Federal funding cuts to insurance offered by state health care exchanges have raised questions about the coverage that would be available next year.
While some people will see prices change, Connect for Health Colorado customers will likely see fewer changes than those buying insurance through the federal government, said Luke Clarke, a spokesman for Connect for Health Colorado.
Some health care advocates and insurers are concerned that the open enrollment period will be one of chaos and confusion. But that is less likely in Colorado, because it is one of 12 states that operate own health insurance marketplaces, maintaining control over advertising and the help it can offer consumers. That will create a striking difference when open enrollment begins Wednesday between those states and the others that rely on the federal marketplace, essentially creating a tale of two countries.
For the individual health insurance market in much of the country, the Trump administration has slashed spending on advertising by 90 percent and drastically reduced budgets for groups that help consumers choose a plan.
It cut the open enrollment period in half, to six weeks. Shortening the sign-up window further, the federal government will shut down its online marketplace, healthcare.gov, for 12 hours of maintenance nearly every Sunday during open enrollment.
The 12 states with their own exchanges are free to chart their own course and make it easier on consumers.
They also can make their own decisions about spending because their budgets are free from Washington politics. State-run exchanges typically pay for their operations through fees charged to insurers on plans sold through their marketplace.
Minnesota, Colorado and Washington will continue heavy advertising for their exchanges.
Millions of shoppers, whether they buy coverage on HealthCare.gov or through their state’s marketplace, will see another modest spike in costs after Trump’s decision earlier this month to halt payments to insurers that help cover some consumers’ deductibles and co-pays. Trump called those cost-sharing payments “bailouts” to insurance companies.
The federal subsidy on actual premiums and the lower co-payments and co-insurance are still available. But some state officials are concerned that consumers will be confused and believe federal subsidies have been eliminated. The worry is that they simply would not bother to shop for a plan, thinking they couldn’t afford it. About 12 million Americans buy individual coverage on the exchanges, according to the Kaiser Family Foundation.
The morning after Trump’s Oct. 12 announcement, Colorado’s Connect for Health exchange sent an email blast to current and prospective enrollees, stressing that “financial help is still available for 2018.”
That’s the kind of autonomy that gives states with an independent marketplace an upper-hand, said Larry Levitt of the nonpartisan Kaiser Family Foundation.
“That’s where state-based exchanges are maybe in the best position to help stabilize markets, by just putting extra resources into educating consumers in a very confusing time,” he said. “They have the ability to dial that up at times like this.”
Here are five key facts for those interested in enrolling or re-enrolling in Connect for Health Colorado. Open enrollment through the state exchange starts Wednesday.
1. Financial assistance is still available: Premiums are expected to rise about 31 percent in La Plata and Montezuma counties in 2018, according to the State Division of Insurance. But those who qualify for assistance will pay 20 percent less for their premiums because tax credits will rise along with premiums,
Insurance companies are still required to provide lower co-pays and co-insurance to those who earn 250 percent of federal poverty level or below, said Clarke of Connect for Health Colorado. The benchmark for 250 percent of the federal poverty level varies by family size. For a family of four, it is $61,500.
The federal government previously funded the lower co-pays and co-insurance through cost-sharing reduction payments to insurance companies, but those were eliminated in October, he said.
About 75 percent of local residents will be eligible for at least some assistance, according to a news release from San Juan Basin Public Health.
People who make 400 percent of the federal poverty level do not qualify for assistance.
For a family of four, that income cut-off is $98,000, Clarke said.
2. Open enrollment lasts until January: The Colorado enrollment period will be open until Jan. 12. For the coverage to be effective by Jan. 1, consumers need to enroll by Dec. 15. The enrollment period is longer than it is for those residents of states who must enroll through the federal health exchange, Clarke said.
3. Colorado expects strong enrollment: President Donald Trump said that the Affordable Care Act, which was put into place during President Barack Obama’s administration, is collapsing. However, the Colorado Health Exchange has been sustainable for several years, Clarke said.
Enrollment in the exchange has increased every year since it started. Following premium increases, the exchange expects enrollment to plateau in 2018, he said.
“The stronger the market, the more healthy people who get in there helps keep premiums down somewhat,” said Vincent Plymell, a spokesman for the Colorado Division of Insurance.
There are about 198,700 people enrolled in health insurance through Connect for Health Colorado. According to a report by the state exchange, 3,500 people in La Plata County are enrolled and 1,000 people in Montezuma County are enrolled.
In general, the exchange serves those who do not have insurance through an employer, such as the self-employed, Clarke said.
4. Insurance providers have changed: In Montezuma County, Cigna will no longer offer insurance through the exchange next year, leaving Anthem as the only provider for residents looking to buy plans on the exchange, Dave Hart, the health program director with the Piñon Project Family Resource Center in Cortez, previously told The Durango Herald.
Two carriers are available through the exchange in La Plata County: Anthem and Friday Health Plans.
5. Free help is available: San Juan Basin Public Health will hold two open-enrollment events for people who have questions or who want to sign up for Medicaid, Child Health Plan Plus or Connect for Health Colorado.
The first open-enrollment event will be held from 8 a.m. to 2 p.m. Dec. 2 at the La Plata County Fairgrounds, 2500 Main Ave., Durango.
The second will be held from 8 a.m. to 2 p.m. Dec. 9 at the Archuleta County Human Services Office, 551 Hot Springs Blvd., Pagosa Springs. No appointment is needed to attend either event. For more information about these events, call Kevin O’Connor at 335-2021.
mshinn@durangoherald.com. The Associated Press contributed to this story.