Colorado Health Insurance Exchange NewsThe Colorado Health Insurance Exchange News helps Coloradans answer the most popular questions about how to get health insurance through Colorado’s insurance exchange, avoid pitfalls and take advantage of federal subsidies that can reduce premiums

Certified by Connect for Health Colorado

Connect for Health Colorado said the 2015 rate increases averaged less than 1%, although we’ve seen several that were 15% and higher.

Customers renewing their plans with Connect for Health Colorado should have received notices explaining renewal options by October 31st.  Changes in income may complicate things for those who received tax credits in 2014.  Customers who receive a notice in November to re-apply for the federal tax credit, must re-submit their eligibility application and select their plan by December 15th to avoid a gap in coverage.

Open enrollment for Colorado residents needing individual/family health insurance plans re-opened on November 15th, 2014 and closes on February 15th, 2015.  Colorado residents needing help with renewals or shopping for new coverage may request assistance.

November 15th Open Enrollment Season’s Guide to Shopping for New Coverage

The step by step guide below helps you quickly see what programs you may be eligible for that can reduce health insurance premiums and how to get ObamaCare compliant health insurance through the exchange at the best rates available.  Don’t like reading?  Watch the step-by-step video or get a free FastPass Review instead.

Depending on household income, you very well may be eligible for federal subsidies that immediately reduce your health insurance premiums. Theses subsidies are Advance Premium Tax Credits. They are NOT available to people eligible for Medicaid or Medicare or who have affordable coverage available through an employer.

Advance Premium Tax Credits are based on (1) the size of your household and (2) your household’s estimated income for 2015.

Step 1. Determine Size of Your Household

DO Include DON’T Include
  • Yourself
  • Your spouse or unmarried partner who needs health coverage
  • Your children who live with you, even if they make enough money to file a tax return themselves
  • Anyone you include on your tax return as a dependent, even if they don’t live with you
  • Anyone else under 21 who you take care of and lives with you
  • Your unmarried partner who doesn’t need health coverage and is not your dependent
  • Your unmarried partner’s children, if they are not your dependents
  • Your parents who live with you, but file their own tax return and are not your dependents
  • Other relatives who file their own tax return and are not your dependents. See IRS rules on dependent qualification.

Step 2. Estimate Your Household Income

You will have to provide an attestation of your expected household income in 2015, which is verified by the exchange with documentation from your most recent tax return, with consideration for reasonable changes. Married couples MUST file jointly in order to get the tax credit.

To estimate your 2015 household income, add the total income from the sources below for (1) you and your spouse and (2) any dependents who make enough money to be required to file a tax return:

DO Include: Wages, Salaries & Tips, Income from self-employment or business, Unemployment compensation, Alimony, Social Security payments, including disability payments, Income from investments, retirement, pensions & rental income, Other taxable income such as prizes, awards, and gambling winnings.

DON’T Include: Child support, Gifts, Supplemental Security Income (SSI), Veterans’ disability payments, Workers’ compensation.

Keep in mind that the Advance Premium Tax Credits are based upon your household’s Modified Adjusted Gross Income. The tax credits will be reconciled when you file your 2015 federal income taxes, so try to be as accurate as possible. Material mid-year changes in income should be reported by calling Connect for Health Colorado’s customer service department so they can make adjustments on the fly.

Step 3. Eligibility for Advance Premium Tax Credits or Medicaid

The chart below is for the 2014-2015 Federal Poverty Levels. Go down to the correct row for Household size using the number of people in your household from Step 1 and then see where your estimated household income from Step 2 falls.

Subsidies by Income and Household Size

 

Tip: You can estimate your Advance Premium Tax Credit with the Subsidy Calculator tool.

Advance Premium Tax Credits are available to people with household Modified Adjusted Gross Income between 138% and 400% of federal poverty level. The tax credits operate on a sliding scale, so the higher the income, the lower the tax credit.

If you make below 138%, you should be eligible for Medicaid. If you make over 400%, you’re not eligible for an Advance Premium Tax Credit. Advance Premium Tax Credits are not available to people eligible for Medicaid or Medicare or who have affordable coverage through an employer.

However, you can use Connect for Heath Colorado to get private insurance with or without the Advance Premium Tax Credit as well as to enroll in Medicaid, as you’ll see in the following step.

Step 4. Applying for Cost Saving Programs, Determining Your Monthly Premium & Getting Covered

Connect for Health Colorado is Colorado’s health insurance exchange and it is the only place you can get a tax credit to reduce the cost of your health insurance. However, you can still get health insurance through the exchange, even if you don’t qualify for or want the Advance Premium Tax Credit.

First, go to Connect for Health Colorado and Create an Account or Login if you already have one.

Next, authorize me as your Certified Agent on the exchange. There is no charge or extra cost for my services and you MUST do this if you would like my personal help. It only takes seconds and your support helps me provide resources like this to serve the community.

To summarize, go to Connect for Health Colorado. Create an account or login. Then, as shown in the picture below, from the “Get Assistance” tab, select “Find Expert Assistance in Your Community.”
Mark Erickson - Certified Connect for Health Colorado Agent

Next, click on the “Continue” button for “Agent/Broker” and THEN Enter Mark Erickson’s State Insurance License Number:  423914
Mark Erickson - Certified Connect for Health Colorado Agent

Click on Mark Erickson’s name and then Select “Authorize.”

Make a note of Mark’s phone number and email address after clicking on his name. After authorizing Mark Erickson as your Agent, you are then welcome to contact Mark for personal assistance.  There is no charge or extra cost for doing so.

Final Step: Connect for Health Colorado’s 3 Primary Tracks

Based on where your household income relative to the size of your household, 99% of people will go down one of three possible tracks.

Track 1) Obtaining Advance Premium Tax Credits: If your income is between 138% and 400% on the chart from Step 3 then to get the Advance Premium Tax Credit, you must first apply for Medicaid using the PEAK system and be denied. After you are denied, the PEAK system will provide you a denial code. The denial code is required to apply for the Advance Premium Tax Credit.

It typically takes anywhere from getting an instant response to 2 weeks to get a Medicaid denial code from the PEAK system. The more accurate and complete your Medicaid application is, the less time you’re likely to have to wait.  You can call 800-359-1991 or 800-221-3943 between 8:00 a.m. and 6:00 p.m. Monday-Friday to check the status of your Medicaid application. You’ll need to provide your Application Tracking Number, which was provided on the final screen of the PEAK system’s online application.

After getting your Medicaid denial code (7-digit number that starts with 1B) from PEAK, then log back into Connect for Health Colorado, click the blue “Eligibility” button, enter the denial code and complete your application for the Advance Premium Tax Credit. This takes about 20 minutes and once that is done then you will be able to browse plans and see the final premiums, for all plans offered, less the Advance Premium Tax Credits you qualified for. Then simply add the chosen plan to your shopping cart and check out.

Money Saving Reminder - If your household income is between 138% and 250% of the Federal Poverty Level be sure to check the Silver plans, as they may have very attractive cost sharing reductions like lower deductibles and out of pocket maximums. You’ll only find these on the Silver plans. Cha Ching!

Track 2) No Advance Premium Tax Credit: If your income is above 400% on the chart from Step 3, if you have affordable coverage available through your or a spouse’s employer, if you do not want to go onto Medicaid, if you are eligible for Medicare, or if you don’t want to take the tax credit in advance, then you can select the option at Connect for Health Colorado’s website to skip determining eligibility for premium assistance. Then it’s simply a manner of browsing the plans, adding the chosen plan to your shopping cart, filling out a brief application and checking out.

Slicing Through the Red Tape - Some people prefer to skip the exchange’s financial disclosure requirements to get an Advance Premium Tax Credit and instead wait and get the tax credit when filing their 2015 federal income taxes. The tax credit is then provided as an increased refund or reduction in taxes owed. This can be a safe choice for people whose income fluctuates during the year or just want to avoid red tape. However, you still must apply through the exchange to get the tax credit! Just skip the Medicaid application and Advance Premium Tax Credit applications.

Track 3) Getting Medicaid or CHP+ Coverage: Simply apply for Medicaid using the PEAK system.  You can do this at Medicaid or go directly to www.colorado.gov/peak.  You will be notified if you are eligible for Medicaid or CHP+. If you have been determined eligible for Medicaid your application data will be transferred to the State of Colorado and will then be handled according to state policies.  FYI: I’m not able to help with Medicaid issues, so for ALL questions about Medicaid or CHP+ or to appeal their decisions call 800-359-1991 between 8am and 6pm Monday-Friday.  You can see Colorado’s Medicaid plan benefits here and look up providers here.

Most Popular Question About Medicaid - What if I qualify and don’t want it? If you are eligible for Medicaid, you can still apply for private insurance plans through Connect for Health Colorado, but you will be ineligible for a tax credit and will pay the full cost of the monthly premiums.

Step-By-Step Video Tutorial

Grab a cup of coffee and watch the video. Then simply follow the video’s instructions above, step by step. You’ll save a HUGE amount of time and confusion and will know what to watch out for. If you need help, please request assistance.


Mark Erickson’s Insurance License Number: 423914Thank you!!

Please watch the video and then carefully read through the information above. The information on this web page answers most questions and it will save you time and energy in the long run. Trust me!

Upcoming Deadlines and Penalties

Not having health insurance can result in a tax penalties that increase each year. You must enroll by December 15th, 2014 to get a January 1st start date on your new policy.  Open enrollment will close on February 15th, 2015.

Open Enrollment and Special Enrollment Periods

After Open Enrollment closes on February 15th people that buy their own health insurance will no longer be able to purchase Affordable Care Act compliant health insurance, either inside or outside of the health insurance exchange until Open Enrollment reopens next year on November 15th.  Exceptions apply if you have a qualifying event such as marriage, birth or adoption of a child, divorce, moving out of a service area, or involuntary loss of coverage. Please note that not paying a bill doesn’t count, so don’t let insurance coverage lapse.

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592 thoughts on “

    • It is fairly complex and there are technical and regulatory hurdles along with many companies to coordinate with. Perhaps it will be done earlier, but we don’t expect it to launch much before 2014.

  1. How can the Affordable health care act increase volume, increase quality and lower costs? This seems to contradict business principles. You only get to choose two of the three, natural consequences determines the third.

      • Increasing volume can certainly lower costs through economies of scale. Since much of the additional volume will come from healthy individuals buying health insurance than many of them won’t need to use, the effect should be even greater (less the smaller impact of individuals who come on board with pre-existing conditions). Insurers will then have the option of significantly reducing costs without making any quality improvements, reducing costs a medium amount while making some quality improvements, or improving quality a lot without reducing costs. Like everything, it’s a tradeoff, but there’s no fundamental rule that says you can’t have some of all three.

        The Affordable health care act is promoting the middle road: some cost reductions and some quality improvements. There are also opportunities to both reduce costs and improve quality at the same time: for example, by increasing use of preventive care.

        Taking digs at politicians won’t help us improve healthcare.

        • Once everyone has insurance coverage we should see a steep decline in the default rate for medical bills. This will allow health care providers to bill for the true cost of the services rendered, instead of a higher rate that has to factor in those who will never pay.

          • Certainly, it will be helpful in hospitals and I hope it will reduce the rates they charge to people with insurance. Time will tell if this results in lower healthcare costs for those with insurance or not.

          • A large part of the problem is that it is the insurance companies who will never pay. We probably all know of a situation where a person has insurance, but the insurance company denies the claim, leaving the policyholder to go into bankruptcy and the care provider holding the bag.
            If you have insurance, you should get the insurance that you’re paying for, and the state needs to hold the carriers accountable for providing that converage.

          • The Colorado Division of Insurance is there to assist consumers in the event of any unfair dealings by an insurance company. They do quite a good job, really.

        • If the ACA lowers cost then why does my health insurance premium rise by 50% as of June 1 2013. How am I supposed to respect the politicians that passed this 25,000 page train wreck?
          I am now paying 18,000$/year for a 6,000$ deductible.
          If a married couple make 50,000/year their premium is 4,200/year
          If a married couple make 80,000/year premium is 18,000/year

          So if you get a 30,000 raise, you pay 10,000 more in taxes and 14,000 more for HCI. You bring home 6,000 more. That works out to an 80% tax. We are supposed to speak nicely about the lawmakers that are doing this to us?

          • It’s not the politicians doing this to you, it’s the insurance companies. By ‘this’ I mean ripping you off.

          • Waiting for the moderator to reply to this one.Jesse has no idea what he, or she, is talking about. In California..”While both UnitedHealthcare and Aetna have a very small share of California’s individual health insurance market, their departure means less choice, less competition, and more market consolidation by the remaining big three health insurers — Anthem Blue Cross, Blue Shield of California, and Kaiser — which means an increased likelihood of even higher prices from those health insurers downstream,” Jones, a Democrat, said in a statement.

            Read more: http://www.foxnews.com/us/2013/07/02/unitedhealthcare-to-stop-selling-individual-plans-in-calif/#ixzz2coxtD2gl
            These companies are bailing because they realize that they will get a lot more clients from the health care exchanges….clients that cost a lot more money to cover, not the young, loaded with disposable income, people that are just “dying”(pun intended) to sign up for Obama’s awesome “free” plan!

          • Colorado’s exchange has most of the major health insurance companies particpating so that should help foster healthy competition. The ACA will provide subsidies to reduce the cost of health insurance to those who qualify, but the only people who would get anything approaching free health care would be those who qualify for Medicaid. In 2014 there will literally be hundreds of plans to choose from and from many carriers, so people will want to look both inside and outside the exchange to make sure they’re getting the best value on health insurance.
            There are concerns about getting a lot of claims from the previously uninsured and how that might effect future insurance rates, but the hope is that enough new healthy people will enter the pool to help balance things out. It’s going to very interesting to see how it works out, as human behavior is often hard to predict.

          • It’s the politicians working for interests of the insurance/pharm/medical industry. The world’s gone mad.

        • That’s takeing a very large assumption that healthy people are going to be the ones now coming onto insurance plans. For the most part, those that are already healthy and active have some sort of insurance policy already. The target demographic of the ADA is lower-middle income (and below) families that do not have insurance. By bringing on individuals who have not had insurance in the past, and may not understand the complexities of insurance/deductables/OOP/etc. will generally seek care ‘because they have insurance’ and then be stuck with the bill because they did not understand the plan. This may scare families into not using their insurance, and thus lowering costs. But overall you’ll see an increased usage from newly insured individuals, combined with the government subsities.

          The ADA has already brought billions in fees to the insurance companies (to fund the law) that are being passed to the consumer. The ADA will not lower costs to the individual.

          • It’s not accurate that most of the young and healthy adults have health insurance. There are many who do not. The Affordable Care Act (ACA) does not fix the complexities of insurance, which is why it is wise for people to work with a health insurance broker who can explain to the plan to them and how it works, to reduce the odds of surprises.

          • Which is why we need to hold our legislators (both Republicans and Democrats) for this mess. Had both sides worked together as ADULTS rather then acting like babies we might have gotten the health care our citizens DESERVE. Write your legislators and let them know how you feel and that you’ll be looking extra hard during the next elections. I doubt I will be voting for ANY career politicians. If you do nothing then you are just as responsible as the legislators who created this train wreck. I don’t like giving so much info to anyone. Why is it that they know we won’t get medicaid but we have to fill out the complete form any way? I’ve already posted this question to my legislators. I hope others do to. And the time needs to be extended due to the mess that’s created.

        • OK Jay, let’s not take cheap shots at politicians and only deal with facts:

          Politicians will do most anything in the way of pandering to get re-elected, ergo, ACA was developed and will become-by far-the most expensive entitlement program in the history of this country and be the most destructive in terms of personal liberty.

          Are these the kind of facts you want to hear?

          • I have been a physician in Colorado for over 30 years and am excited to get this program implemented. We are the only industrialized nation in the world that does not have a national health care plan and rate near the bottom of the list in terms of health and longevity.
            The same scare tactics are being used now to counter this effort as were used back in the 70’s, 80’s, 90’s and 2000’s.
            What personal liberties would universal health care destroy? In ten years it will be part of our nations fabric and a basic right and liberty that we will be proud of.

          • Dr. Smilkstein you are wrong to think that universal health care is a basic right and/or liberty…if you don’t have money, you don’t get care. Do you treat patients in the US without any money? I didn’t think so.

            Being forced to purchase a financial product such as health insurance does not equate to a basic right or liberty.

          • You get care regardless of your financial situation. The question (and problem) is-who then pays for your care if you don’t? AFA is designed to lower the large number of unpaid medical bills, which are a huge burden on society, and additionally are the cause of many, many bankruptcies.

          • You may get care regardless of your financial situation (in emergency situations), but that does not mean that you should.

            I fail to see how it is a collective responsibility to financially support people/institutions that make foolish financial decisions.

            If a person does not, can not or will not pay for a product or service then that person SHOULD go bankrupt.

            If we want to stop this huge financial burden on society imposed by unpaid medical bills the solution is very simple: stop providing care for persons who cannot afford it. If we elect to provide care for persons who cannot afford said care anyway; then we should STFU about unpaid bills being a burden on society.

          • It’s a shame that our legislators didn’t look at what does and doesn’t work elsewhere.

            I’ve used the medical care system in various parts of the world and many of they work very well. The care I got was 1st rate and with none of the attitude you often get here if you’re a patient on medicaid or without insurance.

            Why didn’t they do a better job of research? Because the lobbyists rule. It’s a shame every legislator doesn’t have to wear a coat with every contributor listed and that they don’t have to recuse themselves from legislation that would pay back those big donors.

            All this happens because most Americans don’t do their jobs as citizens. do you realize that more people vote in places where you can be killed for doing so then here? I’ve been voting in every election since I was able to vote. Every woman should vote just because of what our grandmothers went through to get us the vote.

        • Improving the health of our citizenry is crucial for our competitive position in the world. Employers are no longer responsible to make the decision whether or not the employee stays healthy and prospers as an employee, now the employee will take responsibility for their own health and conversly the employer has no strangle hold on those employees who need health insurance to avoid bankruptcy due to major health issues. What about employers who place employees at risk healthwise?, will the employer now be scrutinized for healthy work environments!!!!!!!

          • Balderdash! Medical bills are NOT a leading cause of bankruptcy, especially among the middle class

        • Jay, you clearly have no understanding of how the real world works. Put your head in the sand and keep voting Democratic. Do you even know who the vice pres and sec of state are? sadly, like most libs most likely not.

          • I always find it interesting that people can “know” others by brief statement they make over the net.

            One should never decide someone is a liberal or conservative by statements they make and why make a snotty statement about what all libs are? Just like conservatives, liberals come in all shapes and sizes. And most Americans aren’t one or the other but usually a bit of both.

            Just once it would be nice if people treated each other with common courtesy.

    • Tell that to Amazon.com They increased sales, increase customer service and lowered costs.
      Thats why I buy there as a PRIME member.

      Mike K

    • Part of reform has to do with increasing efficiency of care as well. Pay for performance quality measures may help drive down high costs of care by incentivizing smart/quality/effective/coordinated health care. That’s part of the plan, anyway.

    • What business principles does it seem to contradict? Why do you say we only get to choose two of the three? Really, I’m curious. I’ve never heard anything like what you are saying before and wonder where that comes from.

  2. SCOTUS has gone senile. The question should be asked, “Is there any mechanism granted to Congress within the Constitution that would allow them to create a taxing structure such that you could be forced to buy a car, or a house, or anything else, and subsequently, for the failure to do so, be penalized in the same manner as outlined within the Act?” I’m sure most reading this don’t even understand the simile.

    Under this current ruling, Congress can force you to buy a house, or a college education – how Communist of them to continue the bastardization of the fundamental principles of this country. I just fail to see how it is that the average American can continue to be so painfully ignorant of the law. Seriously. These are fools sitting on the bench. I thought Citizens United was bad.

    Every lawyer I know is screaming to high heaven, and the average person on the street just continues to watch their own favorite brand of Circus e.g. football, baseball, Xbox, etc.

    I, for one, will never pay in to this system. I would rather die in the streets then submit to a pig-ignorant government as we currently enjoy in this laughable joke called the US.

    At some point, the ‘smarties’ need to stop letting the ‘stupids’ tell us what to do. The problem is, by definition, 98% of you are ‘stupids,’ and you lack the acumen and perspicacity to even understand the problem let alone realize the solution.

    • David,

      In general I do not disagree with your statements, but the tone of your email sounds arrorgant and anger and that kind of approach is not helpful. It would be much more helpfull to educate rather than condemn. We all have areas we can impove on and it is much more helpful if people take the time to educate us instead of slam us. For example, you may want to take a look at the definition of simile and metaphor. If people can get by your tone they will see that even you have areas to improve.

