Health care changes near, details explained at Rifle chamber forum
Citizen Telegram Editor
On Tuesday, Americans can start to make – and in many cases, must make – some important decisions about their health care.
Tuesday is when the mandatory insurance provision of the Affordable Care Act, also known as Obamacare, begins. Starting in 2014, most people will be required to have health insurance or pay a penalty if they don’t have that coverage.
To help inform their members and area residents, the Rifle Area Chamber of Commerce held a seminar, “The Affordable Care Act: What You Need to Know,” on Tuesday, Sept. 17, at Colorado Mountain College in Rifle.
Denise Ibsen, owner of Ibsen Insurance, explained that as of Tuesday, Oct. 1, those without health insurance can get help, compare plans and rates, see if they qualify for financial assistance and get in touch with a certified health care broker through the Connect For Colorado marketplace.
“If you enroll in a health care plan by Dec. 15, your coverage will start on Jan. 1, 204,” she said. “And the big thing is you won’t be turned down for coverage due to a pre-existing condition. You don’t have to provide your health history, other than if you have used tobacco or you are expecting a child.”
Ibsen said she, Lois Gross with Gross Benefits and Donny Cochran with Donny Cochran Insurance are certified brokers, along with many others across the West Slope and statewide.
Health care history, marketplaces explained
Linda Gann, West Slope outreach coordinator for Connect For Colorado, gave a lengthy presentation about the history of U.S. health care, what caused health care costs to soar through the roof, and how Obamacare came to be.
In 1960, per person spending on health care in U.S. was $147 a year, she noted. By 2010, that amount had risen to $8,402.
“It’s troubling,” Gann said. “Without a doubt, it’s going off a fiscal cliff.”
In 2008, a Colorado Blue Ribbon Commission on Health Care Reform recommended extending insurance to reduce the “hidden tax” of uncompensated care and stabilize rising costs. Gann said the commission’s key findings were that individuals are responsible for their own health and wellness. The commission also said more emphasis needed to be placed on healthy lifestyles and preventative care and all legal residents of Colorado should be required to have minimum health insurance, called an individual mandate. Enforcement would come through the income tax system, according to the commission, Gann said.
“This solution was presented in January 2008, ten months before the presidential election that year and two and a half years before the Affordable Care Act passed in Congress,” Gann noted. “So this is Colorado’s solution.”
The act allows states to create their own health care exchanges or marketplaces, she added. However, states cannot opt out of the act, Gann said.
“If a state doesn’t operate its own marketplace, the federal government will come in and operate it’s federal exchange,” she added.
Colorado agreed to operate its own marketplace, with federal funding, Gann said.
“There is going to be a lot of noise about these exchanges and affordable care and these kinds of things,” she continued.
Connect For Colorado is a public nonprofit agency that helps individuals and small employers, from two to 50 workers, compare health insurance costs and features, shop different plans, determine eligibility and enroll in a selected plan, Gann said.
Gann noted there is no mandate for those small employers to supply health insurance coverage to their workers, but they can decide to participate.
Connect For Colorado Health is not a replacement for the current health insurance market or brokers, Gann added, and do not negotiate rates between insurance carriers and providers, nor are they part of Medicaid. Medicare and associated supplemental plans are also not handled by the marketplace, Gann said.
“We are not a new government health care system,” she stressed. “Every one of our plans are private plans approved by the [Colorado Division of Insurance].”
Starting in 2014, those with pre-existing medical conditions cannot be denied health insurance coverage, Gann said. About 160,000 Colorado residents will be eligible for expanded Medicaid, she added. Connect For Colorado can help those residents get enrolled, Gann said.
Something for everyone
Ibsen noted those who have not had health problems, or are younger and healthy, should still enroll during the open enrollment period.
“You don’t know if something might happen or you might be diagnosed with a terrible disease,” she said.
Gann said all health insurance companies must spend 80 to 85 percent of the premiums they collect on actual health care or refund the difference to their policy holders.
“So at the end of the year, those health insurers have to justify their rates,” she added. “That’s to start to bring in this Pandora’s box.”
Also, beginning in 2014, health insurance companies can not increase their premiums by more than 10 percent, unless they justify it, Gann said.
“They have to justify it to the Division of Insurance,” she added.
“You’re going to hear about grand-fathered and not-grand-fathered-in plans,” Ibsen said. “If you have a plan that was in place before March 23, 2010, you are grand-fathered and you’re not under this mandate or have to do any of this.”
Website has it all
The group’s website, connectforhealthco.com, has information, a tax calculator and other features to help individuals and businesses understand the act’s provisions and requirements, Gann said. On Oct. 1, it will allow visitors to pick and enroll in a health care plan of their choice, determine if federal financial assistance is available to help reduce costs, she added.
“We’re anticipating at least 45 minutes to an hour per customer,” Gann stated.
Customers must purchase their plan by Dec. 15 to have coverage take affect on Jan. 1, 2014, she said.
“I know people have this sense of urgency; I do, too,” Gann said. “But you’re going to have some time, because none of the policies take affect until Jan. 1.”
Open enrollment runs from Oct. 1 to March 31 for the first year, followed by an Oct. 15 to Dec. 7 enrollment period in following years, Gann noted.
Tax credits to reduce premiums for qualified individual residents range from $15,282 to $45,960 a year. For couples, they range between $20,628 to $62,040 a year, Gann explained. Amounts increase as family size increases, she added.
“We estimate around 500,000 Coloradans will qualify for a tax credit,” Gann said. “Those are paid monthly to the company you decide to enroll with.”
Health coverage is comprehensive, including mental health and substance abuse, prescription drugs and many other categories, many without co-pays, Gann added.
A total of 150 plans will be available from 10 health insurance companies, she said.
“You can look for a health plan by your doctor, or with a certain carrier because you have a loyalty to that company, or you want to see only the lowest cost you can get,” Gann said.
Preliminary plan filings show a wide range of prices, too, she noted. The state has been divided up into regions, with different pricing structures in each region, Gann explained.
Cost sharing reductions are available based on income to help reduce deductibles and co-pays, she said.
Stand-alone dental plans will also be available and vision plans were under development, Gann said.
Small businesses and nonprofits can set the terms of the coverage they will offer their employees, she stated. Not all full-time employees must take that coverage, Gann continued, but they must have a qualified health care plan.
Small employer health care tax credits are available for those with fewer than 25 employees that pay an average annual salary of less than $50,000, she said. Qualified small businesses can get up to a 50 percent credit, nonprofits up to a 35 percent credit.
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