The controversial Affordable Care Act will affect residents of Montezuma and Dolores counties seeking health insurance policies beginning Oct. 1, and guidance is available locally.
Two presentations are scheduled for Dolores and Cortez this month and there will be assistance sites at Southwest Memorial Hospital and the Pinon Project in Cortez to help people sign up for health care policies under the new law. Policies would go into effect on Jan. 1.
The Colorado legislature has voted to set up the state’s own health care insurance exchange, called “Connect for Health Colorado.” The website is www.connectforhealthco.com.
“People can sign up for a policy on their own online or they can come in to an assistance site for free guidance on what their options are,” said Dave Hart, health program director at the Pinon Project. “The third option is to go to an insurance broker in town who has the training to assist people with signing up, and that is also at no cost.”
Two companies are offering policies on the Colorado exchange website: Rocky Mountain Health Plans and Anthem Blue Cross.
The Affordable Care Act, nicknamed Obamacare, is a form of national health care that expands government health services to lower- and middle-income citizens and offers discounted individual insurance polices. The new law was passed in 2010, and goes into affect in January 2014.
It requires everyone to have some sort of health insurance and provides tax breaks based on income levels to help reduce monthly premiums.
An estimated 3,000 residents of Montezuma and Dolores Counties do not have any form of health insurance, Hart said. The new health care law aims to sign up everyone for a policy and provide free or subsidized health care policies for lower-income families and individuals.
A key component is the expansion of Medicaid, a full-coverage government-run health care provider, that will lower its program eligibility standards under the Act allowing more people to qualify.
PATHS to coverage
Hart described the health insurance options under the Affordable Care Act as two different paths.
“When people come to an assistance site, we will do an income screening to see if they qualify for Medicaid, and if they do, we guide them on that path to sign up for the program,” he said.
“If their income is too high for Medicaid, then we will guide them on the path to the insurance exchange and help them pick out a policy that works for them.”
“The tax credits are pretty good, and are based on poverty level,” Hart said. “You can have the subsidy lower your monthly premium or get the entire tax credit refunded at the end of the year.”
Penalties for not signing up for a health care plan under the new law start out small, $90 the first year, but then balloon into the hundreds, Hart explained.
Lower-income families and individuals will benefit from expanded government programs and may now qualify for Medicaid, said Wendy Weygandt, a health advocate with the Pinon Project.
“Before it was more of a lottery-type system, but as of Jan. 1, anybody within the federal poverty level will be automatically enrolled in the Medicaid program,” she said. “We are expecting hundreds more people in the area to become eligible.”
Calculate benefits
A calculator on the Connect Colorado website is a good guide for determining individual benefits under the new law.
A 45-year-old living alone, earning $15,800 per year, will now qualify for government-paid health insurance under Medicaid. That person would not have been eligible for Medicaid before.
At $15,900 annual earnings, $100 more per year, that same person would qualify for a $372 monthly tax credit applied toward an insurance plan, making it affordable to obtain health insurance.
“The combination of subsidies and expansion of Medicaid should allow more individuals to have some form of insurance coverage,” said Kent Helwig, CEO of Southwest Memorial Hospital. “It gives people more peace of mind when they have access to preventative and routine health care in a more relaxed clinic setting, rather than having to go the emergency room when they get sick.”
The Pinon Project obtained a $37,000 grant from Connect Colorado to provide the assistance center. Helwig said the hospital is able to provide the service with current staff but will seek out grant funding if needed.
Assistance signing up for insurance under the Affordable Care Act will also be available at the Mancos and Dove Creek health clinics.
Businesses that don’t provide health insurance are required to inform their employees about opportunities to sign up for health insurance policies under the Affordable Care Act.
Open enrollment for the new program is from Oct. 1, 2013 to March 2014, and again from October 2014 to December 2014.
“People can also sign up during the off periods if there is a life change,” Hart said, “situations like if you had a baby, someone died, or you lost a job and were not eligible for certain insurance programs but now you are. So we will be helping out those folks as well.”
Monthly premiums for the approved 2014 plans vary widely, according to the Colorado Division of Insurance. For example, a bronze plan could cost an individual about $150 to $250 per month, depending on where one lives in the state. Consumers looking for lower copays or deductibles could choose gold or platinum plans, which would have higher premiums. Plans for small businesses also show a similar variation in premiums.
“We’re pleased to see that as Colorado consumers and small businesses shop for insurance this fall, they will be able to choose from a great variety of health plans,” said Colorado interim insurance commissioner Doug Dean.
“Consumers will be able to make better decisions and be better prepared. While it is tempting to compare the costs for the new plans to current ones, it is important to remember that these are new plans with new benefits and new requirements, so it is not an ‘apples to apples’ comparison. We encourage every purchaser to shop around and consider what’s best for their particular needs.”