    • People like yourself are exactly why we need EVERYONE paying into the system. At the moment, the people who are spending money on their health premiums are footing the bill for all of the un-insured. You might think you are young and healthy and don’t need insurance, and that might be true. But what happens when you are hit by a car, fall victim to a nasty virus, shot by a psycho on the street, slip in the tub, etc, etc.. Life is full of risks you might mitigate, but cannot completely eliminate. This is exactly why you need to pay into the system now. It’s paying in advance for services you WILL eventually need!

      • Gravitydude,
        Here is the problem. If you are young and healthy, you can get a catastrophic insurance (which BTW is much, much cheaper than paying full coverage) to cover the stuff you mentioned. Now, you’re forced to purchase an insurance with all the bells and whistles even if you don’t need them. You may not need a chiropractor, well now you’re gonna pay for one. You may not ever get an abortion (ie you’re a male) and now you will pay for the coverage, you may not wish to have counseling of any type, now you’ll pay for that, you may not be interested in sex change operation and now you will pay for that coverage too.…..and the list goes on and on. So, this is not a solution and it certainly is not affordable. You’re forced to pay for crap you do not wish to have coverage for. That’s the only way insurances can cover pre-existing conditions for others. Well, you can solve the issue of pre existing conditions by deregulating insurance companies. Let people keep their insurance wherever they move to or whoever they work for. Right now that’s not allowed. The real solution for our health system is to DEREGULATE insurance companies and drop the monopoly protection. But that is not going to happen because there is too much at stake for the congressman in Washington DC along with insurance companies that do not like competition. Government run healthcare is never going to benefit an individual. It will benefit the insurance companies and fat cats in DC.

        • There is no doubt that mandates for additional benefits drive up costs to consumers. You make some good points.

          • Hi Mark,
            What does the healthcare exchange mean for Colorado? Before the election, I was told that it means Colorado could create their own plan that would be right for the people in Colorado. However, now I understand that all the states with exchange programs still have to follow all of the Affordable Care Act mandates/rules. So, how does this exchange really work and benefit Colorado?
            Thank you.

          • Hi Amy,
            Great question and you’re right! Although the exchange is run at the state level, the driving force behind the plan designs really comes from the federal government. If people are eligible for federal subsidies they have no choice but to get insurance through the state’s exchange if they want to get their subsidized health insurance.
            The way it’s going to work is that the insurance companies will submit plans (Gold/Silver/Bronze) that meet certain Federal requirements that will be marketed through the exchange. The hope is that by having a limited number of plans that meet certain minimum requirements that larger pools of people will enroll to share the risk. Hopefully enough healthy people will enroll to offset the costs of the less healthy people that will enroll. However, there will also be plans sold outside the exchange that may be less expensive. Honestly, it’s not all 100% clear how it’s going to work in the “real world” but we’ll keep you updated here as more information emerges.

        • Waiting to pay into the system until you need it is too late! You need to be paying in while you are healthy so the costs can be covered when you are actually sick. We are all going to age and experience health issues.

          • Agreed. The system is dependent upon everyone’s cooperation and having health insurance.

        • The law also makes available a catastrophic policy for young adults and those exempted from the requirement to obtain insurance due to affordability. Catastrophic plans are less comprehensive and have a lower premium than other coverage. Eligibility to purchase catastrophic coverage is reflected in the calculator, when applicable. Premium subsidies may not be applied to catastrophic coverage.

          This is a quote from the colorado health insurance exchange website. There are catastrophic policies.

          • Yes, subject to limitations for those who meet the requirements. Additionally, there are some HSA qualified plan options with more widespread availability. Thanks!

      • Tell that to all the illegals who will not, cannot participate in this without a subsidy. That subsidy still won’t get them to buy it. They won’t be denied health care, nor will they get a fine from the IRS, as they have no money. So again, how in the world does this fix the problem?

    • I am IN the health insurance business and I can assure you that finger pointing will only lead to your own health unravelling. Here is the bottom line, THERE ARE NO EASY answers on either side of the health insurance debate. I care argue Pro-Obama Care or Anti-Obama care, my suggestion, calm down and deal with it

        • Yes keeping calm is always good, however when the people are so asleep, that they have no idea how our government is robbing them each day, keeping calm becomes the very reason for the abuse. They our president wen’t against the Constitution was the very moment America lost it’s freedom! Now we must be forced to have health insurance, what about the millions of people who cannot even afford it. I’m not trying to rant, but I feel we could come up with fair solutions, and I also feel that our government should be more interested in bettering the lives of Americans rather than keep us dumb, ignorant, and blind. But this will continue until American wake up, and govern themselves! Let’s see how far, our government will go in hurting it’s people before they decide to stand for themselves. I hope the poor, can do more than just keep hope, and faith, but can stand up, and wait not for the fattened, greedy, demons to improve our lives. Money should never come before a human life! That is satanic to the max!

        • Dear Moderator,
          Keeping calm and adapting to change has not helped me at all. I currently have health insurance, but the insurance company is denying me care for some very serious issues due to a car accident that I had years ago. ( by the way with illegal aliens, driving without a drivers license, no insurance, nothing they walked away scott free.) I now have a lifetime of hellish physical pain to deal with and fighting with my incompetent and discriminating insurance company is making it worse. The drs at my insurance company get big year end bonuses to avoid procedures. (disgusting) On top of all this, I will be one of the millions of Americans that will be dumped by my insurance plan, which only cost me $130.00 a month premium and being forced to pay double if not triple that amount in the exchange or even on an individual basis. So exactly how does the ACA help me? Answer: It Doesn’t! Quite frankly I am glad to be dumped by this horrific insurance company and there needs to be audits, oversight and fines to insurance companies who discriminate against patients.
          And to add to all this insult, I am now unemployed and unable to get a job due to my injuries. No employer is willing to hire me, because it increases their liability insurance and they refuse to do that. Thankfully, I have a husband who still has a job, for now!. The entire health care system in this country is a train wreck. All of it! I am frankly sick of it! Thank you

          • I’m so sorry to hear about the accident and injuries and the difficulties in getting coverage for your injuries. If you feel you’ve been treated unfairly, you should contact the Colorado Division of Insurance. They are the watchdog agency that helps consumers in the event they’ve been treated unfairly by insurance companies. The new ACA plans will cover your pre-existing conditions and I hope that you’ll be able to find affordable and better quality coverage through the exchange when it opens in October. I agree there is still much room for improvement with our healthcare system. Take care!!

      • Oh certainly we are in for huge surprises. You know what sucks about surprises, is just that, you never know what will come our way. I got two solutions, #1 like you said above, calm down and eal with it. #2 Get our of America! haha

        • You can go to Canada – Oh wait they have health care there too: OMG. All civilized countries have health care – Now America is joining them.

          • You should revise your statement. America has incredible health care. This debate is about health insurance. Every American has access to healthcare, they just have to decide if they would rather pay out of pocket for the care or pay a premium for health insurance coverage. This should be a choice in our free country but Obamacare is taking away my right to make my own financial decision.

        • Unless you’re rich, you can’t leave. I mean, you can leave but you can’t stay gone.Hahaha. We live on a prison planet with fences and guards all around our cages, I mean borders.

      • These is an easy answer, single payer for everyone. One proposed method, Medicare for All. It just makes so much sense, but of course politically is will be a long, hard fight because of all the health insurance companies & insurance companies lined up against it. I hope health insurance exchanges move us in the direction of universal health care. We should take the profit motive out of health care.

          • Am on Medicare and love it. No denials of anything and a lot cheaper to boot and medications way less expensive. Universal health care only way to go in my opinion.

      • ‘Calm down and deal with it’ is the type of passive nature that is allowing Congress to pass whatever bill they decide, in all realms of our government, not just health care. I don’t know about you, but I’m not so passive when it comes to my own health. I need to know exactly how it’s going to work, how it will or will not benefit me, and how much it will cost me. This bill was rammed through without the kinks being ironed out, and I’m positive that it will be very touch and go as they see how the Affordable Care Act actually works out with the masses.

        Personally, I don’t really want health insurance…sorry if that sucks for everyone else, but I don’t want to be forced to pay into it to benefit everyone else…unless of course, health insurance deductibles disappear.

        • I don’t want to pay for your healthcare when you need it, go to the hospital and either claim indigent care or bankruptcy. Unfortunately the hospital can not turn you away for life saving care so I have no choice but to pay higher costs (i.e. your healthcare).

          If you don’t want health insurance then don’t get it, pay the piddly $95 tax, and be happy. I’ll be happy with it because you are paying into the system to take care of you when you do need healthcare. Win-Win.

    • Lucky for you that as you lie dying in the street someone ill inevitably take you to an emergency room where you will be treated whether you have paid into any system or not. I certainly recommend you look to move out of this laughable country to someplace with less government to get in your way….Somalia comes to mind.

    • “Under the current ruling Congress can force you to buy a house or a college education”????? Health care and the way it is provided is much different than home ownership and a post secondary education. Americans receive medical care first and bills for the care second. You can not show up at a University and take classes without paying. You can not move into a house and not pay for it. But you can receive medical care at a hospital and not pay for it. Now if you were a dog or cat that needed medical care, that care would not be provided until payment was guaranteed.

    • Pretty arrogant reply, no? Armchair philosophy is really easy when you are healthy. At some point in time you, and I do mean you, will need health care and if you choose to die in the street on principle, fine- but for the rest of us who would rather not, good health care that won’t bankrupt us or abandon us in a time of need is a wonderful way to go. If you had or have children you may want to rethink your principled opinion about them dying in the street along with your sad attitude. Spreading the risk and cost makes ultimate economic sense and if you choose not to partake( and pay a penalty anyway) and avoid care as well then please make sure that a copy of your obituary is forwarded to this column so we may all share in your wisdom about choice.
      Wishing you well.

      • Not everyone is a cowardly communist like you Jon. Ensuring that health insurance risk pools are appropriately balanced should not be a function of the US Government. Those who wish to purchase health insurance should be able to do so at market determined rates. Those who do no wish to purchase health insurance should not be forced to do so but should also be prepared to not receive care that cannot be afforded.

    • The Supreme Court decided this was constitutional (although I don’t agree with them) and they are the final authority.

      One does have to wonder if both sides would put on their big boy and big girl pants and act like adult if things might have fared better? The American people deserve legislators who can put the interests of the country ahead of their party and the money they all seem to make while in office.

      I find it interesting that we, one of the richest nations in the world are, number 1 in child poverty numbers, the highest first-day infant death rate out of all the industrialized countries in the world (About 11,300 newborns die within 24 hours of their birth in the U.S. each year, 50 percent more first-day deaths than all other industrialized countries combined) and 48th in child mortality in the world. Extremely poor numbers for an industrialized nation. It’s sad when 3rd world countries do better then we do. And that so many American are out of jobs through no fault of their own. Why does our country do such a poor job taking care of the next generation?

      Personally I’m not sure I’ll be voting for any career politician in the upcoming elections as I see no differences between either party. Both conservatives and progressives are extremes and minorities trying to shove their belief system down the throats of the majority most of who just want to be left alone to live their lives.

  3. Is there any type of ranking/comparison for the quality of the insurance plans being offered.

    Some seem to be more of a discount plan (minimum reimbursement/coverage) than an insurance coverage that you can get via an employer

    • Good question. The plans you’ll find here all have a deductible. There used to be zero deductible plans available in the individual market, but not any longer as they became too costly so insurers quit offering them. Please visit this page if you would like a broker to help you find the closest plan to the kind you want. There is no extra charge for this service.

  4. My health premium just doubled in the last 14 months because of the “Affordable Care Act.” I use little to no services and am very healthy. I am beside myself with frustration. I tried changing my plan but was of course denied because of a couple of minor, one-off services. Talking with RMHP is like talking to a brick wall. They even admitted to me it’s just a computer equation, you can’t actually make a personal case for review. In short, they don’t care.

    Then I see articles about “scrutinizing unreasonable rate increases,” and “Insurance companies must now justify proposed rate increases for your health insurance.”

    Justify to whom? Is RMHP justifying this to anyone? Does doubling count for unreasonable? I think so.

    All I can find is articles on all the generalities regarding the “Affordable Care Act” in Colorado, yet I am being SHAFTED. Please someone, anyone, tell me how or where to get real answers…

    • All the mandates that are being added to health insurance benefits have a financial consequence (higher rates). On one side, there is no more gender bias for health insurance, women can get maternity benefits covered and preventative care has improved quite a bit. On the other side, this has caused rates to go up significantly for some people.
      Individual health insurance rates don’t go up (or stay low) based upon your personal claims history. This is frustrating when people have a healthy year and their rates go up anyways. However, it’s a blessing if you have a claim in the hundreds of thousands or millions of dollars and you discover that your rate went up no more than anyone else’s premium.
      The carriers look at the rates by age (range) and the claim history for people in that group and plan. Of course, they also factor in new benefits and underlying increases in health care costs.
      One of the biggest unmet challenges is that the Affordable Care Act does little to reduce or control ever escalating health costs that are largely responsible for driving up health insurance premiums. The Affordable Care Act will provide subsidies that may give an illusion of affordable coverage for those who qualify, but that is not a long range fix.

      • My claim goes into the millions? On every plan that is offered so far, the lowest is a 7K deduct. And a 40% co pay. So my bill goes to 1 million. I owe 400K? And that is for $300.00 per month? Don’t know what you’re making Mark for your services, but driving a truck,,,I might as well take the pill for the dirt nap.

        • There will be choices with deductibles well below $7K. Also, there are coinsurance out of pocket maximums that limit your financial exposure. So, if a plan has 60/40 coinsurance, after the deductible you would pay 40% of the costs up to the out of pocket maximum and then the plan will start paying 100% for all covered costs, in-network. We’ll have more info on the specifics for the plan designs along with more exacting premiums as we get closer to the October 1st launch date.

          • Huh. Now that we are WEEKS PAST the launch date, I can’t get ANYTHING out of the system: “Thank you for your patience while we work to fix a technical issue. “

      • “One of the biggest unmet challenges is that the Affordable Care Act does little to reduce or control ever escalating health costs that are largely responsible for driving up health insurance premiums.”

        I thought the whole point of this Act was to counteract the ‘escalating health costs’ by having more people pay into the system and effectively lower insurance premiums? If that isn’t going to happen, then what exactly is the point of this?

        • That’s a fair point, but the ACA will help make health insurance more accessible for many and more affordable for some. Getting more people paying into the system is a positive step, but controling healthcare cost inflation is another piece of the puzzle that remains to be dealt with.

          • That’s silly! ….and for what purpose pray tell would the government want to do that? Sounds like you just don’t want to pay for something right now you don’t need. You are only one accident or serious illness away from changing your tune. Awaiting your attitude adjustment to this blog when that happens. Remember you will need healthcare someday. We all do, no exceptions!

      • Carriers encourage us to divide ourselves into groups of healthy and unhealthy people by raising rates in excess of the cost of medical care. The healthy people get tired of the rate increases and hunt for better rates, while those with health problems are denied the opportunity to change policies. Voila!, the sick are in one group. the healthy have let that group for another. The insurers can then claim the sick group requires an even greater rate increase!

        Think about this. In the 1990’s insurers paid out 93% of premiums to health care, Now, by law, they must pay out only 80%. But think about it further, If I have to give you 80% of what I make, the only way I can make more is to give you more. What incentive do I have to limit the amount I pay you if doing so limits the amount I can make? What incentive does an insurer have to pay less for medical care if doing so limits the amount they get to keep?

        Looking at the numbers, If I collect $100 in premiums, I pay you $80 and keep $20. But if I collect $125 in premiums, I don’t mind paying you $100 because its the only way I get to keep $25 instead of $20.

    • You might want to read the act itself, oh sorry I believe it’s over 1000 pages long, but I’m sure no one will have trouble memorizing nor fully understanding the policy!

      • Yes, the ACA is so long and complex that teams of lawyers and regulators are still working to sort it all out – and that’s what they do for a living.

  5. Thank you for the helpful reply. I guess I’m one of the extremely unlucky ones to get hit hard on every side of the equation. Great for gender equality, but I’m a single male paying dearly for someone’s maternity care. Talk about socialization, I’m paying dearly for everybody else.

    My premium increase seems grossly out of proportion, totally unjustified and extreme. What about aspects like this “Scrutinizing unreasonable premium increases” referred to here: http://www.healthcare.gov/law/resources/co.html

    Aren’t there any independent agencies or some kind of counsel who can help scrutinize rate increases or reasons for denial of plan changes on a case-by-case basis? I can’t afford health care insurance anymore, let alone health care. I call RMHP and all they say is “Too bad.”

    Even with the positive changes in for more people, how can anyone justify doubling people’s premiums? People are ok with this? Nobody saw this coming?

    • I appreciate where you’re coming from and while you’ve been hit harder than many, you’re not alone. Many people in the insurance industry did see this coming and tried to sound the alarm, but in the end healthcare reform was drafted by lawmakers who didn’t fully grasp the economic impact of some of their well intentioned actions.
      The Colorado Division of Insurance does review rate increases and requires that companies justify their increases. I don’t know if they can fix your situation, but they may look into it or discuss it with you.
      If you like, our company can help you look at other more cost effective options from other carriers. Fill out the quote form and we’ll be happy to research the options for you. Thanks Chris!

      • Chris, This is very frustrating to be because with the AHC, they would essentially eliminate Brokers from the equation. Yes, talking directly with insurance companies can be difficult, however, brokers in the community have been dealing with this for years and can usually get things done that the general population cannot. No one in the governing board has consulted with those of us in the “trenches” as to how to approach any of this.

  6. Ok thank you again for a focused and helpful response. I will research through the division of insurance and look for a better quote as you suggest.
    Regards,
    Chris

  7. I am really interested to know what protection I will have in place that will limit my premium, deductible and out of pocket expenses. I currently have employer sponsored health insurence, and it is excellent coverage. I will be leaving my employer to persue a career change, and may need to buy my insurence through the exchange.

    • I’m afraid the exchange isn’t slated to open until October of 2013. In the interim, you’re welcome to visit this page if you would like a broker to shop plans from all of Colorado’s major carriers to help you find good quality coverage. There is no extra charge for this service.

      • I did speek to an insurance broker, and it is clear that buying individual insurance will not cover me for my pre-existing conditions. I am understanding that this will change when the exchange opens, or in 2014. Is this correct?

        • Individual health insurance is scheduled to become guarantee issue (no rejections for pre-existing conditions) on January 1st 2014. Colorado’s health insurance exchange may be operational as early as 10/1/2013. However it remains to be seen if any insurance companies will start offering guarantee issue health insurance ahead of the January 1st deadline.

  8. Why is Colorado shelling out to run an exchange when the federal government is setting one up? Wouldn’t Coloradans fare better if insurance providers across the nation compete for our dollars rather than the few within Colorado?

    • That’s an interesting thought. The good news is that no Colorado tax dollars are allocated to operate the Exchange. The US Congress provided funding for states to build exchanges. The operating costs of the Exchange are expected to be funded by the federal government through 2014. By 2015, exchanges need to produce enough revenue to cover their own operations.

      Even if the federal government ran the exchange, as will be the case with a handful of states, the plans carried withing the exchanges will still differ from one state to the next, as states continue to regulate policies on a state by state basis. As healthcare costs differ greatly from one state to the next, this is an advantage to states like Colorado with lower costs of healthcare relative to higher cost states like New York and New Jersey.

      • Are you suggesting the no one in Colorado pays federal taxes? Of course Colorado tax dollars are supporting this non-sense. Please tell me why I can buy everything else I want, from almost anywhere on the planet, but I am stuck buying insurance inside Colorado.
        Thanks.
        Thomas

        • You can buy electricity from outside the local provider? water? gas?
          Can you get a mortgage loan from anywhere? hazard insurance? car insurance?

          Can you really buy everything else from almost anywhere? no

          Insurance is a regualted by the state. In order to buy insurance from anywhere – regualtion would hav eto be eliminated (which didn’t work well for insurance when it was unregulated) or decided at the federal level. I prefer a local regualtor.

  9. I am not even sure why as a business owner we became the people to provide health care to people? Why are we even responsible for that at all? But, if I have to be then I should be able to dictate certain things. For example, no overweight, out of shape, unhealthy employees. No more smokers or drinking alcohol. No more trips to McDonalds for lunch or candy at the desk. If you are overweight and now have hypertension and diabetes then get in healthy shape or work somewhere else. Seriously, if we have to pay for YOUR health insurance then we should have a say in your lifestyle. From a business owner with a bunch of unhealthy lifestyle people.

    • There are plenty of people who agree with you. A number of leading economists think the practice is outdated and places American corporations at a disadvantage in the global economy.

      Employers started providing health insurance benefits after World War II and the practice has continued. The government’s tax code making the expenses deductible to businesses can also share some of the blame for why this practice continues all these decades later.

