Mesa County’s Health Access division so far.)

Here’s what we know: Publicly run health insurance plans, known as Qualified Health Plans (QHP), will start for those who need it as soon as Jan. 1. More folks will likely qualify for Medicaid. Plus, under ACA, those with pre-existing conditions will no longer be denied healthcare coverage.



The only health-related question asked of those applying for health coverage under ACA will be: “Are you a tobacco user?”

Geographic location and age could also impact pricing, “though older adults are given proportionately more tax credits to offset their higher premiums,” Health Access Manager Rhonda Lofing said. And income by family size is the main factor when determining what health insurance will cost on a sliding scale,



The ACA also sets out guidelines requiring everyone nationwide to have some type of health insurance — whether public or private, through work or purchased independently — starting in 2014. Those who choose not to enter the healthcare marketplace and remain uninsured will experience tax penalties that will increase over the coming years if they continue to opt out. Plus, without medical insurance, they’ll be required to pay full price for their care.

THERE’S FREE HELP OUT THERE

If you need help navigating the Connect for Health Colorado Marketplace, Mesa County has its very own Hilltop-run Health Access division open for business near St. Mary’s Hospital. There, free assistance by certified guides are available for everyone who needs it — in person, over the phone, online, or a combination of all three.

“There are subsidies available, and educating yourself online or with personal assistance is the best way to determine what options apply to you.” Lofing said.

And for those people who don’t have access to a computer or find the web-based health insurance marketplace confusing, Hilltop Community Resources’ Director of Community Programs Jackie Sievers said: “We can do it for them, read out the questions, and enter it online for them.”

“The customer service center can take applications over the phone, as well as directly with Connect for Health Colorado customer service staff,” Sievers added.

TOP 10 THINGS TO KNOW

Here are the top 10 things you should know about the ACA going forward:

1. Local Marketplace and Assistance Sites are now open, even during the government shutdown.

“Colorado has been a leader in setting up the marketplace with lots of plans,” Lofing said. “High security standards have been prominent in the design of the Connect for Health Colorado website.”

2. You’re in good hands as a Colorado resident.

“Colorado is ahead of the game,” Sievers said, in setting up exchanges with more carriers, more plans and higher security standards than other states.

That’s because the Colorado Blue Ribbon Commission (a state healthcare committee) already developed a variety of healthcare reform measures in 2009, but funding wasn’t in place at the time. Sievers said many of those recommendations are being utilized now through ACA funding.

3. The Connect for Health Colorado Marketplace is designed to offer affordable healthcare coverage for all who need it.

According to Sievers, insurance premiums under the Connect for Health Colorado Marketplace should not exceed 9.5 percent of yearly income for an individual, or 8 percent for a family. Plus, there are many subsidies available for a variety of income levels.

“Subsidies are all based on family size, how many dependents you have,” she said.

Want to know what you qualify for? There’s a financial calculator available online for price scale and subsidies, but to get the most accurate answer both Lofing and Sievers suggest making an appointment at the local office for personal assistance. Or folks should contact a certified broker or call the customer service line at Connect for Health Colorado.

“Go through the process to know exactly what you qualify for,” Lofing said. “Just like taxes, you’ll need to go through the entire process to see what the bottom line is.”

4. Colorado residents may apply for health coverage through the new marketplace in four different ways:

— Online: http://www.connectforhealthco.com

— Phone: 1-888-752-6749

— With a certified guide at a certified assistance site

— With a certified broker or agent

5. To receive coverage in 2014, open enrollment is set from Oct. 1, 2013, through March 31, 2014.

If you want to start health coverage on Jan. 1, Lofing said “you must be enrolled and the insurance company must have received your first monthly payment by Dec. 15, 2013.”

“Don’t panic, but don’t procrastinate too long,” she continued. “It’s important and it can help protect families. No one wants to go through medical bankruptcy.”

And just like private health insurance, qualified events like births, deaths and job loss will enable people to get coverage mid-year outside open enrollment.

6. If your income changes throughout the year, you’ll need to report it.

Subsidies may change depending on your income level, so notify Connect for Health Colorado directly through the assistance site or through a local certified broker/agent, Lofing said. This applies when estimated annual income varies by more than 10 percent.

7. Already have Medicare? Then Sievers and Lofing said you don’t need to do anything else — “You’re covered!”

8. The marketplace application process is streamlined to include other programs.

Sievers said qualified guides at Hilltop’s Health Access Office will screen everyone to see if they now qualify for Medicaid, Child Health Plan Plus, advanced premium tax credits and cost-sharing reductions through one process.

9. The application process for the Connect for Health Colorado Marketplace is designed to be paperless.

“Data to obtain coverage can be entered online if desired; no paper applications are required,” Lofing said.

10. Adults will qualify for Medicaid starting Jan. 1.

In 2014, Medicaid covers adults and expanded its eligibility requirements — it’s not just pregnant women and children who qualify.

“Different kinds of coverage options will be available,” Lofing said. “In this area, Medicaid uses Rocky Mountain Health Plans, a local insurance organization that’s very well-respected in the community.”


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