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.