      That being said, The Affordable Care Act does not require employers to provide health insurance for their employees. However, there may be penalties for some bigger companies.

      The Employer Responsibility provision of the Affordable Care Act applies businesses with more than 50 full-time workers. To learn more read the Employer Bulletin on Automatic Enrollment, Employer Responsibility, and Waiting Periods.”

      On the page that is linked to they go on to define, “For purposes of section 4980H, a “full-time employee” is an employee who is employed on average at least 30 hours per week.”

      The health care law doesn’t “require” larger employers to provide health care to employees, but beginning in 2014 the law imposes penalties on businesses with over 50 employees that don’t provide “affordable” health care to employees. Here are the details of this portion of the law:

      •Starting in 2014, large businesses (those with 50 or more full-time workers) that do not provide adequate health insurance will be required to pay an assessment if their employees receive premium tax credits to buy their own insurance. These assessments will offset part of the cost of these tax credits. The assessment for a large employer that does not offer coverage will be $2,000 per full-time employee beyond the company’s first 30 workers.

      •To be deemed “affordable,” the health care insurance provided by the employer must pay for at least 60 percent of covered health care expenses, and employees may not be forced to pay more than 9.5 percent of their family income (before deductions and adjustments) for coverage offered by employers. The question of how an employer is supposed to know the amount of “family income” is not yet addressed.

      •If a business fails to provide any coverage or the coverage is deemed not to be affordable, the amount of the penalty is $2,000 per worker, but the first 30 workers are excluded from the calculation.

    • You know I am many, my voice is many, and I speak for most with all of their voices combined, it’s okay for business owners like yourself, to sit back and pay your employees minimum wage, never give raises, slave your employees, and get fat off of there sweat, but oh is it a problem when you greedy Bosses have to pay for your employees health insurance. This country needs some MORALITY! that is why it is falling!

    • Interestingly enough most German businesses provide showers and locker rooms to their employees, so that they can bicycle to work, then clean up before they reach their desk. Almost everyone has a physically active hobby or interest. Yet they still require that everyone pay into their healthcare system for 3 years before they can opt out and purchase their own plan. And the government taxes heavily those businesses that FAIL to provide showers and locker rooms, because they know that such irresponsible business owners contribute to poor health of the populace. How was your bike to work today?

      • That’s very interesting way to incent healthy behavior and reduce obesity. It might be a hard sell in the US though.

  10. Moderator:
    I am currently in a dispute with my health care provider (a large national provider) regarding the negligent medical care I received at the hands of two of its doctors during a one-day hospital stay earlier this year. To date, I have diligently followed the provider’s internal dispute resolution process but, after two internal reviews of my quite serious complaints, I have received little more that form letters that do not even acknowledge the standard-of-care issues that I have raised but then go on the deny my requested remedies for redress.

    As a result of my experience with the provider’s internal dispute resolution process, I have concluded that the provider’s process is biased against me (and clearly for the corporation) to the extent that I cannot get a fair hearing regarding care issues I have raised. Moreover, it is clear that the corporation controls all of the experts, all of the relevant medical records, and has the administrative as well as the legal resources to defeat me at every turn — and so far, they have done so. Further weakening my position, this provider requires that its insureds agree to settle disputes through private, confidential, binding arbitration that is not appealable to the courts. Furthermore, all of the arbitrators — typically, retired judges — are beholden to the provider for continued inclusion on their “neutral arbiters” list.

    So how do the rules for inclusion on the Colorado Health Insurance Exchange ensure that Coloradans insured through the exchange do not continue to fall prey to the power of these large insurance corporations? That is, how will Colorado Health Insurance Exchange regulations and procedures protect Colorado health insurance consumers from abusive corporate power but also ensure unbiased external review and warranted corrective action when the normal standard-of-care has been neglected by a health care provider?

    • I’m sorry to hear you had such a bad experience! If you received negligent medical care that’s really an issue between you and the healthcare provider. However, if your provider is an HMO then the healthcare provider and the insurance company may be the same organization.

      The insurance company’s responsibility is to pay for the treatment, as per the terms of your contract (policy) with the insurance company. If you have a problem with the way a claim is handled your first action should be to appeal the denial with the insurance carrier.

      If you still feel that you are treated unfairly in the way the claim was handled, then you can file a complaint against the insurance company with the Colorado Division of Insurance, the regulatory agency that oversees Insurance Companies and that acts as an advocate for consumers.

      I don’t expect the Colorado Health Insurance Exchange to address concerns regarding quality of medical treatment nor is it likely to moderate issues between you and your health care provider.

      When you see a provider you often do have to agree to arbitration. I don’t see that changing anytime soon, although I agree that this puts the consumer at a huge disadvantage as they have to agree to play by the provider’s rules (which may be biased against consumers) if they want treatment.

      • Moderator:
        Thank you for your reply and I do understand my health provider’s (a large, national HMO) dispute resolution process and that my last stop before mandatory arbitration is the Colorado Division of Insurance. However, I’m not optimistic that they can be of help since Colorado health law lacks rigorous requirements for consumer protections when the health care provider is negligent.

        The Colorado Health Insurance Exchange, using its regulations and procedures, can be a vehicle for the implementation of the sort of consumer protections that my case — as well as many many others — shows is clearly needed. Simply, the exchange could exclude health insurance plans that do not have strong consumer protections built-in.

        The fact that you do not envision the subject consumer protections for our new exchange is problematic; therefore, my further question for you is: to whom, among the exchange implementation management and staff, should I address my concern? That is, who on staff has the authority to address the need for the types of health care plan consumer protections I have demonstrated through the above?

  11. I understand those households with gross incomes between 133% and 400% of the 2012 Federal Poverty Level will receive a subsidy. Is the subsidy paid to the insured after paying for the insurance or does it lower the cost of the insurance? And how is the subsidy calculated?

      • This is Nuts!!!!!!!!!!!!!!!!!!!!!!!!!

        If your premium is 20K/year for a married couple and you earn 399% go FPL you get a 14,000$ check from the FED. If you earn $401% you pay the 20K!

        If you don’t get married you get a much bigger check from the FED because you get subsidized with an income of below 80K versus 60K if your married.

  12. Hi! Good forum. Do I have this right? Those that will get a subsidy will be in the form of a tax credit? And that will come at tax time? So, in the meantime those who don’t have much money will have to wait to be credited and until then they will have to pay the regular price for the plan they choose? If that’s correct, I’m not sure how that’ll encourage people to purchase insurance if they have to wait for the credit. Or, will they get an immediate break on their monthly premium? Thanks in advance.

    • That’s a great question Gene! It’s actually better than that.
      According to the Kaiser Foundation, “For most tax credits, people apply for the credits when they file their taxes. However, because the cost of insurance is so high and many low and moderate income people would not be able to afford the coverage without upfront assistance, the law allows for eligible individuals to take the tax credit in the form of an advance payment. In this case, once an eligible individual selects and enrolls in a plan, the advance payments are made directly to the insurer. The enrollee is then only required to pay the remaining share of the premium to the insurer.”

    • Good question. The exchange will be online, but there will be phone numbers for support. Also, Health Insurance Agents and Brokers will be able to assist you, in person or over the phone with enrollment.

        • Yes, there will be Navigators in Colorado, but it’s not yet decided how that program will work and who those will be. You can read about it here, but California is ahead of most states when it comes to the exchange implementation.

  13. I’m wondering about pre-existing conditions, will the exchange help folks who have previously not been able to even get insurance? My husband and I work for ourselves, because of some minor pre-existing conditions we’ve been unable to get a policy. Thank goodness for CoverColorado, but it’s expensive. How will the exchange help folks like us?

    • Hi Kirsten, The exchange will absolutely help people like you. Not only will pre-existing conditions no longer be a factor starting on January 1st, 2014, but if you make less than 400% of the federal poverty rate you may also receive subsidies through the exchange to reduce the cost of your insurance. If you’re not eligible for a subsidy, you’ll want to shop both inside and outside the exchange to find the plan that is the best overall value. A broker like this can help you shop all the plans inside and outside the exchange at zero cost to you.

  14. I would greatly appreciate getting your thoughts on a few quick questions:

    – The Colorado Health Insurance Exchange is a public exchange, correct?

    – Is the Colorado Health Insurance Exchange looking to form partnership for referral purposes?

    – Does the Colorado health insurance exchange offer a referral/renewal fee per eligible application that leads to a purchase? If so, what is this referral & renewal fee?

    2. Do partners still receive a referral & renewal fee per exchange eligible application that leads to a purchase of Medicaid? If so, what would be the referral & renewal fee? If not, what might be our incentive for pushing Medicaid (<133% of FPL) qualified applicants to your exchange versus any other exchange?

    3. Are the referral & renewal fees constant regardless of the level of subsidy needed per applicant? E.g. Does a partner receive the same referral/renewal fee for an applicant with a household income of 200% above the Federal Poverty Line (FPL) as an applicant with a household income of 350% above the FPL or as an applicant with a household income greater than 400% of the FPL?

    I appreciate your time in getting back to me on these two questions. I’ll look forward to hearing your response.

    -Tyler

    • The health insurance exchange in Colorado is a public program. They are looking at compensating agents for assisting clients with finding plans in the exchange, but to the best of my knowledge the details of how much and under what circumstances are not yet decided. I know they are actively discussing it and hopefully they’ll come up with a fair method to compensate brokers, so there will be no agent bias for directing clients to plans outside or inside the exchange.
      A level playing field is in consumers’ best interest, as agents and brokers play a vital role in helping consumers make an informed choice of insurance plans and carriers. Even as plans designs become more standardized, there will be differences and consumers want to make the best choices for their families.
      Even highly educated professionals often don’t understand the critical basic aspects of how health insurance plans work and how and when deductibles and coinsurance apply and how this can impact their personal finances. This requires well informed agents and brokers that can speak to consumers and answer their “how, when and what if” questions.
      Plan descriptions and brochures are wonderful, but busy people often don’t read them or just skim them at best. Agents play a vital role in helping consumers avoid unwelcome surprises when that unexpected illness or injury occurs.

  15. Since the percentage of income the customer has to pay is based on their income do they have to submit a copy of their tax return for income verification to the exchange? And does the customer or the insurance company apply for the subsidy.

    • First off a disclaimer that I’m not a tax professinal and I am not qualified to give tax advice.
      Based on the info below it looks like people must provide tax returns for income verification for any subsidies for insurance acquired through exchanges. Customers will pay the premium, net the subsidy directly to the insurance company. The government pays the subsidies directly to the insurers.
      According to the Kaiser Foundation, “For most tax credits, people apply for the credits when they file their taxes. However, because the cost of insurance is so high and many low and moderate income people would not be able to afford the coverage without upfront assistance, the law allows for eligible individuals to take the tax credit in the form of an advance payment. In this case, once an eligible individual selects and enrolls in a plan, the advance payments are made directly to the insurer. The enrollee is then only required to pay the remaining share of the premium to the insurer.”
      According to this IRS publication (http://www.irs.gov/pub/irs-drop/reg-119632-11.pdf), “Section 6103(l)(21) permits the disclosure of return information to assist Exchanges in performing certain functions set forth in section 1311 of the Affordable Care Act for which income verification is required (including determinations of eligibility for the insurance affordability programs described in the Affordable Care Act), as well as to assist State agencies administering a State Medicaid program under title XIX of the Social Security Act, CHIP under title XXI of the Social Security Act, or a basic health program under section 1331 of the Affordable Care Act (if applicable). Section 6103(l)(21) identifies specific items of return information that will be disclosed and permits the disclosure of such other items prescribed by regulation that might indicate whether an individual is eligible for the premium tax credit under section 36B or cost-sharing reductions under section 1402, and the amount thereof. After an individual submits an application for financial assistance in obtaining health coverage provided pursuant to Title I, subtitle E, of the Affordable Care Act (“the application”) to an Exchange or State agency, the IRS will disclose the available items of return information described under section 6103(l)(21)(A) to HHS. Pursuant to section 6103(l)(21)(B), HHS will then disclose the information to the Exchange or State agency that is processing the application.”

  16. It is my understanding that high deductible plans will be eliminated under the Affordable Care Act. I am 50 years old and currently have a $5,000 deductible plan with an HSA. My premium is just south of $300 per month. According to Kaiser’s premium calculator, my premium under the ACA will be TWICE that amount. If this actually happens, I will not be able to afford health insurance which will force me to pay a penalty to help others get insurance while I go without. I have worked hard all my life. I do not make a lot of money however I make just enough that I will not qualify for a subsidy (and I really wouldn’t feel good about other tax payers paying for me anyway, even if I did quality). Have you heard the same things I have heard about high deductible plans being abolished and what have you heard about the accuracy of the Kaiser health premium calculator?

    • Great questions Kathy! If your current health insurance plan is grandfathered, you should be able to keep your current high deductible health plan. Under the Affordable Care Act (ObamaCare), it exempts most plans that existed on March 23, 2010 — the day the law was enacted — from some of the law’s consumer protections. Grandfathering can help preserve consumers’ rights to keep the coverage they already had before health reform.

      It is also my understanding that most non-grandfathered high deductible plans will not meet the federal requirements for plan designs under the ACA. I’ve not heard anything about the accuracy of the Kaiser Foundation’s Health Reform Subsidy Calculator’s accuracy, but those costs seem to line up pretty well with my personal expectations. I sure hope the feds loosen up the plan design requirements between now and 2014 or else a lot of people are going to be very upset.

  17. I have been under an individual health insurance plan for the last two and one-half years. Because I was in the process of obtaining this plan when the ACA was enacted and was accepted into this plan several days after the ACA’s enactment, this plan for me is not-grandfathered. However, others who had this same plan prior to the ACA’s enactment are grandfathered. The insurance company for my plan quickly stopped accepting new applicants soon after I was accepted into the plan. This plan provides broad coverage so it appears to meet all of the mandates required by the ACA. I wanted to know if I would be able to keep my current plan or whether my insurance company was going to have to kick me out of this plan as of January 1, 2014.

    • That’s an excellent question. I don’t know that you’ll have a truly definitive answer until next Fall at the earliest, as regulators may make changes between now and then. It is possible that your plan could meet the minimum coverage guidelines and if that’s the case you may be able to keep it. However, as things stand today most people with non-grandfathered plans will have to change plans on January 1st, 2014.

  18. Thank you for this service. I will be 60 years old this year and am currently covered by my employers group health plan. I am intending to leave my job towards the end of 2013. I have a pre existing condition that would exclude me from any health insurance plans as they exist today. Would I be obligated to purchase COBRA (at an astronomical price) in order to be able to purchase health insurance through the Colorado health insurance exchange , when it becomes available? A second question, my husband has his health care through the V.A. Is the V.A. considered credible evidence of health insurance in order to avoid penalties?

    • You’re very welcome and you would likely have to get onto COBRA if you retire before the end of 2013. However, in late 2013 you will be able to also shop for coverage through Colorado’s health insurance exchange for a 1/1/2014 effective date. Hopefully those rates will be better than COBRA, but time will tell.

      Individuals are considered to have minimum essential coverage to avoid penalties for any month in which they are enrolled in one of the following types of coverage for at least one day:
      ■ Employer group health plan
      ■ Individual health insurance policy
      ■ Government plan such as Medicare, Medicaid, Children’s Health Insurance Program (CHIP), TRICARE or veterans coverage
      ■ Student health coverage
      ■ Medicare Advantage plan
      ■ State high risk pool coverage
      ■ Coverage for non-U.S. citizens provided by another country
      ■ Refugee medical assistance provided by the Administration for Children and Families
      ■ Coverage for AmeriCorp volunteers

    • Good question. You would use the exchange in the state that you claim residency in. Both CO and FL will have their own health insurance exchanges.

  19. Mr. Moderator: We currently provide health insurance for all of our employees and would like to keep the policy and coverage we have. Will we be required to drop our current insurance and purchase throuth the exchange? If not, will we be subject to a penalty?

    • You will be able to keep an employer sponsored group plan to cover your employees. The real question is if you’ll need to keep the exact same plan or if you’ll have to change to another ACA compliant plan on 1/1/2014.
      If your current plan is grandfathered then you may be able to keep the current coverage. The Affordable Care Act (ObamaCare) exempts most plans that existed on and before March 23, 2010 — the day the law was enacted — from having to change plans.
      However, some carriers (like Kaiser) are not offering grandfathering on their small group (2-50 employees) employer sponsored health insurance plans, so the health insurance carriers also have a say in this.
      Your best bet is to contact your Broker or insurance carrier to ask them (1) if your plan is grandfathered and (2) if you’ll be able to keep your current coverage after January 1st, 2014.
      As it stands right now, if you do need to change plans in 2014 it appears that you may have options both within and outside the exchange to consider, so working with a knowledgable broker will be helpful. The options inside and outside the exchange will be more clear before the 4th quarter of this year.

      • I wanted to know where you received the information that Kaiser was not going to continue its grandfathered small group plans.

        Thanks.

        • I was told that by a Kaiser small group representative last Friday. You’re welcome to call them to verify it, but that’s what I was told. I was a bit surprised as well.

  20. It has been the case with Kaiser since the beginning of health care reform … going back to 2011. Not anything new.

    • Yes, the reference was intended to inform people that may not be aware of this.

  21. Have you determined what your plan designs will be for different levels of coverage (i.e., copays and coinsurances, etc.). If not, when might this information be available?

    • Great question! First off, this isn’t the exchange itself, but a forum that discusses the exchange, the Affordable Care Act and how this will affect Coloradans. Specific plan designs have not yet been determined, but we hope to see those on the exchange by October of this year. We expect most of the major carriers to offer plans on the exchange, but we may not know specifics for things like copays and premiums until October.
      More generally speaking, according to the US Dept of Health and Humana Services, health plans will be categorized according to the value of the benefits they provide. The lowest-value plan will be bronze, in which patients will be responsible for about 40% of the costs of covered benefits. For the silver plans, policyholders will pay 30% of the costs; for a gold plan, 20%, and for a platinum plan, 10%. These “Metal levels” are supposed to help consumers compare insurance plans with similar levels of coverage and cost-sharing based on premiums, provider networks, quality metrics, etc.
      The law is also supposed to limit plan deductibles to $2,000 per individual and $4,000 per family. The new ACA plans would cap current out-of-pocket costs to $6,250 per calendar year.

      • Many of the individual & family plan deductibles that I have been seeing on connect for health colorado website are upwards of $10K some are over $12K.

  22. As part of the exchange program, will State of CO employees who want to retire early (before they are eligible for Medicare) be able to keep the same health insurance options that they have as active employees?

    Thanks,
    PMM

    • I don’t believe there will be any special treatment or insurance programs for state employees in the exchange, but you certainly would be eligible to use the exchange like anyone else. I don’t know if you will be able to maintain your current insurance benefit levels and that’s something you would need to contact the Human Resources department to find out.
      However, at a minimum, I believe you should be able to maintain the state program’s benefits through COBRA for 18 months after retiring. That being said, if the state’s benefits change when the Affordable Care Act comes into full force on January 1st, 2014, your benefits would change also – even if you’re on COBRA.

  23. Assume an employer with over 50 employees is unable to obtain coverage from any insurance carriers due to the inability to reach the minimum participation required by the carrier (even if the employer agrees to pay more of the employee only premium so it is well under the 9.5%). Will the employer still be faced with the $2000/employee penalty?
    EXM: Empoyee earns $10/hr x 30hrs/wk x 52weeks x .095 = $1482 employees portion of premium. Employees can’t afford the $123/monthly premium or even $100/mo and therefore waives off coverage. No other coverage.
    Employer can’t get 70 – 75% participation, therefore carriers won’t offer coverage. What happens?

    • Assuming that participation rate requirements remain unchanged, then that appears to be partially correct. However, it looks like the penalty may exclude the first 30 employees and apply when employees receive premium tax credits to buy their own insurance. I’m not qualified to offer legal or tax advice, but this may be helpful:

      While the Affordable Care Act does not require employers to provide health insurance for their employees, the Employer Responsibility provision of the Affordable Care Act applies businesses with more than 50 full-time workers. To learn more read the Employer Bulletin on Automatic Enrollment, Employer Responsibility, and Waiting Periods.”

      Then on the page that is linked to they go on to define, “For purposes of section 4980H, a “full-time employee” is an employee who is employed on average at least 30 hours per week.”

      The health care law doesn’t “require” larger employers to provide health care to employees, but beginning in 2014 the law imposes penalties on businesses with over 50 employees that don’t provide “affordable” health care to employees. Here are the details of this portion of the law:

      • Starting in 2014, large businesses (those with 50 or more full-time workers) that do not provide adequate health insurance will be required to pay an assessment if their employees receive premium tax credits to buy their own insurance. These assessments will offset part of the cost of these tax credits. The assessment for a large employer that does not offer coverage will be $2,000 per full-time employee beyond the company’s first 30 workers.

