AAFP 2013 State Legislative Conference

November 2, 2013Lindy Hinman

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Key Changes

• Starting in 2014, you cannot be denied health coverage based on a pre-existing condition or your health history

• Health history or medical needs will not affect your ability to apply for health insurance or the cost (except tobacco use)

• Free preventive services, including screenings and annual exams• Set open enrollment periods for commercial health plans

that will provide coverage for the calendar yearo Oct. 1 2013 to March 31 2014 o Oct. 15, 2014 to Dec. 7, 2014 for future years o You can sign up at other times with qualifying event

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Colorado’s Health Reform Story

• Passed in May 2011• SB 200 establishes the

framework for the state Exchange

• Governed by a Board of Directors

• Legislative Implementation Review Committee  

• Mission is to increase access, affordability, and choice for individuals and small employers purchasing health insurance in Colorado.

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What is Connect for Health Colorado?

An open, competitive marketplace for individuals and small employers to:

• Compare information regarding cost and quality• Shop health plan features containing the same base benefits• Determine eligibility for and access new federal financial

assistance, based on income• Call, chat or sit down with trained representatives for help• Enroll in a health plan• A combination of high-technology and human network to

assist Coloradans in finding health insurance

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Connect for Health Colorado is NOT

• A replacement for the current market or brokers

• Engaged with negotiating rates between carriers and providers

• Part of Medicaid

• A new government health care system

• A State agency or regulatory body

• An organization that pulls funding from Colorado General Fund

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Getting Help

• Customer service center: 1-855-Plans4Youo Call uso Online chat

• Assistance Sites and Health Coverage Guides• Brokers and Agents

• Certified Application Counselors (26, vast majority are provider organizations)

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Individuals and Families

• The Marketplace is for Coloradans who: o Currently buy insurance on their own, o Are uninsured, o Are not eligible for Medicaid, CHP+, Medicare, or o Don’t have access to affordable coverage through their employer

• Online shopping, with assistance by phone and in-person

• Insurance carriers compete for your business:o 10 carriers in individual market o 150 health plans availableo 6 carriers are offering 22 dental planso Health plans will provide more comprehensive coverage

• Customers can access and apply for new federal financial assistance to lower premiums, co-pays and deductibles

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Small Employers

• Small group market for small employers with 2-50 employees.o Various options for employers to provide coverage to

their employees• 6 carriers offering 92 small group health plans• 7 carriers offering 45 small group dental plans

o Available small business healthcare tax credits for small businesses and non-profits with up to 25 employees and less than $50,000 in average wages

• Employers with up to 100 employees can be served in 2016

• Defined contribution and decision support tools available online

• Employers can choose 1 plan, 1 carrier, multiple carriers, multiple plans

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Affordability

• New resources available based on income

• Medicaid will be available to many more Coloradans • Individuals earning up to about $15,000 a year

• Advance Premium Tax Credits (APTCs) available to Coloradans who earn too much for Medicaid and up to $45,000 a year for individuals and $94,000 a year for family of 4

• Tax credit can be used on a prospective basis to offset monthly premium costs or deducted at the end of the year

• Health insurance plans with lower co-pays and deductibles also available to certain individuals and families who earn too much for Medicaid

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Get Started: Quick Estimate of Eligibility and/or Browse Plans

www.prd.ConnectforHealthCO.com

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Premium Tax Credits for Individuals & Families

Financial help to reduce the cost of premiums (tax credits)

• Individual earning between $15,856 to $45,960/year

• Couple earning between $21,404 to $62,040/year

• Family of four earning $32,499 to $94,200/yearo Tax credit can be applied up-front by IRSo “Reconciled at” the end of the yearo Tax credit is higher for older Coloradans, especially

for those ages 55-64

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Cost Sharing Reductions for Individuals & Families

Financial help to reduce out of pocket costs (such as co-pays and deductibles)

• Individuals earning $15,856 to $28,725/year • Family of 4 earning $32,499 to $58,875/year

o Enrollee cost sharing charges are automatically reduced when an eligible person or family enrolls in a silver plan

o People do not have to keep track of their spending or get reimbursed

o Not provided as a tax credito Not “reconciled” at the end of the year

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FAMILY SIZE YEARLY INCOME400% FPL

1 $45,960

2 $62,040

3 $78,120

4 $94,200

5 $110,280

6 $126,360

Maximum Income Eligibility for APTC

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FAMILY SIZE YEARLY INCOME

1 $28,725

2 $38,775

3 $48,825

4 $58,875

5 $68,925

6 $78,975

Maximum Income Eligibility for CSR

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How it Works

• Apply using the single streamlined application• Calculate tax credit and cost sharing reduction

eligibility and amount based on income (Marketplace determination)

• Choose a health plano Tax credit amount is the same regardless of the cost of the

health plano Cost sharing reduction benefits only applied to Silver Level

Plans• Decide to claim the tax credit right away or later on

taxeso The tax credit may be applied up front on a monthly basis,

paid by the IRS directly to the carrier lowering customer’s monthly premium

• Adjust the monthly tax credit to take less per month if income fluctuates

• Report changes in income or household size to Marketplace

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Adjust the monthly tax credit to take less per month if income fluctuates

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Financial assistance application process

Shop and Compare

Medicaid denial

Advance Premium Tax

Credit

In October, finish

enrollment through

Customer Service Center

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Health Plan Shopping

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Compare Health Plans

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Individual Marketplace Open Enrollment

Shopping starts October 1, 2013Coverage Begins January 1, 2014

Oct. 1 Dec. 15 Jan. 1, 2014 March 31, 2014

Open Enrollment

Begins

Deadline for

enrollment to have

coverage Jan. 1, 2014

Coverage begins

Individual Open Enrollment Ends

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Benefits for Consumers

• Makes comparing and purchasing health coverage more convenient and competitive

• Provides broad array of choices in one place

• Helps you make an informed decision by creating transparency about your options

• Only place to check eligibility for new tax credits and apply them right away to reduce your costs

• Offers a statewide network of trained professionals to assist consumers

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Medical Providers

• No impact on agreements between carriers and providers

• New carriers entering market in Colorado

• Medicaid expansion/Guaranteed Issue = More demand for health care services

• Network adequacy considerations

• Provider groups assisting with obtaining health coverageo Hospitals (incl critical access hospitals)o FQHCso Safety Net Clinics

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Spreading the Word!

• Marketing campaign: light rail, billboards, t.v., print ads, street teams (grassroots), focus on colleges and universities

• Ancillary campaigns

• Materials available on website

• Request a speaker

• Order brochures and other materials at our online store

• Refer people to website and Customer Service Center

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Contact

• Website: www.ConnectforHealthCO.com

• Email questions: Info@ConnectforHealthCO.com

• Toll-free help by phone: 1-855-PLANS-4-YOU (855-752-6749) 7 am to 8 pm Monday to Saturday