      • To be deemed “affordable,” the health care insurance provided by the employer must pay for at least 60 percent of covered health care expenses, and employees may not be forced to pay more than 9.5 percent of their family income (before deductions and adjustments) for coverage offered by employers. The question of how an employer is supposed to know the amount of “family income” is not yet addressed.

      • If a business fails to provide any coverage or the coverage is deemed not to be affordable, the amount of the penalty is $2,000 per worker, but the first 30 workers are excluded from the calculation.

      Please note that some of these rules are still being interpreted and please work with a professional for all guidance on all legal and tax matters.

  24. I’m a 60 year old who purchases individual health insurance on the open market. My insurance plan is coming up for renewal in May and the contract lasts one year.

    I believe will be eligible for premium and cost sharing subsidies in 2014. But, I understand I can only obtain these subsidies if I purchase insurance from the exchange.

    Must I purchase insurance from the exchange now in order to eligible for the subsidies in 2014? I believe that the cost of subsidy insurance will be significantly higher than the insurance I’m currently carrying.

    • The first thing you want to do is determine if your current policy is “Grandfathered” or not. Under the Affordable Care Act (ACA or ObamaCare), it could be “Grandfathered” if it went into effect before March 23, 2010 — the day the law was enacted. Grandfathering can help preserve consumers’ rights to keep the coverage they already had before health reform.

      Even though your plan renews in May and the carrier may guarantee the rate for a year, you should be able to cancel the coverage at the end of any current month in which notice is given to the carrier. You can call the carrier to confirm that.

      If the policy went into effect after March 23, 2010, then you’ll almost certainly have to get a new policy that is ACA compliant and includes all the federally mandated benefits. If you are eligible for the subsidies then you will almost certainly be best served by purchasing insurance through the exchange, as the only way to get the benefit of the subsidies is to purchase your insurance through the exchange. Still, you may want to consider working with a licensed health insurance broker that works with multiple carriers both inside and outside of the exchanges, so they can shop all the plan options for you.

      Hopefully with the subsidies you’ll find that the rates will be reasonable. The multiples that insurance companies are alloweed to charge people in their 50’s and 60’s will decrease as a result of the ACA and this should help reduce some of the cost burden on older Americans. So that’s great for more mature people like you and I, but younger folks will see their rates go up more to compensate for our reduced costs.

      You may be able to see the rates on the new plans by October 1st, 2013 and the effective date for these new plans will be January 1st, 2014. Vermont has already released their rates on their exchange, so perhaps we’ll get a preview before then.

  25. My income hovers around 133% of the federal poverty level. In 2014, I’m not sure if I’ll be eligible for Medicaid or have to purchase insurance to avoid a tax penalty. I know I’ll need to purchase insurance through the exchange if my income is above 133% of the poverty level in 2013.

    If my income is below 133% of the poverty level, how do I apply for Medicare in 2014? Can I do that through the exchange?

    • Beginning in 2014, the Affordable Care Act extends Medicaid coverage to all individuals between ages 19 and 64 with incomes up to 133 percent of the federal poverty level, or $14,856 for an individual and $30,656 for a family of four (based on the 2012 federal poverty level). Regardless if your income is just above or below the 133% level you’ll want to sign up for health insurance through Colorado’s public exchange this fall. Starting as early as October 1st for a January 1st, 2014 effective date, you can enroll in Medicaid through the exchange or even if you earn too much to be eligible for Medicaid, you should still be eligible for a large subsidy to substantially reduce the cost of health insurance.

  26. As long as income is equal to or below 133% of federal poverty level,
    one is qualifed to get medicaid coverage, just on the basis of income. Before affordable care act, one needs to be also fall into a category (individuals with disabilities, parents with dependent children, children and pregnant women) to be eligible for medicaid.

    Also Anyone can purchase insurance from insurance exchange regardless of income too low or high. People who are earning between 100-400% of Federal Poverty Level can get health premium credits and cost sharing subsidies, which will lower their out of pocket cost for health insurance premium. Premium credits lower the cost of health plan premiums, one has to pay and cost sharing subsidies increases the coverage level of a health plan. You can find more information on these at ObamaCare Subsidies For Qualified Health Plans.

  27. I have a friend working in the underground economy. Doesn’t report any income to the government and hasn’t filed a tax return in decades.

    Will they be able to get Medicaid coverage through the Colorado exchange in 2014?

    • I’m not a tax professional, but your friend should certainly consult with one. I’ve heard that all Americans are required by law to file a tax return every year, even if they owe nothing. If the IRS catches up with this person the fines could be substancial, so it sounds like something worth getting out in front of.

      Also, it’s important to get a 2012 tax return filed with the federal government, because the exchange will use that information to determine the amount each person/family will pay for public (Medicaid) or private health insurance. If your friend didn’t file taxes for 2012 he/she could miss out on that and even pay a fine. The penalty for not having insurance in 2014 is $95 dollars. But in 2015 it goes up to $325 and is $695 in 2016. Again, your friend should consult a tax professional, of which I am not one.

      • Thank you for your prompt answer, but it raises another question in my mind.

        No, not all Americans are required to file a federal tax return. According to IRS Publication 17, whether you need to file a tax return depends on gross income, filing status, and age. (It may be to one’s benefit to file, but it’s not required by law.)

        For example, IRS Pub 17 says that a single person under the age of 65 who makes less than $9,750 does not need to file a federal tax return.

        Is there some provision in the ACA or exchange regulations for those that are not required by law to file a federal return?

        • Everything I’ve read says that income tax returns will be used to determine eligibility for subsidies and public programs, but perhaps there is a workaround for that. Your friend might want to try calling his/her local county Medicaid office and ask them how that situation would be handled today.

          • FYI. I called the local Medicaid office. They told that the income information will be provided by the applicant to the Exchange and affirmed by the IRS. As long as the income information the applicant provides is consistent with the information that the IRS has, it is not necessary to have filed a federal tax return to qualify for Medicaid.

          • Thank you for your update and I’m sure that information will be helpful to others. That’s encouraging news for your friend. Since that situation is a bit unususal, your friend might want to seek out the services of an exchange “Navigator” to help him/her enroll. Navigators are supposed to have extensive training. I would think the county Medicaid office will be able to refer him/her to one in the Fall, if the county office themselves are not trained as Navigators.

  28. actually two questions–

    1) Under ACA, will those with “high deductible” health insurance plans (mine is from Anthem, their plan 051/551) be allowed to keep them (and if so will they be required to tax penalty as they do not meet the new criteria for “health insurance”), or will such high deductible plans go away, and no longer be offered by insurers, being replaced with new plans that comply with ACA?

    2) Under ACA those whose income is under 400% of poverty will be eligible for a subsidy from the Federal Government. Will this subsidy be paid at the time the premium is due directly to the insurer, or will a taxpayer be required to request it afterwards, say by a new line on the 1040 form?

    Thanks for your reply!

    • Great questions! Under the ACA, HSA plans may or may not be affected depending on whether they are group (insurance through an employer) or individual (coverage for yourself and/or family that you purchase directly). Deductibles will be limited to $2000/$4000 (Ind/Fam) in-network. Both Group and Individual out of pocket maximums (deductible plus coinsurance) will be capped at $6400/$12,800 (Ind/Fam), in-network, which synch up with IRS requirements for HSA plans. So, new ACA compliant HSA qualifed plans will have lower deductible limits than the HSA plans in the individual market, but the out of pocket maximums are identical.

      Of course, Grandfathering or how old the policy is also comes into play. The Affordable Care Act exempts most plans that existed on March 23, 2010 — the day the law was enacted — from some of the law’s consumer protections. Grandfathering can help preserve consumers’ rights to keep the coverage they already had before health reform.

      For your second question, The health insurance tax credit is paid in advance to a taxpayer’s insurance company to help cover the cost of premiums, so you only pay the amount less the tax credit.

      • Thank you so much for responding so knowledgeably and promptly!

        I am 62 and have an individual plan where the maximum annual out of pocket is appx. $8,500, and I began with this insurer and policy in 2011, so my guess is I will not be grandfathered in.

        As a result, my guess is, I would be well advised to wait until the exchange comes into being (10/31/13?) and purchase new insurance through the exchange so that I can take advantage of both the new lower deductibles/maximum annual out of pocket expenses, and simultaneously qualify for whatever subsidy my income level permits.

        and once again, thank you for your response!

        • You are quite welcome and I’m glad the information was helpful. If your income is below 400% of the federal poverty guidelines then you’ll definately want to shop for insurance through the exchange for one of the new ACA compliant plans and use the subsidies your income level permits to reduce your out of pocket premium costs. Please keep in mind that the new plans will be effective January 1st, 2014, although you may be able to start shopping and applying for them through the exchange as early as this October. Have a great day!!

  29. I keep hearing reassurances that. “if you like your health care plan at work, you can keep it.” But what about those of us who hate our employer-provided health care plan? Will we be able to leave our employer plan and join one of the plans offered by the Insurance Exchange? Can I have the money my employer is currently paying for my abysmal coverage diverted to help pay the cost of a plan from the Exchange?

    • If you don’t like your employer provided health care plan you can open enroll in one of the plans offered by the Insurance Exchange. If you are eligible for any premium subsidies those may help reduce your out of pocket cost. However, the ACA won’t force your employer to give you the money they were paying towards your employer provided health care plan.
      Depending on the size of your employer (50+ full time equivalent employees) the ACA may force your your employer may be forced to offer better coverage or pay a penalty. The Affordable Care Act treats coverage as “affordable” if (a) the employee’s premium does not exceed 9.5% of that employee’s household income, and (b) the employer covers at least 60% of the actuarial value of coverage. A large employer that fails to offer affordable coverage will be subject to an excise tax of $3,000 per employee who receives a tax credit through the exchanges. While this is a larger dollar amount than the tax for failure to offer coverage, this tax is only multiplied by the number of employees who receive a tax credit, rather than by all full-time employees.

      • Thanks for the info. This is why the support for ACA is so lukewarm. Those with extreme cases do get help. The rest of us are still stuck with the same broken system. Individuals still have no control over their health care. They’re stuck with whatever their employer chooses. The premiums aren’t the issue, it’s the coverage. I’ve paid over $4,000 out of pocket in the first 4 months of this year. My premium is $6000+/year, so my medical has cost $10,000+ so far this year and there is no end in sight. We need a Medicare option for everyone who wants it, including the ability to redirect employer contributions to pay for it.

        • You’re very welcome and I’m glad you found that helpful. I hope the cost side of the equation is addressed soon as the current trajectory appears to be unsustainable.

  30. I have a very unussual situation, tht probably covers several different scenerios for other people so I’ll break it out and see if you can answer at least some of these questions. I have insurance through my company that covers my immediate family, I also have a mother-in-law that lives with us and she is on meidcare. Now my son is mairred and both are under 26, however, both are students and neiter one is employed at this time. My son is covered under my play; however, my daughter-in-law is not allowed to be covered under my plan and her father has either refused to or forgotten to keep her under his plan–he has other children whom he provides coverage for so this is not a matter of a finacial burden for him. So if I claim her on my taxes because of the support I’m providing both of them I’ll be fined because she does not have insurance. So if I’m reading the above information correctly the only solution is to not claim her–she has no income and therefore has no need to file a tax return. However, as the option to cover children to the age of 26 is not mandatory she will not have coverage due to her father’s refusal to carry her…thus leaving her to fall within the cracks of Obamacare? So what options would be available to her given she has no income?

    • Children are eligible to be enrolled on their parent’s plans regardless of whether they are married or single, students or not, employed or unemployed, claimed as dependents or not. When they turn 26 they need to get their own policy. Your daughter in law is not eligible to be covered under your policy as a dependent. As to whether you can/should claim your daughter in law as a dependent on your taxes, that is something you need to consult with a tax professional on.
      Under the Affordable Care Act she will be required to have health insurance starting in 2014. The flow chart at this web page may help you sort this all out. If she has no income, she very well may qualify for Medicaid. She’ll want to go through the Exchange web site when it opens in October to see what she qualifies for. I hope that’s helpful!

  31. I have two questions that I cannot seem to find the answers to:

    1) Will my husband’s VA disability payments be considered income in 2014 under the new health care initiative? and will they be considered part of MY income if I am the only one who needs health insurance, as he is covered by the VA?

    2) Does anyone have any idea what the range of prices will be to buy insurance in 2014? I realize that there will be a range of plans to choose from, from bronze to gold and so on, but how much will these plans cost?

    I will be the only one buying insurance as my husband is covered under the VA, but I will be 60 years old this year and will need to buy insurance for myself. I will be resigning from my job at the end of 2013 and will basically have no income of my own. I really do not want to go on Medicaid, bit will this be my only choice, even if I want to buy insurance?

    I guess that’s 3 questions. Thanks!

    • Household income is used and includes incomes of the taxpayer, spouse, and dependents. In determining eligibility for subsidies, exchanges will calculate enrollees’ household incomes using Modified Adjusted Gross Income, or MAGI. The MAGI calculation includes such income sources as wages, salary, interest, dividends, and Social Security. MAGI calculation does not include income from gifts, inheritance, and Survivors Benefits, and some other income sources are partially excluded.
      You’ll have to consult with a tax professional on the question about whether Veterans Disability payments are excluded or included in the determination of your household income. I think they may be, but I can’t provide any definitive answers.
      I’m afraid we can’t provide a list of the range of prices yet, but you should see those by October 1st.
      You will always have the option to purchase your own insurance rather than enrolling in Medicaid through the exchange and a Colorado health insurance broker in will be able to help you with that.

  32. I’m 41. My husband had a vasectomy after our last child. I’m not going to have any more children; so why do I have to pay a higher premium for an insurance plan to cover maternity related medical care? My “children” get well child check ups until they are 21? My son will register for the draft at 18, and all three will be able to vote at 18 years old. They are tried as adults (if they have committed a crime) at 18 years old (sometimes younger.) They are no longer legally children after 18! I have to cover “children” until they are 26? I had served six years in the military and had been deployed to Somalia by the time I was 26! I was pregnant with my first child when I was 26. Am I going to be required to provide health insurance for my grand children, too?

    • You bring up an interesting issue. The Affordable Care Act has already made it illegal for insurers to deny insurance to “children” under the age of 19 with pre-existing conditions. While “children” are allowed to stay on their parents’ policies up until their 26th birthday, I’m not aware of any legal obligation for the parents to do so. However, I believe the parent might have to pay a penalty IF they claim uninsured “children” as dependents on their taxes.
      Thank you for your service Nicole!!

      • You didn’t answer my first question. Why do I have to pay for a higher premium which includes coverage for maternity when I plan to have no more children? I currently have a high deductible policy with no coinsurance. That suits me just fine. I’d much rather pay for services that I actually receive rather than for insurance that I don’t use. I’m down right irritated that I am being forced to buy something that I don’t want and that I will be forced to accept government assistance. Right now the government doesn’t aid me. I can afford my medical insurance without their aid. Because of this law, the government will shell out hundreds of dollars a month for a plan that I don’t want and will not use. How is that going to help anyone? While I don’t agree with fraud, since I am being forced to give up my current plan and buy another more expensive one, I am going to take every test, see every doctor I can for every check up, and encourage eveyone I know to do the same. The only way to make this law going away is to cause it to collapse.

        • The law in Colorado mandates maternity coverage on all new policies. It is not my place to defend or rationalize the law, but all opinions are welcome here.

          • i am 47 and my better half is neutered. He has two grown children, and we took the responsible approach so we would not have children. It’s not fair that I would have to pay for maternity care!! Count my vote….that’s ridiculous. Many of my friends have made a conscious decision not to have children, and we should not be penalized for that choice.

  33. I am a veteran. Will I still be allowed to use the health exchange, and will I be forced to go to the VA for my needs? Will there be an advantage to being a veteran when it comes to the new healthcare law? Will I get support from both the exchange laws and VA?

    • Veterans will certainly be able to use the Exchange and will not be forced to exclusively use the VA. It should help provide more rather than fewer options.

        • The VA may cover some benefits not covered by health insurance that is acquired through the Exchange, but I don’t believe there will be any coordination of benefits between the two plans.

          • So it sounds like if I take my insurance to a non-VA physician, then there will be no option to get VA to pick up the rest. You said “no coordination” which means exactly what?
            Also, what if I take my insurance to VA? Doe VA simply take what insurance pays and nothing more?

          • I belive that you are correct that if you take your exchange purchased insurance to a non-VA physician, there will be no option to get VA to pick up the rest. Coordination of benefits would apply if the VA and the private insurance company worked together to cover benefits, but I don’t believe that will be the case at all. You may want to call the VA to get that answer straight from the proverbial horse’s mouth, to be sure.

  34. Hello, I am a licensed health and life insurance producer in Colorado and would like to try and get a job on the new Colorado State Health Insurance Exchange. Would you be able to direct me to where I might apply and/or who I might talk to?

    Thank you for your help in this matter,
    Andrew Spodek

  35. 11 insurance companies have submitted health plans and rates information to Connect for Health Colorado exchange. This private website shows some sample rates from a few different insurance carriers.

  36. I am an RN with 34 years of hospital nursing experience. How and where can I apply for an insurance “navigator” position with “Connect for Health Colorado” and the health insurance exchange? Thank you

    • That’s great!! Please follow this link. You are a bit early, but there will be more information on becoming a Navigator forthcoming.

  37. Jeff …

    Rates for 2014 will be dependent on your modified adjusted gross income as reported on your 2012 tax return.

    Rough example: If you — as a single person — have a modified adjusted gross income of $45K or less, you will qualify for a subsidy from the Federal Gov. So, at $45K, your rate for the Silver Plan would be about $355 per month. If you’re married, then your household modified adjusted gross income could not exceed $60K in order to qualify for a subsidy. At $60K, the premium for you and your spouse would be about $475 for the Silver Plan. If your income as a single person, age 60, were to exceed $45K — modified adjusted gross — then your premium for the Silver Plan would likely exceed $700 per month. If married, with modified adjusted gross income above $60K, then your monthly rate for the two of you will likely be close to — or exceeding — $1500 per month for the Silver Plan. Silver Plan is the second lowest plan and the plan expected to be selected by the vast majority of people on The Exchanges.

    The flip side of the above ‘high’ example is that, your monthly rate will be markedly lower (or, your subsidy markedly higher) were you as an individual to have significantly less modified adjusted gross income of $45K as an induvidual or $60K as a couple. Example: If your modified adjusted gross income as a couple were $42K, then your monthly rate would be $333. If you’re single and your modified adjusted gross income were $35K, then your monthly rate would be $273 … and so on. Firm rates for Colorado are said to be released in Aug/Sept.

    Modified adjusted gross income of $14K or less per individual OR $21K or less per couple will qualify for Medicaid which means that your health insurance will have NO cost.

    If you have kids aged 25 and under that you need to include on your insurance, then that adds another multiplier. I took your question as if you weren’t trying to insure kids.

    • I don’t know how you got your numbers but here is how I am calculating it.

      Picking the rate for 55 year single person living in Boulder Colorado and buying Siliver plan from Kaiser Foundation Health Plan of CO. (see the chart at bottom of this post: http://insuranceexchangehq.com/colorado-insurance-exchange-proposed-rates/ to find the rates). The rate is shown as $441 per month and does not include affordable care act subsidies.

      Now assuming if this individual’s modified gross income is less than $45960 (ie less than 400% of federal poverty level) , this person will qualify for health care subsides such that his annual cost for health care should not be above 9.5% of his annual income so this will come down to $45960 * 9.5/100 = $4366.2, maximum health care cost per year or $363.65 per month.

      So instead of paying $441 health premium, this person will pay $363.54 per month a saving of $77.46 or 17.5% reduction from orignal $441.

      • That’s still outrageously unaffordable. Especially since you still have significant out of pocket expenses (40%?) if you actually use your healthcare.

    • So what is “adjusted income” according to the new law? Does it mean my income after any deductions?
      Is it adjusted after a credit applied towards my income?

      • “Modified adjusted gross income” (not adjusted gross income) is used to determine eligibility for susbsidies. To get thsi number, first calculate your gross income. Gross Income is the money earned through wages, interests, dividends, rental and royalty income, capital gains, business income, farm income, unemployment and alimony.
        Then add any foreign income, employer-paid adoption expenses and interest from employee savings bonds used to pay higher education expenses. Finally, then you subtract items like moving expenses, alimony paid, self-employment taxes.

        This should give you a good estimate of your modified adjusted gross income, but here is a good page from the IRS on calculating the modified adjusted gross income. Note: This should not be taken as legal or tax advice. Please consult with a tax professional.

        • Do you also subtract the personal deductions allowed by the IRS that would bring my taxable income to $0? Danged if I can even figure out how to sign up, much less what’s available.

    • Rates for the 2014 ACA plans will not be higher if you have pre-existing conditions. However, rates are higher if you have tobacco use in the last 12 months.

  38. Tom …

    The spreadsheet you referenced does look promising, if finalized. My numbers came from the berkeley calculator:

    http://laborcenter.berkeley.edu/healthpolicy/calculator/

    Until about 10 days ago the calculator on connectforhealthco.com exactly mirrored the berkeley calc. Now, the CFH calculator shows only the subsidy that one qualifies for, excluding a bottom line rate projection. As I said, it’s promising.

    I answered a question coming from a 60 year old. The strata included on the spreadsheet are wide: 27-39, 40-54, 55-64. My guess is that someone over 60 will be paying quite a bit more for their health insurance than $441, if OUTSIDE of the exchange — meaning modified adjusted gross above 400% FPL. Still, based on referenced spreadsheet, I expect that the rate for a single person, age 60, will be less than the $700 per month that I stated (probably closer to $600 per month, I would guess). I encourage people to play with the calculator above. kff.org has a similar calcultor.

    At first glance, Colorado appears to be preparing one of the best (if not the best) Exchanges in America. That said, (self employed) individuals and families earning more than 400% FPL will be paying significantly more for his/her/their health insurance as will individuals (especially) under age 30. The positive thing is they’ll be guaranteed to qualify for it, regardless of any pre-existing condition. Some private insurers in the CO market will also weigh in with options outside of The Exchange for those above 400% FPL.

    It appears that CO will have a robust menu of options for its residents … really, there is no reason for anyone to opt out of participation.

    Thank you.

  39. All of you have nailed it. 100% righteousness. Except for one small point. Any “system” that allows the consumers of healthcare to engage in daily self destructive activities such as are endemic/pandemic and epidemic in this culture, will realize in short order the consequences of attempting to provide “quality” healthcare to the masses who are determined to destroy their own health, is doomed to failure. Yes after having worked in the frontline trenches of healthcare for the last 25 years, the never ending phenomena of witnessing year after year the denial of services to those who really need it, by their insurance companies (can we say HMO?) I have no doubt which direction healthcare is headed in this country. Doubt my word? Call me on it. Walk into any nursing home and ask them what their batting average is when it involves calling the HMO’s on the patients behalf/doctors orders requesting an authorization number for whatever intervention is being requested. A ball player with that kind of average would never get a contract with anyone. Oh by the way a stated goal of ACA is to convert all straight medicares to HMO’s. Happy aging!!

  40. Are there any exemptions for people who have had bad experiences with doctors? I was strangled and raped by a doctor in my teens. I have also worked at hospitals and have experienced sexual harassment and bullying from doctors. These are the kinds of people I do not allow in my circle. Where is my exemption?

    • That’s terrible and I’m so sorry that happened to you. I’m not aware of any special exemptions for those circumstances. However, if you get a good PPO plan you should have a good selection of providers to choose from. You might try using some of the review sites to locate a good ethical doctor that you can feel safe with.

  41. Michele … Not to worry. Currently, you are not required to go to a doctor for any reason. And when Health Reform aka ObamaCare goes into effect next year, you will NOT be required to see a doctor either. You will have to carry health insurance; however, which may come in handy were you to fall off of a cliff, get hit by a car, or have a stroke rendering you unconscious and in need of the emergency room. Hope that helps.

    • Great question! While, we can’t give a definitive “Yes” or “No” until the exchange opens in October, given the federal requirements for HSA qualified plans law, HSA plans could meet the exchange’s bronze plans requirement of 60 percent actuarial value. Regardless, there will certainly be ACA compliant HSA qualifed plans offered in the private health insurance market, outside Colorado’s exchange.

  42. I tried to get a quotation from Anthem-Blue Cross for medical insurance beginning next but their Website will let me do. In addition, the Website is not user friendly seems overly complex—I get the distinct impression that the medical insurance companies have not got the message that they need to compete for our business—they seem to be presenting the public face and posture that the public has learned to hate intensely!

  43. I travel frequently throughout the US and also abroad. I have had good luck in the past with carrying Blue Cross as it has a World Card program and some good suport both on the internet and via personal contact at a call center. I know that to receive the best benefits while traveling I will need to sign up for a PPO program.
    My question is which one will provide the best out of area cover? Especially overseas?

    A second, question, I make about $27000 annually, single. The cost of $200 premiums is high as far as I am concerned. In the past I have carried only catastrophic insurance and pay for my routine outpatient care. I go to clinics and use mostly generic medications. I realize that ACA insurance is far superior to this type of insurance and am grateful that it has been enacted as I currently have celiac disease (gluten free diet) and high blood pressure (controlled) but have been basically uninsurable.

    I have been unable to find out what my options would be under bronze plans and also what my portion of the cost would be.

    Thanks in advance.

    • I would have to say that the best out of country coverage will still be Anthem Blue Cross Blue Sheild, who will be selling PPO plans both inside and outside the exchange. I agree that their international BlueCard program is quite good. That’s who I currently have my own insurance with as well.

      With the bronze plan, the insurance would cover 60 percent of all health care costs. This means the insured, on average, is responsible for paying 40 percent of the costs.

      At $27,000 for a single person you should be eligible for a subsidy of about roughly 1/3 of the total premium, which should make the ACA plan through the exchange quite competively priced. In October, we’ll be able to give you the exact rates for the bronze and silver plans. We can help you compare that premium and plan against your current plan coverage and even help you enroll. Hope that’s helpful!

  44. Why can’t I seem to find any details of the plans and premiums available through the Colorado exchange? The DenverPost printed an article last month claiming these rates were fair, but none of the websites seem to provide this information.

    • You can view some sample rates here for the Silver Plan. With the Silver health insurance plan, the insurance would cover approximately 70 percent of all health care costs. This means the insured, on average, is responsible for paying 30 percent of the health care costs. Plan details and final rates will be available on October 1st, but I hope this interim information is helpful.

  45. If I lose my coverage through my employer (i.e. lose my job), can I sign up any time or do I have to wait until the next open enrollment period? Thanks.

    • If you have an involuntary loss of coverage that will trigger a special enrollment period, so you won’t have to wait for open enrollment.

  46. Mark, is there any way to contact you by phone. I am a member of Denver Association of Insurance Professionals, a non-profit eductional association, we are very interested in scheduling a speaker for our October meeting to provide an overview of the upcoming changes in the healthcare requirements and its impact on individuals. Would it be possible for me to contact you?

    • Sherrill, thank you and I’ll send you an email with my contact information, so we can discuss that.

  47. I am wondering what forms we are required to provide to our employees with regard to the Insurance Exchange. This website seems to be a little difficult to manuever. In reading the IRS formal announcement for 2014 relief, it clearly states that we are still required to distribute the Notice of Exchange Availability to our employees. Where is it that I can find a printable version of this communication?

    • Starting on October 1st, you can go to the Connect for Health Colorado website to sign up for Medicaid for enrollment effective dates of January 1st.

  48. Hi! I’m an agent. I’m wondering if Colorado will have its own certification tests and exams (different than those released by CMS last week for the federal exchange) in order to sell exchange products in CO?

  49. A family of two with an income 62,040 $ get a monthly subsidy of 426$.
    If the family makes 10$ more the subsidy goes abrubtly to ZERO!
    It does not look right to me. Any comments?

    • Couples earning roughly between $20,000 to $62,000 a year are eligible for federal subsdies. However, keep in mind that the couple’s household Modified Adjusted Gross Income is the actual number used. Yes, even a few dollars could ultimately separate who is and isn’t eligible for federal subsidies. You can see where you’re likely to fall using the exchange’s subsidiy calculators here.

        • Domestic partners are supported in Colorado. Your partner, through a common law marriage or civil union or domestic partnership, will be able to be covered through your health plan, through Connect for Health Colorado.

  50. With ACA thresholds a family with very low income is forced into Medicaid.
    Can the family buy private insurance through exchance even if it is not subsidized? (I have assumed here that although the income is low the family has savings and preffer a private insurance that is better than Medicaid )

      • But if I do not use the exchange and later into the year my income qualifies for ACA I will not get the subsidy.
        The income estimation looks to me like a high risk estimation since nobody know for sure the futuire income. Am I missing something?
        Thanks

        • If you’re unsure of your income estimate, then using the exchange is the best bet if you don’t want to worry about missing a potential subsidy.

  51. If my income level qualifies me for Medicaid – does that really mean that my only choice is Medicaid or receive no subsidy at all for purchasing a plan from the exchange. What if I know my 2013 income will higher than my 2012 income and therefore make me quallified for a subsidized exchange plan.

    • It’s my understanding that if you qualify for Medicaid that you would not be eligible for a Federal subsidy for a standard exchange plan. However, I’m not 100% sure if you’ll be able to get a plan through the exchange without a subsidy or not. I believe the answer is no, but can’t say for certain at this point. I can tell you that there will be very similar plans available outside the exchange at competitive rates.

    • Great question!! A “Metropolitan statistical area (MSA)” is a relatively freestanding area of the state determined by one or more large population nuclei, together with adjacent communities, that have a high degree of economic and social integration with the nuclei. Here’s a link to the MSA service areas.

      If you watch the second video above (3 minutes) it explains how subsidies work and what factors are used in determining income.

  52. Will Medicaid eligibility still be based on certain unearned income (gifts, etc) added to Earned Income when ACA begins or will it adhere to the ACA MAGI criteria.

      • Thank you, I’ve read that report. It appears to be the most current. But at this point it only details the differences between the two Income measurement systems as advise to Congress. Can you check with the Colorado State Exchange program to see if they have made a decision for the State?
        Thank you.

        • Your best bet will be to (1) call your local Medicaid branch to verify it or (2) contact the exchange directly. As you may have follow up questions, going straight to the source is best.

          • Tried both Medicaid sent me to the Exchange, and the Exchange does not know and sent me back to Medicaid. My understanding is that this was supposed to have be set up by now. Please help.
            Thanks.

          • Sorry you’re having trouble getting a definitive answer, but Medicaid should be the ultimate authority as to how the rules will be applied. Please keep in mind that it’s still quite early, as the exchange won’t even open until October and the new plans won’t take effect until January 1st. There are a number of grey area type questions that will have to be sorted out. My suggestion is to try them again in mid-October, as they may be better able to answer that question then.

  53. You don’t give the necessary information. Please publish the details, such as deductible and total out of pocket expenses. Why do you hide these things. They are very important to making a decision.

  54. I have carefully saved through the years and plan to retire in 2014 yet not claim SS benefits or enter into Medicare until later. My income would fall to from 100K per year in 2013 to about 36K per year in 2014. Could I enter the program and qualify for subsidies in 2014 or would I have to wait for the tax return verifications of income to “catch up”

    Thanks,
    Greg

    • Congratulations on your upcoming retirement! In determining eligibility for exchange subsidies, income will be based on your attestation of your expected income in 2014 and will be verified by the exchange with documentation from your most recent tax return, with consideration of reasonable changes you expect.
      Exchanges will calculate enrollees’ household incomes using Modified Adjusted Gross Income, or MAGI.
      To see how MAGI is calculated, please see the second video on this web page. It’s only 3 minutes and explains how that’s calculated.

      • I was a student in 2012 and 2013 earning enough only to qualify for Medicaid. I am starting work now and expect my income to be above the Medicaid limit in 2014.

        I prefer private insurance with a Federal Subsidy.

        How and when will the attestation to projected 2014 be done. Can you lose your insurance and the option to Medicaid if whoever runs the ACA does not accept your attestation to 2014 income.

        Thank you.

        • The attestation will be done on the application done through the exchange. The exchange training hasn’t yet addressed what happens if the MAGI estimates provided are inaccurate.
          In the case of subsides, it’s a reasonable expectation that any under or over payments can be trued up when you do your taxes.
          If you attest to income that is too high for Medicaid and get a subsidized plan instead, I don’t see any way they’re can take your insurance away so long as you continue to pay the premium. However you will not be able to change your mind and get onto Medicaid until the next year’s open enrollment.

          • Thank you.
            I’m a bit confused about one statement you made…
            “it’s a reasonable expectation that any under or over payments can be trued up when you do your taxes.”

            What do you mean by “any under or over payments can be trued up when you do your taxes?”
            Are you referring to the 2014 taxes? And what are you referring to by under or overpayments as well as how will they be trued up?

            Thanks.

            Thank you.

          • So, when completing the attestation of income on the exchange application, if you underestimate or overestimate the amount of income for 2014 enough to where it changes the subsidy amount, I expect that when the government will collect or refund (true up) the difference between the subsidy provided and what the actual subsidy should have been when doing your 2014 taxes. This is a reasonable assumption or else it would encourage people to under-report income to increase the size of the subsidy if there were no mechanism in place to correct for that.

  55. Arbeit Macht Frei – Third Reich
    Ministry of Truth – 1984
    Spending is better than mending – Brave New World
    “The Affordable Health Care Act” – B.H. Obama

    • “Exercise freaks … are the ones putting stress on the health care system.” ~Rush Limbaugh, accusing people who exercise of being the reason why health care costs are so high, June 12, 2009

    • “Cholesterol has nothing to do with heart disease. Nothing wrong with saturated fats.”
      ~Rush Limbaugh, disputing science despite his own hospitalization back in 2009 for chest pains, March 8, 2011

  56. I used the cost calculator, which was really helpful, but I wonder if you can answer a question for me: My husband and I purchase my stepson’s health insurance, but his mother claims him each year on her tax return… How do we make sure that the subsidy information reflects him, too?

    Thanks!

    • That is a complex situation. I found a source at HMS (please read this document) that says that “The parent(s) who claims a child as a dependent on the tax form is responsible for securing their coverage, not necessarily the parent who is living with/providing for the child.” That document also reflects that this may be at odds with court orders. You may want to call the exchange 1-855-752-6749 and perhaps to HMS itself. The last page of that document provides some contact information. Would you let us know if you get a definitive answer?

  57. I have been reading through all of the information I can get my hands on and attending learning opportunities regarding the ACA and the plans being offered, etc. I just want to know how a family with 2 kids and who make under $40,000 a year and are already struggling to make ends meet can afford even $100 extra dollars a month going out for something they may never use? The deductables are pretty high and the co-insurances are not very good either, in my opinion. In my opinion, a middle of the road plan should not have a deductable over $500 and the co-insurance should not be less than 80%. In my whole work-life and in dealing with insurance companies, that has been the norm, not a 2000/40 plan. Let’s just take the food out of the mouths of babes!

    • WestColo … Because $40K w a spouse and two kids is below 250% of the Federal Poverty Level (FPL), ACA is built to give you what you are requesting — about $500 deductible. There are special considerations for those that are below 250% FPL. However, if I were you, I would look into CHP+ today as your situation will get your kids covered now, if they aren’t already. Finally, yes budgets are tight; still, $100 per month is close to what the penalty would be for opting out (in 2014). Your plan will include inexpensive prescription coverage, low deductible, low co-pay for office visits, and emergency room coverage as low or no cost. Hope this helps …

  58. It is my understanding that a family of four will pay a penalty of $285.00 or 1% of their income, whichever is greatest. You may consider not buying it if the penalty is less expensive that the cost of the insurance. This is only for the first year, the penalty goes up after that.

    • Melody … Certainly, one has the option of not participating in subsidized health insurance as offered due to ACA. But it is important to “mythbust” some information that is out there and believed by some.

      Here is the valid information: 1) You cannot enroll into a health insurance plan as you (or your child) are being wheeled into the hospital — your injuries or heart attack or stroke or severe asthma attack will NOT be covered expenses. Without health insurance, you will be fully responsible for those bills and you will likely be facing bankruptcy and/or having a lien placed on your property if you cannot pay your hospital/doctor bills. 2) If you do not enroll into a health plan by 3/31/2014, then you will not be able to enroll into a plan again until 10/2014 (open enrollment) and you will not have coverage until 1/1/2015. 3) Depending on what part of Colorado that you live in, you will have a choice of at least 3-5 different PRIVATE health insurance carriers with which to enroll. Your insurance is then subsidized by the Federal Government, based on your personal circumstance and income. Unless you are on Medicaid or Medicare, you are NOT on a government health insurance plan, though the private carriers must comply to the HHS requirements as outlined by ACA. 4) Private health insurance carriers had a choice here in Colorado to participate in the Colorado Exchange (Marketplace), or not. About a dozen carriers chose to due so, although not required to. 5) There are and will be numerous high deductible plans available for purchase OFF of the exchange — both Qualified Health Plans (QHP) and non-qualified. There will be adequate choice.

    • Starting in 2014 the charge for not having health insurance will be $95/person or 1 percent of household income, whichever is larger. In 2015, the penalty will increase to $325/person or 2% of household income. The penalty increases to $695/person or 2.5% of household income for 2016.

  59. Assume income of a person varies from initail estimate. Initially it does not qualify for ACA because the income is either too low or too high. It buys insurance outside the exchange but at the end of the year total income was within the ACA limits. Now it can not claim subsidies because it bought private insurance outside the exchange. Is it any solutions to this? Can we still buy buy insurance through exchange?

    • If income is too low for a subsidy the person will qualify for Medicaid. If the person purchases a plan outside the exchange they are not eligible for a subsidy, even if an error was made in their income estimate and they were, in fact, eligible for a subsidy. However, you CAN purchase insurance through the exchange even if you do not believe you’re eligible for a subsidy. In theory, you should then be able to reclaim that subsidy (in the form of a tax credit) when filing your taxes.

  60. Question: Wife and I will be moving to Colorado from Montana either this autumn or in Spring 2014. How do we fit into the exchange requirements for Colorado? For example, when must we obtain coverage in Colorado to avoid penalties, etc? Can we apply for coverage before we officially become Colorado residents, e.g. before the move or before residency established?

    • Good to hear from you. You should first make sure that you have coverage in Montana, as of 1/1/14. Before moving, call your Montana insurance carrier and find out how much time they will give you to get a new policy after you advise them that you’re moving out of state. It’s typically a pretty short time frame, 30-60 days. That will trigger an “Involuntary Loss of Medical Coverage” which is a special qualifying event so you can then enroll in a plan in Colorado. You should be able to apply for a plan through the exchange as soon as you physically move here and have an address. You just want to watch the timing of when you give notice and the date you apply for the new coverage to avoid any lapse in coverage.

  61. How do I learn more about the provider requirements for services covered in the plans. I understand some are not yet decided and I would like to ensure that my practice (mental health) is in compliance, but I cannot seem to find information on that side of the policy.

  62. Okay so I have a question. My employer less lan 14 people does not offer health insurance. We currently are covered by my husband’s employer policy but that contract may be ending. If it does, that leaves my husband unemployed, us without coverage, but our 2013 taxable income above the threshold for subsidies for coverage. What then? The tables published so far mean that the $780-1200 out of pocket would be way more than my family could afford on my income (and waht he could get on unemployment alone). So we just brace for the tax penalty of being uninsured plus having that liability? Double whammy, double the stress?

    • If this happens before the end of 2013, you’ll have literally hundreds of options that are off-exchange. For people that are not subsidy eligible the exchange may not be the best solution. If there aren’t any serious pre-existing conditions in your family, some carriers will let you sign up for a pre-ACA plan in 2013 and keep it until December of 2014, delaying the impact of the more expensive ACA plans. Your best bet is to work with a health insurance broker in Colorado to help you evaluate the options inside and outside the exchange.

      • Unfortunately, we already have experienced in the past that we can’t get coverage because of pre-existing conditions. I didn’t consider it a serious health condition (not life-threatening) but apparently insurance companies don’t agree.
        So, again, the “affordable” part of ACA doesn’t really turn out to be so affordable but is mandatory–Catch 22.

        • You will no longer be able to be denied coverage with the new 2014 ACA compliant plans. In your case, as I mentioned before you may be able to find something more affordable with one of the off-exchange options. I agree that “affordable” isn’t the best description for most health care in this day and age.

          • Thank you. While I’m a bit skeptical that off-exchange plans post 2014 will be more affordable, I do appreciate you pointing out that they will be an option, as I don’t know that I really understood that part–and I work for a magazine in the allied healthcare field! So, that tells you that there’s a lot people still don’t understand. I do really appreciate that this forum was established where questions could be asked.

          • You’re very welcome and I’m glad this forum is helpful to you!

  63. If the insurance companies can no longer deny coverage for pre-existing medical conditions, then why not simply sign up for insurance once you get sick?

    It seems that it would be cheaper to just pay the penalty for not having health insurance when you don’t need it; than to pay the incredibly high monthly premiums…actually I have no idea what the cost of a policy would be for a healthy 30 year old male but I would imagine at least $500/month for a decent policy…(not even considering the co-insurance, deductibles, co-pays, etc, etc, etc).

    Seriously…why not just sign up for insurance when you are in the hospital? Any medical condition you have will technically have been “pre-existing” at the time you sign up for coverage….unless I totally missed something.

    • Excellent question!! If you go without insurance and pay the tax penalty, there are a number of safeguards to protect against abuse of the system. Open enrollment is limited to once a year, so if you opt to go without insurance you’ll have to wait until the next open enrollment period. If you happen to need insurance during open enrollment when you apply the coverage is not instantly binding. Coverage begins the first of the month following application, if before the 15th of the month and the first of second month following if after the 15th. So, if someone is in the hospital for a several days one could rack up tens of thousands of dollars in expenses before the health insurance begins. Most people don’t get to choose when they’re injured, have an appendix burst or a heart attack.

      • Thanks for the quick reply and information! I guess I don’t understand however how a patient that opts out of coverage during the open enrollment period by electing to pay the penalty; and then attempts to sign up for coverage upon getting sick is abusing the system. I mean its not like the patient wrote or had any say in how the rules were designed.

        If you consider the example you proposed in which a patient who has elected to pay the penalty by opting out of coverage, later gets sick and decides to sign up for coverage….but that the open enrollment period had already passed and would not be open for another six months or so. If a patient in this scenario gets stuck with a massive hospital bill, how are they able to pay for the care?

        If I were a hospital administrator and was dealing with a someone in this scenario I would simply allow the patient to defer payment of medical bills to the hospital until insurance coverage could be obtained during the next open enrollment period….That way the hospital will have a guaranteed payment from the insurance company rather than waiting for the patient to pay off his exorbitant hospital bill.

        If hospitals do this then it would still be more affordable for people to simply pay the penalty and opt out of coverage.

        • Insurance companies will not pay for claims that occur when the policy was not in force. If a hospital administrator submitted a claim to an insurer for a claim that happened before the new policy started it would be denied. If the administrator fudged the claim dates they would be guilty of fraud and could be in serious trouble.

          Maybe I shouldn’t have said, “abusing the system” but if we don’t all participate then it winds up costing people with insurance more to help pay for people without insurance who may not be able to pay their high hospital bills. I’m not trying to defend the current system, so much as trying to explain it. I hope that makes sense.

  64. Just received a letter from my insurance company giving me 30 days to stay or go and a quote of what the ACA will cost me which is more than double the exorbitant rate I currently pay and never use because of high deductible. Is this a scare tactic? Also, if I go by earned income alone, I am poverty level (working part time) but I also have an inheritance. How do they calculate income in this situation? Don’t know what to do…

    • If your current plan’s rate is doubling then it’s time to shop for a new plan, even if you only keep it for the remainder of 2013.
      If the inheritance is an asset (in a bank account) then I don’t believe that will hurt your chances of getting Medicaid, as there aren’t asset tests any more starting in 2014. There’s a short video on how they calculate the income used for subsidies at the top of this page. It’s the second video at the top of the page.

      • My current plan stays the same but if I switch to an ACA plan it will more than double so I guess you answered my question to stay where I am. I spend over 4000 a year in premiums but never go to the doctor. May make more sense to keep that money in the bank and pay cash when
        necessary

        • I got a similar letter from Humana with the two options, extend what I have now or choose another ACA compliant Policy for a thousand dollars more. It sounds like you should shop the exchange and possibly qualify for expanded medicaid. After reading the above comments doesn’t that make sense?

          • It would be best to go over your options with your health insurance broker, but I’m assuming you’re talking about an early renewal offer from Humana.
            That might be worth taking, as then you could delay signing up for the ACA plans until late 2014 if the ACA plans prove to be more expensive. However, if the ACA plans through the exchange are less expensive you could then sign up for a new policy, effective 1/1/14 and cancel the old plan then. I don’t know all the in’s and out’s of the offer, but that’s something to consider.

          • I called Humana and they told me that they are no longer mandating early renewal. Supposedly a letter was sent out a couple days ago saying I have until the end of the year. I hope it’s true since accepting a policy, shopping the exchange and possibly cancelling a policy does not appeal to me. Hope it’s true.

          • I’m glad to hear that and that should give you plenty of time to shop the various plan options. Open enrollment runs from 10/1/13 through 12/15/13 for January 1st, 2014 start dates.

          • The letter came today stating that the August letter contained certain mistakes. They sincerely apologize for any confusion. They asked me to please disregard it. They are working to revise the letter with the CO Division of Insurance and that I would receive the revised letter shortly.

          • Thank you for the update and that’s a step in the right direction to clarify things!!

  65. Small business under 50 employees and currently offers insurance to 4 full time employees. Will we be required to offer to all employees now, or changes to current programs?

    • The Affordable Care Act does not require employers to offer health insurance to employees. However, beginning in 2015 the law imposes penalties on businesses with over 50 employees that don’t provide “affordable” health care to employees. Here are the details of this portion of the law:

      – Starting in 2014, large businesses (those with 50 or more full-time workers) that do not provide adequate health insurance will be required to pay an assessment if their employees receive premium tax credits to buy their own insurance. These assessments will offset part of the cost of these tax credits. The assessment for a large employer that does not offer coverage will be $2,000 per full-time employee beyond the company’s first 30 workers.

      – To be deemed “affordable,” the health care insurance provided by the employer must pay for at least 60 percent of covered health care expenses, and employees may not be forced to pay more than 9.5 percent of their family income (before deductions and adjustments) for coverage offered by employers. The question of how an employer is supposed to know the amount of “family income” is not yet addressed.

      – If a business fails to provide any coverage or the coverage is deemed not to be affordable, the amount of the penalty is $2,000 per worker, but the first 30 workers are excluded from the calculation.

  66. My income varies greatly from year to year. 2012 was a very low (nearly non-existant) income year. 2013 is a very high year. This low-high-low will repeat for years to come. I’ve adjusted my personal budget, so surviving during the low years is not a problem for me, but I wonder how this will affect what I pay for health insurance through the exchange. Will my rates and/or subsidies just also vary from year to year? Will they always be a year behind since they’re based on the income from the previous year?

    • The subsidy is based on your estimates for the coming year, so there may be years where you qualify for a subsidy and other years where you do not. If your estimate is high or low, the subsidy (which is really a tax credit) should be able to be “trued up” on your income taxes.

    • I don’t know the percentage, but it is certainly easier to find providers who will take Medicaid in major metro areas. Many people need to change providers when going onto Medicaid. Since Medicaid will be expanded it will be interesting to see if more doctors take Medicaid or not.

  67. Currently I am unemployed and next year in July my COBRA insurance expire. Is this considered a life event? Can I apply in July using the exchange or should I cancel COBRA at the end of this year so I can start 2014 with a new coverage under ACA?

    • When your COBRA runs out that would be considered a qualifying event for a special enrollment period, so you have a choice of enrolling then or for the plans that start on January 1st. I suggest shopping the exchange plans to see if they might be a better value than COBRA. If you’re eligible for a subsidy then that will almost certainly be an attractive option.

    • The insurance exchange facilitates the purchase of insurance policies from insurance carriers, but is not an insurance company itself. The pharmacy benefits are determined by the insurance carriers themselves.

  68. Apparently the out of pocket maximum requirement has been deferred to 2015. Will Colorado insurance policies have an out of pocket maximum? It’s really not insurance without it, and it will make a difference in which policy I choose.

    • While it’s true that federal officials granted a grace period until 2015 to some insurers, allowing them to set higher limits, or no limit at all on some costs, this likely applies more to self insured employer groups and secondary insurers. This should have little or no impact on the exchange plans.
      Still, carefully review ALL the policies moving parts when evaluating the exhange plan options including:
      -Size of the PPO networks
      -Deductibles
      – Coinsurance
      – Coinsurance out of pocket maximum
      – Drug copays
      – Brand name drug deductibles, etc.

  69. I don’t have insurance now and never go to the doctor except for well checks. I figure I’m saving myself thousands a year. But now that it will be mandated, I am wondering if I can wait until Jan 2014 to apply for insurance? Will I be fined if I don’t have coverage starting on Jan 1? Also, I just saw something on the Internet that said people will get a rebate if they don’t use 80-85% of their insurance. I’m assuming that would be true in my case with my current lifestyle. Is that a true statement? Do all insurance companies have to abide by the rule if it is true?

    • If you’re in between jobs you can go without health insurance for up to 3 months before having to pay a penalty. Otherwise, to avoid a penalty for not buying insurance, a household would have to determine the annual premiums on one of the lowest-quality plans in a state exchange, figure out how much of a tax credit their income would entitle them to, and then calculate if the resulting out-of-pocket expense was more than 8 percent of their household’s modified adjusted gross income. If it was, they would not pay a penalty if they decided not to buy health insurance.

    • The fine is much less then the coverage. And if you don’t have a rebate they can’t even collect the fine. Personally I supported health care in the US this is a train wreck. I’m not giving the government that much information just so they can file it away until some idiot loses it.

  70. I just received a notice from Blue Cross / Blue Shield that it is canceling a medical insurance plan that I have due to the new “affordable” heath care law. It said it can no longer offer these particular individual plans according top this new Federal law. Effective 1/1/2014, I have no medical coverage. When I called about this notice, Blue Cross / Blue Shield mentioned it would be instead offering new coverage through an HMO, but that the details of this plan would not become available until October 1st. They don’t seem to have their act together and the customer service representative was very vague and couldn’t answer many of my questions. Hardly comforting….Why was my choice for a specific medical insurance coverage plan eliminated? I thought this was about individual choice and selecting coverage that fits ones particular situation. Why is the government dictating what type of medical insurance plans are to be offered? Why not let the market decide what type of plans and coverage to offer individuals? I have a very basic plan with a high deductible.I was happy with the particular medical insurance coverage plan that I had before. Now I need to scramble to find new coverage. I have a sneaking suspicion that what will be is offered instead will cost much more than I currently pay now. If this happens, is the government going to make up that increase in cost? If not, why not?

    • Those notices are very confusing and apparently were required by the Division of Insurance. I’ve heard that another letter will be coming out allowing many Anthem individual members the option to elect to keep their current plan until the end of November 2013. So many things are changing the insurance companies are scrambling to keep up and don’t have answers for all questions. I can’t answer on behalf of the government, but I suspect that unless you’re eligible for a subsidy that your health insurance premiums will indeed go up. However, to be fair, the coverage may also improve over that which you had before. I suggest working with a licensed health insurance broker to help you shop all the on and off exchange plan options to get the lowest price going forward. You should have until Dec 15th to apply for new coverage to begin on January 1st, 2014.

  71. I received probably the same letter from Anthem as the person in the above comment. They state they will no longer provide this PPO plan but I can sign up for their HMO plan. Checking your calculator, that premium more than doubles, with lower levels of coverage than my current plan. Also, their proposed HMO plan is one that the huge majority of local physicians have refused to participate in.
    I think a major stumbling block in the ACA is that there simply are not enough primary care physicians in many areas (and most of the country) to take on all the patients the Act is required to cover. Also, they’ve failed to factor in physician resistance to participation in these plans.
    Under the Health Exchange formulas, I, a primary care physician who treated thousands of patients over a 25 year career, can now only get health insurance through Medicaid!

    • It will be interesting to see the various carriers PPO networks and I agree that access to quality care is of the utmost importance to consumers. You should get an option in the mail to keep your Anthem plan through Nov 20, 2014. Those notices are being mailed out next week according to Anthem.

  72. My Humana high deductible health insurance went from $95 a month to $426 a month over 7 years. Over this time and after many discussions with DORA there was nothing they could do. They are a toothless organization, just a bunch of paper pushing math checkers for rate increases. The Humana insurance company has no motivation to hold costs down because in the end they don’t care as they are guaranteed a return above expenses on health care costs. Just like a public utility. Until individuals are in control of the expenditures on health care there will be now reason for providers or insurance companies to control costs. Any why we have 50 states building essentially the same health care exchange system seems like an incredibly stupid duplication of services. Those of you who think that costs will come down as more people are insured are just deluding yourselves. There is no reason to reduce provider costs, people will pay it because their insurance covers it. Providers and insurance companies are both sitting pretty making money as we foot the bill.

  73. A 60 year old family member with MS currently pays $900 a month for health insurance. She learned recently that her premiums will now be $1300 a month. Under Obamacare will her pre-existing condition no longer cause her to pay more?

    • Yes, under ObamaCare people with pre-existing conditions pay no more than anyone else for health insurance. Only smokers have to pay more and they pay an extra 15%. ObamaCare should be very helpful for your family member, but please keep in mind that the coverage start dates are not until January 1st, 2014.

  74. Thanks to Obamacare, I will no longer be able to afford health insurance. It’s either go without health insurance or have the mortgage company foreclose on my house. That’s a no-brainer. And to add insult to injury, I will have to pay a penalty for not being able to afford health insurance! I think I’ll move to Panama or Costa Rica, where the government doesn’t interfere with your life nearly as much as in this country. The cost of medical care in those countries is a fraction of what it is here, so I can afford to pay for my medical expenses out of pocket and not need health insurance at all. This Obamacare is the worst program ever enacted by the U.S. Government. It will bankrupt the country and force a large number of middle class people to take up residence in second or third-world countries where health care is affordable. Obamacare is NOT affordable for middle class Americans like me!

    • Many middle class Americans will qualify for federal subsidies to reduce the cost of the health insurance options under ObamaCare. The exchange is retooling their subsidy calculator to make it more accurate, so please check back here in October to see if you qualify for any premium relief.

  75. A family member would qualify for Medicaid under the new ACA. He has pre existing conditions but was covered by a high risk pool run by the state. He has several physicians who do not accept Medicaid. He needs to stay with these doctors. Would he be better off going through the Exchange and pay the full amount without subsidy or can he get insurance with his pre existing conditions outside of the exchange at a lower rate?

    • I just asked someone at the exchange this question.
      If someone with pre-existing conditions qualifies for Medicaid they have 3 options.
      1. Enroll in Medicaid through the exchange.
      2. Get a plan through the exchange with no subsidy.
      3. Get an off-exchange plan with no subsidy.
      So long as the effective date is 1/1/14 or later he can’t be turned down for pre-existing conditions under any of the 3 scenarios. available off-exchange that are not available within the exchange, so I suggest looking at both on and off-exchange plans to make sure you’re getting the best value.

        • By the way, why are some of the plans off the exchange. From what I’ve read on this forum they are less expensive. Do they, in general offer less coverage and are they indeed less expensive?
          Thank you.

          • Insurers have the option of selling plans on or off the exchange and some do both. We will be better able to gauge the pricing after all the new plans are loaded in the software in October, so we can make accurate comparisons

          • Great question! The exchange will only show the on-exchange plans. However some broker websites (http://www.coloradohealthinsurancebrokers.com) will have free online quote engines to show visitors the rates for both on-exchange AND off-exchange plans for 1/1/14 and later effective dates. This is supposed to go live on 10/1/13, assuming the software updates are all completed on schedule.

  76. mike k – you have a choice to shop at amazon.

    this bill leaves every american without the free choice to purchase something that many people will not even use (as previously stated by the mediator – that was the whole idea…). president obama and congress had a real chance to actually do some much needed fixing to a very broken market, and they blew it. instead, what has happened is the insurance companies have been given free reign to charge whatever they want, provide very minimal coverage, and walk away with the american peoples money. i can’t understand why our government has betrayed us in this way. i’ve been reading the bill. does anyone here actually know how much it costs for basic insurance? it’s outrageous! luckily, i have a job that pays for a lot of it. when my wife lost her job, we could keep insurance through cobra – for $600 a month (that’s supposed to be a discount)! how could anyone afford that unless they live like executives? this bill did not have the american people in mind when it was created. the politicians don’t live in the real world. they live nice cushy lives with nice cushy jobs and they either think everyone lives that way, OR they think that people that don’t live that way don’t matter. there will be a LOT of people who just can’t aford to get insurance. the lower middle class and the poor make up the majority of the population, not buisness executives. let me tell you, when you are struggling to pay rent – you are NOT thinking about what health insurance should you chose. you are wondering if you should get the chicken ramen or the beef ramen. THEN you wonder if they’ll shut off your lights because you’re three months late. this is the life of an average american. we are barely getting by and they pull this S%^t ?! i do not burden the system. i pay my taxes. i do not recieve government benefits at all. i have a fairly decent job… this is really going to cut into money that i could have used for things like food, and electricity. these people have no idea what it’s like to be an average american. i doubt that half of them would make it a year on my salary (like i said it’s not bad either). the system is broken – they put a very expensice band aid on it. they should have done with this what they should have done with fannie may – either let them fail or actually fix it. how many billions of dollars is going to educating people about this again? here’s the cheapest way to educate people – televise a short description (using the media). does it really cost 6 BILLION dollars ? – just speak slowly! isn’t that what any of the great presidents would have done ? i used to be proud of this country. i am starting to become ashamed to call myself an american. all we do is throw money at any problems that come our way.

    • In my life my lovely, freedom hugging health insurance companies have denied family members coverage and have in just a few short years gone from charging $600 premiums to $1,700 premiums for the same coverage. that was in the early 1990’s and then again in the late 1990’s. Two companies did that too us. Why? No reason needed, cause they could. So don’t give us the freedom of choice bull. My doctors and yours were told to wait on doing any surgery until some guy in a cubicle from another state gave thumbs up or down. Freedom? A free market? Bull. Now it’s getting messy. Now after 50 years of trying to do something we have a new game. Don’t like it, too bad. Free Choice? I just saw a bunch of choices lining up from CIGNA, Kaiser, and a lot of other companies on the Colorado exchange. There is the same choice, but now I can go to my doctor and get a check up for free. Any doctor I want to go to. I don’t have to worry about either buying food or getting a check up, I can do both. That’s way different. And my wife who ‘had’ breast cancer over 7 years ago, and none is to be see of it, can go on with life as a ‘normal’ person because the freedom loving health insurance companies can’t black list her as a cancer on society. the ACA was a reaction to a bad industry gone rotten, ticking people off by neglect and greed. now it’s messy. Now the greedy suckers have to worry about us. The American people. To bad.

  77. Questions for anyone willing to answer: What care providers are signed up for this program? Is the State assuming current medicare providers will be willing to work within this program? What kind of wait period for service care providers to give anyone some service? The subsidies also look deep so how long with they last before they go to full price? Who advocates for customers of this program and gets results if we are running into problems?

    • I don’t have answers to every one of your questions, but will do my best. The providers are determined by the health insurance plan carriers. It is up to the individual insurance companies to contract with the providers. Some carriers will have larger networks than others and it’s a safe bet that the lowest cost insurance plans with the smallest networks will likely have the longest wait times for getting treatment.
      I’m not aware of any sunset clause for the subsidies, but future legislation could change them.
      The exchange will refer you to your insurance company if you have a problem with the carrier, so your best bet is to work with a health insurance broker, as otherwise it’s just up to you to deal with the insurance company if you have problems. You can also complain to the Colorado Division of Insurance if you’re dealt with unfairly by an insurance company.

      • This is what I found with a quick google search, from an article on PolitiFact written January of 2013.

        “… PolitiFact first examined the claim that members of Congress are exempt from the provisions of the Affordable Care Act in 2009, when the legislation was still under consideration in Congress.

        We rated it False. That claim was based on the assumption that the health care reform plan would have sent everyone — except Congress — into a new “public option” federal insurance plan. It would not have.

        In fact, the law as passed did not even include a public option — and Section 1213 of it requires members of Congress and congressional staff, starting in 2014, to buy health plans created by the health care act or offered through the state exchanges the act establishes.

        Political scientist Norman Ornstein, a long-time observer of Congress and a resident scholar at the American Enterprise Institute for Public Policy Research, debunked the claim of congressional exemption in a piece he wrote for the Washington newspaper Roll Call.

        “On the assertion that Members of Congress are exempt from the provisions of the Affordable Care Act: also false,” he wrote. “Members of Congress are subject under the health care reform law to the same mandate that others are to purchase insurance, and their plans must have the same minimum standards of benefits that other insurance plans will have to meet. Members of Congress currently have not a gold-plated free plan but the same insurance options that most other federal employees have, and they do not have it provided for free. They have a generous subsidy for their premiums, but no more generous (and compared to many businesses or professions less generous) than standard employer-provided subsidies throughout the country.”….”

        • Nice try at explaining less than half of the truth. Your Google search and Politifact are severely lacking. It is correct that members of Congress and federal employees in general are subject to the same law. What is not factual is that they have the same treatment as the general public in the implementation. Federal employees receive a subsidy toward the purchase of coverage, courtesy of the American taxpayers, regardless of where their income fits in comparison to poverty level. In the case of Congress, this subsidy ranges from $5,000 per year for individuals to $10,000 per year for families regardless of pay level. That means that a representative that receives a salary in excess of $170K receives this subsidy courtesy of the taxpayers. Try putting that salary level into one of the subsidy calculators on the Internet for private citizens and see how much subsidy you get? Answer=0

        • Regardless of the validity of that “google search” what about the “We can’t read it until we pass it” This law is a sham that signifies the government overstepping their bounds and butting into peoples lives the way they were not intended to based on the Constitution.

  78. Mark,
    Many thanks for your diligent, fine work! It’s evident that you are determined to answer any and all questions in regard to a disconcerting, and confusing, topic–a great help.

  79. Inheritance is not suppose to be included in one’s MAGI under the ACA. What if the inheritance is in the form of an inherited Beneficiary Traditional IRA (from my mother)? My final distribution is in Jan., 2014. Income tax is due on Traditional IRA disbursements, so this is included in my MAGI on my tax return.

    • That technical of a tax question is best suited for a tax professional, as an arguement could be made both ways. Personally, I would contact a CPA so I could be confident that it’s being handled correctly.

    • There is quite a range of deductibles and copays, depending on the plan selected. You’ll be able to see the copays, deductibles and rates for all the exchange plans starting on October 1st at the exchange’s website “>Connect for Health Colorado.

  80. Hi. I am 49 year old male, and a part-time adjunct instructor at a local CO community college. The college refuses to offer benefits to its part-time employees, nor has it hired a full-time employee in my dept. in the 7 years I have worked there, despite several retiring or leaving. They just sent out an email advising that all part-time hours will be capped under 25 (so they do not have to pay benefits). I have not had health benefits for the last 15 years, despite having several preexisting conditions.
    I only make 25K a year, but have a wife and daughter who also have no health benefits, as my wife’s employer would charge her $300 a month just for herself, which we simply cannot afford. We live paycheck to paycheck like many Americans, and recently went through a bankruptcy and foreclosure, mainly due to medical costs for my pre-existing condition which required many surgeries, and eventually swallowed all our savings, our built credit and then bankrupted us.
    We will not qualify for subsidies as we now make a combined 60K gross a year, but with rent and all the other bills (we have no credit cards and one small car loan), we cannot afford an insurance premium of 400-500 a month, as the rate table has quoted me, and that is for the very cheapest plans. I would be better off just paying the penalty!
    I know everyone who reads this will say “Go get a better job!” Well, I have been looking for fulltime employment for the last 2 years, after I finally figured out my school was never going to hire me fulltime. Why would they? I do the same workload as a fulltimer but for a third of the pay and no benefits! I have put in hundreds of applications and resumes and had ONE interview that went nowhere, and I have great skills and qualifications, but that doesn’t matter. It’s who you know.
    So keep telling me how great the ACA will be for my family. Plain and simple, if we could afford a premium as quoted, we would pay it, but we can’t. If I could find a better job, I would, but I can’t. Where does that leave us? We are screwed either way. All I see with the ACA is more money for the greedy insurance companies by forcing people to pay, even when they can’t afford it.
    It is in the govts. best interest to keep us taxpayers healthy and continuing to work so we continue paying those taxes, so necessary health care should be a right of every taxpayer, paid for by our taxes! But no, the govt. has to keep sending billions to other countries, subsidizing corporations who pay no taxes, building tanks we don’t need, and all the rest of the trillions of dollars wasted annually by those in charge, while us who foot those bills get the shaft.
    And now they want even more from me? You can’t squeeze blood from a stone! However, if that stone is thrown with enough force, it can draw blood . . .

    • Some of the early subsidy calculators were off. The exchange has a new one here and it appears to me that you are eligible for a subsidy. I don’t know if that will bring the premiums down into the “affordable” range, but I wanted to let you know. You’ll be able to do live quotes at Connect for Health Colorado on October 1st. I hope that’s helpful!

    • If your income is too low you qualify for Medicare but under ACA is only an income requirement. You do not need to sell your houase or car. If your income is low to medium you qualify for ACA subsidy. If your income is above thean you are not really poor so you can pay for your insurance and most imortant you can not be denied for pre -existing conditions.
      So ACA is giving you three good choices and you should be in one of these categories.

  81. I’m on Medicare, but I’m not happy with my supplemental plan. I have 2 questions: Does the exchange offer medicare supplemental plans? Can supplemental plans still exclude members with pre-existing conditions.

    • I’m afraid the exchange does not include Medicare or Medicare supplement plans, so you do not have any options in the new marketplace at this time. Yes, supplemental plans can still medically underwrite. However Medicare Part C (Medicare Advantage) plans might be an option worth looking at as they have much less stringent medical qualification standards.

    • You can put in a fake name if you like, but the age & zip code effects the rates. Because quoting for the new ACA plans doesn’t go live until October 1st you won’t see the new ACA plan rates until the software is updated and we can quote 1/1/2014 rates.

  82. My granddaughter, 20 yrs old, is not on her parent’s policy. She is independent, living away from her mom and dad. She works at McDonalds and does not get enough hours to be considered full time, so she does not have insurance through her employer.

    The calculators that we’ve looked at only show “over 21″ or “child under 20″ Does she NEED to be on her mother’s plan? Or can she go to the exchange for her own insurance? How should she look for insurance plan info in this case?

    • People 19 years old and older can get their own policy, so she should be fine to get her own plan if she wishes or can stay on her Mom’s plan until her 26th birthday

  83. They are connected with private and public organization. The clients get assistance in the form of counseling and therapy. They can also educate and help in creating public resources.thanks to all.member

  84. I am an American Indian, Does that change the threshold that would qualify me for Medicaid. I would rather have private insurance through the exchange

    • If you are a member of an native American tribe then you should have special qualifications. I was told that actual membership is required. I’m moving today so I don’t have full net access. You may need to Google a bit to get more details.

  85. I currenly have health isurance through a retiree medical plan offered by my former employer.
    The price has doubled every year for the past 8 years. I can no longer afford it. Am I eligible to purchase a plan through the exchange instead?

  86. I am a self employed small business owner and I currently have the equivalent of the Obamacare “Gold” level plan which is less expensive than the rate quoted here for the Colorado exchange “Silver” level plan. What happened to the hollow promises from Obama and the Democrats that this legislature would reduce health insurance costs by $2,500 per year??? Who will hold these LIARS accountable?

      • There was no subsidy for health insurance before the ACA, although some people were able to deduct the premiums they paid from their income taxes.

        • Exactly. No subsidy before ACA. So now for a lot of people insurance is more affordable. I would not go without insurance a single second. It is not worth the risk.

  87. This truly is a train wreck. The rhetoric from Washington and backed by so much of the press is a smoke screen. It is hard to believe anything our elected officials are doing right now, Throughout history our Government has never been able to run any business better than the successful private sector who ultimately elects and pays them for their representation. If any company or business owner ran their business like our Government does, every single one of the businesses would be bankrupt. The difference is that we continue to fund outrageous, crazy and non logical ideas which these bozo’s vote for. I know they did not consider my interest nor yours when voting for this mess. They had an real chance to do something right but instead they lost the fight to powerful insurance lobbyists. Now they claim they can work magic but in reality they can only sell feel good propaganda. It sounds good; but business and economic reasoning already disprove their rhetoric, It is only a matter of time and this law will prove to hurt our nation much more than it was able to assist those in need.

    Washington is certainly operating with dis-function and our system is broken. Those whom have sworn to protect you have instead sold you down the river of “self interest”. As your mothers and fathers said, “If it sounds to good to be true – then it probably is”. Unfortunately, the only real way to fix this and the current mess in Washington depends on us. Stop counting on everyone else to pave your path and become accountable, If you like the current direction of our country then you have the right to vote and maintain the status quo. For me, I will be accountable to future generations and I refuse to vote for ANY and ALL representatives who would trade the future of this once proud nation for this radical lab test. Our national debt is scary, yet we will borrower more to subsidize this mess and turn insurance providers into multi-trillion dollar companies

    In the meantime let’s all smile and play nice. After all and regardless of my opinion, this law was passed and now we must all deal with it. What a shame for us and the generations yet to come. All “Hope and Change” has accomplished so far has been “Dope and Shame”. The Banks reap billions through our bail out and now insurance companies have been provided the right to rob our retirements. the fix was with regulation or de-regulation, but this will not make insurance cheaper for the masses. Wait until a majority of users are on the subsidy take, When this occurs as it will in time, ask yourself how the Government intends to fund this mess then? Quality care will become no care. Wake up America before we all die in our own ignorance. Suggestion, charge the rest of the world what we pay for medical research and development. Our drug costs soar due to necessary research and development, yet we sell the drugs to other countries at a fraction of what we are charged, No wonder Canada can afford (?) a national health system. Americans carry the majority of the cost burden for medical research and development while they pay for use only. It would never reciprocate to us like that. No single answer to a complex issue but this law does not address the issues which could and should have been addressed.

  88. The idea that everybody will get insurance because of Obamacare is laughable. Even the gov’t says something like 30MM people still won’t have insurance. But that’s not the problem anyway. The problem is the disconnect between consumers of health care and the cost of what they consume. The current system is crazy, and Obamacare makes it much much worse.

  89. Well I went shopping on the Colorado exchange. If you and your wife are in your 60s (or older), you might just as well roll over and die. The premiums are double what I pay now, as are the deductible and the copay – for less coverage. I could spend $30,000 before the insurance company even has to pay anything. So who’s in bed with the insurance companies? Who authored the Affordable Care Act (the name is a joke)? It’s like seeing a Twilight Zone episode unfold before our eyes! Don’t forget to vote in 2014 and 2016!!!!!!!

  90. $1,258 per month on ObamaCare versus $716 prior to. I no longer get deductions for not smoking and passing a physical. The bottom line is I now subsidize smokers to the tune of $516 per month. The Right has it right on this one. Shut it down.

  91. I would just like to say that I am a healthy, 24 year old male. I will be participating in the (hopeful) shutdown of “ObamaCare” as I will elect to never purchase health insurance, and be a part of a group of Americans that refuses to fund this unconstitutional law (Supreme Court ruled it Constitutional as a tax, this is taxation without representation) I wish all of you signing up for this the best of luck, but know that there are people out there besides myself that will refuse to pay into this socialist system of health care. Since this law’s foundation is based on young healthy people paying into it, I hope with every piece of my soul that I am a contributor to the downfall of “ObamaCare”

    • lol, assuming that was directed at me, that’s no problem at all. I can just go ask daddy government to help me with the stream of welfare checks they give out. Won’t have to work another day in my life! Yay government dependency!!!

      • You pay insurance for your car and it does not mean you are living in a socialist country and is not constitutional. Insurance is a good financial tool. If you have an emergency who is going to pay your 50k bill ? Taxpayers. Unless you are 24 and already rich. There are some people believing thy will never be sick, other think they are young and they’ll never die. When they reach 40 they become a little wiser…

        • Car insurance is mandatory because of damages to others. Heath insurance is for damage to me. Why in the world do you think those are the same things? You don’t know much about definitions do you? Either way I’m not paying for it, when faced with a decision of a $95 (this year) penalty, up to $650ish once it all goes through and based on my income ill be saving half of what i would pay to be in this system. Have fun with your month+ long wait times because they are adding 0 new doctors but 16,000 new IRS agents

  92. I have been temporarily out of the country for a year, but am planning to return to Colorado in January, 2014. I still own property in Colorado with my family and will be using that address as my residence. Can I apply for insurance while I am still abroad, or do I have to wait until my actual return.

    • That’s a residency question, which can be tricky. You’ll be best off calling a health insurance insurance broker to get the best help.

  93. I determined monthly health care premiums/deductible on the Connect for Health Colorado site against my current premiums/deductible and determined that I will be paying from $150-$250 more per month (dependant on carrier) under the lowest-level coverage Bronze Plan.

  94. I do have a question…and I’m quite offended by ObamaCare. I am 60 years old, have not been to a doctor for over 35 years, live and work a very active/healthy lifestyle, and at my age, I don’t want health insurance. I’m OK with facing the consequences of letting nature take ‘her’ course…either old age, or natural death by disease. I don’t want the younger generation paying for older people’s health concerns. I’m more interested in purchasing life insurance so when I pass my family will have a home that is paid for, and enough money to take a vacation to scatter my ashes and celebrate my life. I don’t believe in western medicine, pharmaceuticals, and living until you are 80 years old in pain and degeneration. Why are we being forced to buy into a program that we will not use? Why do I have to pay a premium to assist the diabetics, smokers, etc. that have made life choices that throw them into a situation of multiple health problems. Insurance should be a choice. I have never fulfilled a ‘deductible’ in my life…why start now? In a few years under ObamaCare I will only be given comfort drugs because I will be too old to save!

    • Dear Kimberly,
      If you get into a really bad car accident and do not have insurance at all you will be treated at the hospital even if you do not afford 100k. Who is paying the bill ? Taxpayers. That is why you are “forced” to buy insurance. There are millions of people who believe they will never get sick and other millions that don’t believe they are going to die some day.

  95. The working middle class is the subsidy for this debacle. Those who already have purchased health insurance will see their premiums double and those who don’t want health insurance will be forced to purchase it to fund the law.

  96. 40% more under Obamacare for my monthly premium. I am a 50-year-old, nonsmoking female and make just enough that I don’t qualify for a subsidy but not enough to be able to afford this outrageous increase. I guessed from the very beginning that the end goal was a single-payer system and to get there, the current health insurance system would have to fail. We are well on our way…

  97. Jason … For the vast majority of people who choose to go without health insurance in 2014, the penalty will be 1% of your adjusted gross income: $40,000 = $400 penalty, etc … The $95 penalty applies to those who go without and have extremely low income. The irony of that is: If one’s income is so low that the penalty for going without health insurance is only $95, he/she could qualify for and get full blown health coverage with little to no deductible for about $95 (PER YEAR) or less. But sometimes there’s no figuring people, is there?

    • See the thing is, is that 1) I morally oppose this law. 2) I don’t have the time, patience, or energy to deal with any sort of bs paperwork for it, as well as have 0 intention of using it. I’m not waiting hours/days/weeks just to deal with some doctor. And 3) I sincerely hope (since this entire law is based on having healthy young adults buy into it) that by me not buying into it that I contribute to its downfall and dismantling.

  98. Jason … If you follow the example of my last post: $40K income = $400 penalty, etc … then you ARE paying into it. Only, God forbid, when you fall off of a cliff or blow a knee out skiing, or God double forbid — you are diagnosed with cancer — you may find it even harder to get the treatment you need. And what you’ll really need is a bankruptcy atty. You see, you’ll be paying in, no matter what. Time to move to Ecuador, yes?

    • Paying the penalty is SUBSTANTIALLY less than the actual amount that is required for the system to work. I believe I haven’t been 100% clear with my “rant” as I do plan to get health insurance, when I reach a point in my life where it is reasonable and necessary (Out of college, in a solid career) Lol not sure where Ecuador came from, but I would never leave this country, lived here my whole life and I love America, I fought for America. I just have no respect for our government (both the left and the right) and the policies being implemented. The problem I have is the “mandate”, and the fact that this bill, the ACA, is fraught with stupidity and no real way for it to work (no new doctors, 16,000 IRS agents). If this was private sector ran (I know its not the governments insurance program, I mean that the government is involved with its implementation) and not a mandate, it would probably be a pretty awesome deal. However, the Constitution only provides for “life, liberty, and property” Health insurance is not a right, it should not be a mandate, I have better things to spend my money on as a 24 year old healthy male. The fact it was declared Constitutional (Unconstitutional based on commerce clause) by the Supreme Court based on taxation, I wish for anyone to tell me how this is not “taxation without representation. The fact Nancy Pelosi stood there and said “We can’t read it until we pass it” tells me its just more governmental influence in our daily lives where it does not belong. As an average citizen, my best option for protest is to not buy in, pay the menial penalty, and hope that, like most things our government runs, it will fall flat on its face and we can actually get to work fixing this country. The ACA is not an effective, productive, or beneficial way of helping Americans. It helps the government sit there and increase dependency on its programs and policies. The federal government should not be this involved in individuals lives, it should be involved in national and international affairs and the states should be left to handle issues such as this, as is stated in the 10th Amendment of the Constitution. Health care is not a federal concern, it is a state concern.

  99. C’mon!…we aren’t talking car insurance here. We are all firmly engrossed in the car insurance program. We aren’t talking car accidents here. I have catastrophic insurance…with a very high deductible. Your reply is so silly…people don’t like to think about or discuss death. I support OUR government, work, pay taxes,and support those that either can’t, or don’t want to work and abuse the system. This bill is promoting the abuse of yet another “system.” Ask a Canadian that is in line for years waiting for knee surgery, or an Italian that shows up at the ER how good their insurance systems are working. If it is such a deal, why aren’t the Congressmen/women all required to sign up for it? Good enough for me, good enough for them.

    Haven’t you heard…only guarantees in life are death and taxes?…and now ‘they’ want to tax you to stay healthy.

    • Lol I thought the car insurance thing was a little weird too. Definitely agree with all of that. This program will just stall any beneficial effects of health care and back log the system with red tape. People won’t get the care they need when they need it because “everyone is entitled to it” Health insurance is not a right, people don’t understand that. Our society is becoming exponentially dependent on the federal government.

      • If we want to continue to describe ourselves as “The Greatest Nation” or “The Greatest Democracy” or “The most advanced country in the world” then we should be able to provide health care for our citizens. It is not a right it is common sense. We are in 2013 not in 1800. The system is based on private insurance, private hospitals and the government is helping with a tax reduction. ACA may not be perfect but it is a good start. Let us improve it not destroy it.

  100. My son has no health insurance and is a seasonal worker. He currently is in the CICP program. I was told that he would changeover to Medicaid? Is this true? Please advise.

    • Yes, that should be correct, effective 1/1/14. He should go to the exchange website and apply for new coverage. The exchange will map him to the appropriate program would should be Medicaid.

  101. We were told we could keep our own insurance, but then received a letter from humana blue cross that our family PPO policy was no longer available for us, but they can offer a HMO plan. Hmo’s are worthless plans that eliminate any choice or options from the insured with lower premiums but higher deductibles and other fees. I have had HMO insurance before and it was a huge hastle and waste of time and money. Is this going to be the way ACA will lower premiums? By significantly raising deductibles and fees while decreasing choice and medical options? It MAY improve things for a small percentage of coloradans but it seems like many of the working folks (societies producers) will be left out, again.

  102. Sorry … but when you Say God forbid … if something should happen … lets get real … Jason will not be turned away from care and next open enrollment will be allowed to come on to a plan guaranteed issue.

  103. Reading through these comments leaves me wondering: Why all the complaining? I thought the whole point of health care reform was to get as close to having everyone covered as possible. Why all the discussion about “my” rates going toward other people’s coverage, and what this does “to me”? When we collect money to buy pizza for the house, isn’t the goal to get pizza for everyone to eat? Do people really get upset that they paid in more than that guy that ate six pieces? What is wrong with us?

    • Must not be paying close attention…. or maybe and more likely, just hearing what you want to believe … million’s will still be without coverage and to compare buying pizza … to paying a much… with emphasis on MUCH higher premium for coverage because of the mandates is ludicrious! The premiums are going up by double-digit … from renewal in 2013 instead of a 2014 mandated plan. Subsidizing is TAXING!

      • I am paying attention – I know that not everyone will be covered. Single payer would have done that, but we chose to go the mandated insurance route instead, so the idea now has to be to get as close as possible. And you’re right – this is way more important and way more expensive than pizza. If we want decent healthcare in this country, and we choose privatized, insurance-based healthcare, we have to pool our money so we can buy together. We are all just roommates in this big house, and we should look out for one another.

  104. Having been a part of the medical profession for 38 years and watching the drug companies and medical/surgical equipment companies hijacking the American public with their exorbitant fees (to cover research) and watching the doctors’ fees follow suit, something has to change. My little blood pressure pill is not worth double digits. If the ACA can make changes in the extortion going on in the medical community and we get back to charging fair fees for medication and products and the hospital and physicians follow suit, I am all for it and will continue to be optimistic about Obamacare.

  105. I believe something must change as well. Obamacare is a start. But we need some leverage and perhaps evolving to single payer is the way to go. Kathy, you might find this interesting.

    Obamacare: The Gift To Insurers That Will Keep on Giving
    By David Sirota

    This week’s healthcare-themed government shutdown and the much-vaunted launch of the insurance exchanges has predictably jump-started the latest season of “The Politics of Obamacare.”

    In this made-for-TV cartoon series, the battle over the new law has been depicted as a fight between competing small guys. Bam! Democrats insist opponents of the law don’t care about the uninsured, even though the new law will leave millions of people without health coverage. Ker-pow! Republicans claim that proponents of the law don’t care about struggling businesses, even though America’s for-profit employer-based system puts U.S. businesses at a competitive disadvantage.

    Now, as a Wile E. Coyote government hurtles toward another fiscal cliff and as cable news substitutes red-versus-blue prognostication for fact-based health policy reporting, few in D.C. bother to mention that Obamacare really isn’t designed with patients, most employers or even health care in mind. It is primarily designed to further enrich one tiny handful of businesses: health insurance corporations.

    There are a many ways to see this amid the capital’s latest riff off a Hannah-Barbera production.

    One way is to look at what Obamacare is, and what it is not. It most definitely is the legislative manifestation of the insurance industry’s biggest wishes of all, providing massive no-strings-attached subsidies to the industry, and using government power to force citizens to become the industry’s permanent customers. It also is not what the insurance industry most fears – it is not only not a single-payer system, it doesn’t even include a public option that would allow people to altogether avoid the rapacious private-insurance industry. It also does not prevent insurance companies from employing their typical devil-in-the-details tactics – the kind that provide the patina of health insurance while limiting access to actual health services.

    Asking exactly why Obamacare was structured like this is another way to see that the law is really a gift to insurers hidden in the gaudy wrapping of altruism. That’s because the answer to that critical “why” question is simple: the law was written by the insurance industry.

    Remember, the primary architect of Obamacare was Liz Fowler – the insurance industry executive who temporarily took a government post to write the new law, and then quickly moved back into health care lobbying. She was ably assisted by an battalion of her fellow insurance industry cronies, who in 2009 deployed their army of lobbyists to shape the underlying health care legislation. She was also backed up by many other Obama administration officials who worked on the legislation and then immediately headed to the lucrative world of insurance-industry lobbying.

    Of course, the fact that the health insurance companies have so much cash lying around to pay a mercenary army is probably the Obamacare cartoon’s most conspicuous smoking gun of all. Indeed, while Obama and Democrats have proudly claimed that the new law finally cracks down on insurance profiteering and attempts to reduce the health insurance industry’s outsized economic footprint, the financials suggest exactly the opposite is happening.

    Since the passage of the Affordable Care Act, for example, health insurance CEOs have surged to the very top of the economy’s salary list. They are being handsomely remunerated for the fact that since Obamacare became law, the stock exchange has witnessed a boom in health insurance company share prices, as investors have jumped into companies whose profits are now government-guaranteed.

    The visuals since the day Obama signed his health insurance bill into law tell this part of the sordid tale. Just take a gander at the stock-price graphs of major insurers like United Health, WellPoint, Aetna, Humana, Cigna, WellCare and Magellan Health Services (for starters). They all show the same thing – a sky’s-the-limit curve up toward profit heaven. Forbes’ Robert Lenzer notes that in just this year alone, “The value of the S& P health insurance index has gained 43%” – aka more than double the gains of the S&P 500 as a whole. It’s the same trend in the last 24 hours, too. That’s right, for all the talk of those exchanges finally cracking down on insurance industry profiteering, insurers saw stock price spikes the instant the exchanges went online.

    It all highlights what a recent J.P. Morgan report suggests: namely, that Wall Street sees the exchanges as opportunities for even more profiteering than ever. Why? Because, in the words of one giddy investor, the launch of Obamacare represents “the moment of the sun for the (insurance) industry.” That’s especially the case with the Obama administration now waiving some of the relatively few high-profile consumer protections that progressive legislators managed to sneak into law.

    If this taxpayer-funded gift to the insurance industry promised to extend better, more affordable health care to more consumers over the long-haul, then perhaps you could have honestly labeled Obamacare a piece of public-interest legislation – yes, an inefficient, overly expensive piece of public-interest legislation, but public-interest legislation nonetheless. But labeling it as such today is absurd. After all, insurers are already gaming the exchanges in ways that contradict President Obama’s promises of better health care choices. Meanwhile, for many Americans, costs are expected to rise. In fact, at the very moment the industry is enjoying huge profits, it is openly promising to soon use its new leverage under Obamacare to jack up premiums.

    True, many low-income Americans will initially benefit from subsidized coverage. But as Barron’s details in an article appropriately headlined “How to Profit From Obamacare,” the growing subsidies will not necessarily be used to provide health care over the long term. Instead, they may increasingly be used to pad the profit margins of the insurers contracted by Medicaid. And with Obamacare statutorily cementing insurers role as profit-taking middlemen between taxpayer subsidies and health care providers, the only way to permanently maintain health care services will be to submit to a now-institutionalized extortion scheme. Either Obamacare coughs up more taxpayer money to pay the insurers’ ever-increasing levy, or more people lose their coverage and die for lack of any health insurance whatsoever.

    Summing up what this all means in practice, the Institute for New Economic Thinking’s Marshall Auerback put it this way:

    We’ve had a bailout for bankers and now the principle seems to be extended to the insurance industry. As Randy Wray and I discussed in a recent paper, the health care bill just signed into law entrenches the centrality of private health insurance companies and contain no serious proposals to limit costs. More people will get hit with deductions, co-pays, annual limits (for several more years), exclusions, out of pocket expenses. This will ensure that health care remains too expensive to actually take advantage of new insurance. And many currently insured people are going to get higher taxes. Premiums will rise.
    Despite its opportunistic bluster, the Republican Party establishment has no substantive objections to any of this. Historically the most reliable – and reliably bought-and-paid for – ally of the insurance industry, the GOP isn’t any more angry that Obamacare bails out the party’s insurance industry campaign donors than it is mad that the law leaves millions of Americans uninsured. No, the Republicans’ faux rage against Obamacare merely reflects a willingness to prioritize their partisan hatred of Obama. They loathe him so much that they are willing to recklessly shut down the government in protest of what is basically their beloved Heritage Foundation’s health care plan (this extreme partisanship is topped only by the Heritage Foundation itself – it apparently despises the president so much it is willing to publicly campaign against its own health care ideas simply because they now have Obama’s name on them).

    Democrats, by contrast, are today defending the new law by diverting attention from the fact that in exchange for massive campaign contributions, their party’s lawmakers actively helped torpedo real health care reform – and not just in 2009, but by their own proud admission, in the future as well. Rather than acknowledge that inconvenient truth, Democratic partisans are now storming cable television studios to try to replace conversations about health care with celebrations about the law’s ostensible expansion of health insurance.

    Now sure, it must be said that such an expansion isn’t wholly insignificant. Banning insurance discrimination for those with pre-existing conditions and getting more people some modicum of minimal coverage should moderately improve things for some people – at least until the insurance oligopoly’s premiums become unaffordable and/or the list of covered health services is whittled down to nothing.

    But don’t be fooled by the Democratic talking points and Obama administration reports which insinuate that the “until” part is just some nightmarish fantasy that will never materialize. It isn’t a fantasy, because until the law fundamentally changes to both create elements of a single-payer system and truly disempower the insurance middlemen, Obamacare will never be fundamentally about health care. It will be mostly about private health insurance. And those are two very different things.

  106. Jason … Your ignorance is showing more and more. Ignorance is not an insult, just pointing out that you’re either uninformed or you prefer to purposely misrepresent. You offer little support for your claims … example, “If this was private sector ran … and not a mandate, it would probably be a pretty awesome deal” and; “The ACA is not an effective, productive, or beneficial way of helping Americans”.

    1) At the time the ACA was approved by the House and Senate, it was voted on by representative of U.S. Congressional Districts and Senators from each of our 50 states a majority approved it. Thus, people who were voted into office by their constituents in each of their respective districts and states. Finally, the ACA was signed into law by a President voted into office by an overwhelming electoral margin and an impressive popular vote margin. That president was then re-elected by another overwhelming electoral margin and impressive popular vote margin, even when the U.S. voters knew that electing Romney would have effectively killed the ACA, most likely. How is that taxation without representation?

    2) Thank you for your service to our country. If that service was military service, then you likely qualify for a VA health insurance benefit. I triggered my Dad’s benefit for him 40 years after he left the army, when he needed it. I was amazed and thankful that we found he still qualified. He only spent 2.5 years in the service back in the 50’s. A VA health benefit is financed about 75% by the Federal Gov’t — at least that’s what my pensioner friend who spent 20+ years in the Marines has told me (Tricare) — aka government run healthcare.

    3) I agree. Certainly, ACA is not perfect and it can be improved. Please tell me how leaving 40-45M people without affordable access to healthcare was working so well, the condition preceding ACA … your comment, “If this was private sector ran … and not a mandate, it would probably be a pretty awesome deal”.

    4) Jason, you will likely get your wish as in the end each state will have the option of opting out of ACA if they wish to create a single payer system for their state as detailed in PPACA. Vermont has already started this process and I wouldn’t be at all surprised if CA, CO, MN, WA, NY, IL, and OR will do the same thing. If single payer is eventually approved by the state of CO, will you be on board?

    5) I respect your right to abstain from the subsidy that you are due in order to get affordable health insurance. And you may be correct for your particular situation in that most health 24 y/o don’t use the doctor or emergency room very often. Usually in the case of accident. I also know of a 27 y/o woman who just broke her ankle requiring surgery with pins inserted, etc. All in, her bill came to about $6K, most of which was covered by insurance leaving her with about $800 out-of-pocket. As she only makes about $20K per year, her premium of $140 per month was not easy for her to make each month. NOW, she will move to the exchange and in January, she will have a monthly premium of $25-$50 due to ACA. This is just one example.

    I wish you the best, Jason. Just look around (and less in the mirror). You’ll see what’s going on. It’ll start to dawn on you. Probably.

    • To answer your questions stated above:
      1) It is taxation without representation as it was proposed to the American people that it was in no way a tax. Also it allows Congress to potentially use this act in the future to use taxes to coerce people into buying specific products on a broader scale.

      2) Yes, I was Army. I refuse to deal with VA health care, not enough time, not enough patience, not enough issues (Yes this is a personal choice…just like health care should be)

      3) The 40-45 million people without insurance should not have insurance. Simple as that, either your young and healthy and don’t want to spend money on it, or your too poor to get it. Either way health insurance is not a protected right in the Constitution, and if i choose to not have it I should not be penalized for it. Should the government help those in need? Yes. Is this a fair and reasonable way on the basis of our founding fathers? No,

      4) As for the single payer system, that is the exact opposite of what I want for our country. Like I said, health care is not a right, should not be taxed, and should not be given to all. It is quiet possibly the largest socialization (not socialist) entitlement in US history and can very possibly bankrupt our already ridiculously high debt. I believe health care should be an option for all, just the same way a luxury car or college is. It should not just be passed out to the masses.

      I appreciate the civilized discourse this “forum” has become. Instead of continuing lengthy replies, I will simply agree to disagree. I wish you and all others joining this program the best of luck, as only time will tell us the true answer on how this law will develop.

    • Obamacare is all about control. Obamacare does nothing to improve healthcare.

      The proper role of government was to protect equal rights, not to force citizens what to buy. Each citizen should accept the responsibilities of their own decisions. That is how we learn from life experiences.

      I know a doctor who only handles patients that pay for their service. In order to handle health insurance, Medicare or Medicaid patients would add 40% or more overhead.

      Since the deductible is much higher than current plans, the decision to pay the penalty or not pay for insurance merits serious consideration.

      Citizens like Jason should have to make an informed decision.

    • Appropriate reply to an inappropriate response (ignorant)… and in my humble opinion … classic … with some darned good insights, remember that Congress’ change in makeup during the last election and current polls was brought about by disenchantment … with Obama Care.

  107. How will the Obamacare plans play out for someone who currently has Medicare and Tricare? Since the Tricare pays almost all of what Medicare doesn’t cover, this person has no need for any other medical insurance (except for dental and vision coverage). Will Medicare and/or Tricare change to the point that an individual might have to purchase additional insureance?

    • People on Medicare and Tricare can keep the coverage that they have. I’m not aware of any changes to either of the programs as a result of ObamaCare, other than reducing the size of the “donut hole” for Medicare Part D plans.

  108. To the Moderator
    The Colorado Health Exchange forces you to go through PEAK to determine your Medicaid eligibility. The PEAK application uses their old system and does not use the mandate to determine Medicaid eligibility bases on 2014 estimated income. It instead asks for recent pay stubs, assets, etc. I was a 28 year old student with no income last year but will be earning income this year. I assume PEAK will determine I am Medicaid eligible and I will not be able to access Federal subsidies through the Exchange. This is all in violation of the Federal Law stated on Healthcare.gov saying that Medicaid and subsidy benefits will be based on your attested 2014 income. This is a serious Marketplace error, PEAK should not be using their old application, and this was confirmed by speaking with people at the Exchange, yet they say there is nothing they can do! What can you do?

    • Regarding the new Medicaid eligibility requirements, when you go through the Connect for Health Colorado website, it does use 2014 income to determine Medicaid eligibility. I would call the exchange again and see if you get another answer from someone else. Personally, I would give them a couple weeks to come up to speed and then start fresh.

      If they still refer you to Peak then your best bet is to go directly to the source and contact your local Medicaid office and address it with them. You can also call Medicaid Customer Service at 303-866-3513.

      • If you attempt to sign up for insurance on the connectforhealthco web site, it will stop you at the federal subsidy section and tell you that you need to receive an “official denial” for Medicaid from PEAK before you can continue, and to enter your “denial number” to continue. This is what the original poster, Joel, is referring to. The moderator’s response does not address the issue at all. I had exactly the same problem, so I completed the 20+ pages of ridiculous information requested from PEAK on October 1st. 10 days later my application still has yet to be processed, so I can’t move forward on my health insurance application. We don’t need to talk to anyone, we need connectforhealthco.com to stop sending applicants to PEAK. I’m sure they would appreciate it as well.

        • So, are you saying that even if you make to much to be eligible for Medicaid, you still have to go through that long PEAK application for Medicaid, get denied and THEN you can apply for the subsidy? I heard this from someone else and would like to verify if that is, in fact, the current process. I heard that PEAK application takes a solid hour to complete.

          • Yes, that is exactly correct. It’s obvious that I make too much for Medicaid yet I’m sure I’m eligible for the subsidy. But the connectforhealthco.com site requires that I fill out the PEAK application and wait for a denial before I can continue. It requires my “denial number” from PEAK in order to move forward in the process.

          • Thank you very much for the update. I hope this process is corrected soon.

          • Yes, the exchange forces anyone wanting to apply for a subsidy to first apply to PEAK and get denied. The PEAK website says that it will take 45 days to process that application. This has big implications for people wanting to start health insurance by Jan 1. If everyone eligible for a subsidy has to first go through the PEAK process, then the real deadline for starting an application on the exchange is Oct 31. An applicant need the first 45 days to get he or her denial from PEAK and then must finish applying for a subsidy and choosing a plan in one day to get an application in by Dec 15, the deadline for a Jan 1 start date. This is not a good system.

          • We’re seeing denials from PEAK come through within a week thus far.

          • My insurance agent says I have to go through the entire PEAK process. Including providing all asset information in order to apply for the subsidy. This is the Colorado process and will not be “fixed”.

          • Yes, that’s the current process for now. It appears Medicaid (PEAK) is allowed to do asset tests when reviewing Medicaid eligility for applications submitted before 2014. This makes the process quite detailed (painful) for people who already know they won’t qualify for subsidies. I suspect that it will improve after 2014. Whether or not it will change or improve before the end of the year is anyone’s best guess at this point. People I’ve spoken with haven’t ruled it out.

          • Here’s the latest update on my situation. I applied on October 1st. It is now November 7th and I still haven’t received my obvious denial. Instead, I received several letters in the mail full of additional forms I am required to fill out in order to receive my denial. I called PEAK to have them look at my income so I can receive an immediate denial, and I was told by two different service reps that there is no way they can process my application without this additional and irrelevant information. In fact, the forms even say at the top “does NOT affect your medicaid eligibility”, yet I still have to fill them out. My current insurance is CANCELLED as of Jan 1st thanks to my insurer, so I have to get this done, but it doesn’t look like I have any hope of finishing my application any time soon. What we are looking at here is a total time expenditure on my part of roughly 3 hours for a medicaid denial that should have only required 1 piece of information and 15 seconds. Until I get this denial, I can’t move forward on the connectforhealthco site.

      • Just what are they doing with all this information??? Just how safe is our info? And why so much?????????? Why didn’t they fix all this before rolling out such a massive mess? And it’s not a whole lot of comfort to be told it will be better in 2014.

  109. I recently went to Connect for Health Colorado to get a quick quote for insurance coverage for my two children and myself. I live in Garfield County and it quoted me nearly $800 a month for coverage. When I entered a different zip code for the Centennial, CO area, the cost went down by more than half. Why on earth is there such a discrepancy in costs? It seem Ludacris that those of us living in small towns (where most employers are small business owners and can’t afford to offer insurance benefits and most residences in these areas are not raking in the $$) are being screwed. The Colorado insurance plan was initially being touted as a plan to drive down costs and my understanding was if we were all able to buy into this plan costs would be lowered, why are insurance companies feeling it’s acceptable to make our costs so much higher? While our neighboring counties are indeed wealthy counties, it’s the counties that are wealthy, NOT the those of us working stiffs who happen to live nearby.

  110. I am a 35 year old male in excellent health. I exercise regularly and eat healthy. I make about $40k a year. My monthly insurance premium will double under the new law (that’s with a paltry $24/month subsidy). If my participation in the new health care scheme supposedly helps defray the overall costs of health care in this country, then shouldn’t I have a say in how people live their lives? If it’s fair to require me to help subsidize everyone’s healthcare costs, then it seems fair to require people to ride a bike for at least five hours a week, stop consuming high fructose corn syrup, and eat more whole foods.

  111. This is a disaster. My policy does not meet the requirements although it meets MY requirements which is the only thing that matters in MY opinion. In addition, most of the young people you are trying to force into buying insurance to cover the older/poorer in the population are NOT going to sign up, they will opt to pay the penalty. There is no way this can work. Colorado needs to fight the Feds on this one.

  112. I currently have no health care coverage and shopping for an interim plan to carry my family through to January 1, 2014. Less expensive short-term plans are not considered credible coverage. Will my ability to get a new plan under the ACA be effected if I am coming in with non-credible coverage plan?

    • No, you can get a short term insurance plan to bridge coverage until 1/1/14. There should be no adverse effect.

  113. So you can’t be turned down for a pre existing condition, but I’ve been hearing that even though you can’t be turned down for insurance the insurance company doesn’t have to cover the pre existing condition. Is that true?

    This deal just keeps getting better every day doesn’t it.

    • Yes, you can’t be turned down for a pre-existing condition for insurance plans with 1/1/14 and later start dates. They do cover pre-existing conditions, so that’s not accurate. Lot’s of mis-information out there, so I’m glad you decided to fact check it.

  114. Are hospitals capped in any way for what they can charge for certain things. Because I have heard and came here to verify, that some hospitals are charging some kind of charge to cover people who can or won’t pay their deductible.

    Like say if I went to the hospital for surgery and I am fully covered , can the hospital tack on a fee to cover other people who don’t pay their deductible?

    • This is a major part of the rationale for the controversial, “Individual Mandate” that requires everyone to have insurance or pay a penalty. When people don’t pay their medical bills those costs are passed onto everyone in the form of higher insurance costs (and higher costs for cash payers too.

  115. How about preventive care? Will this new insurance pay for services such as Chiropractic or acupuncture? I would rather help maintain my health with natural methods instead of drugs or surgery when ever possible.

    • Those benefits are not part of the federally mandated preventative care, so you’ll have to look at each policy to determine if those services are offered. In all probability, if they are covered they will be subject to the deductible, as is the case with most health insurance policies today.

  116. What a joke. A 9.5 percent tax increase on every household in The U.S.

    Prices won’t go down, they will always stay at 9.5 percent of your income.

    Not well thought out.

  117. Hello I am 65, and pay for Medicare plus a gap policy (not yet receiving SS). My wife is 55, and currently enrolled in a high deductable private insurance plan. Both of us are retired, and draw our annual income from tax-free savings, and a small amount of taxable income (approx: $ 5,000/year) derived from CD interest. When I use the online calculator, insurance premiums are in the neighborhood of $1,300/mo (higher than we currently pay for premiums and also higher than our taxable income). I know that we would not qualify for Medicaid, as our investments, both taxable and non-taxable would preclude that. With so little current taxable income to report, are there credits available to lower monthly insurance premiums via the “exchange” that I don’t see when using the calculator, or are we confined to staying with my wife’s current insurance carrier?

    • From what I’m hearing, there seems to be a disconnect right now with the way the subsidies are being applied for. In theory, in 2014, it should NOT take your assets into account, just your Household Modified Adjusted Gross Income, so (in theory) you may qualify for Medicaid. I suggest waiting a couple of weeks for things to get straightened out with their website. I wish I had a clearer answer for you, but some things are clearly still being worked out. However, I can tell you that if you do qualify for Medicaid and don’t want it, that no subsidies will be available. It will either be Medicaid, keeping your current coverage, or getting one of the new plans with no subsidy.

  118. Here is what amazes me. I was at Auraria campus for a health and human resources fair on Tuesday Oct. 8. Numerous social service agencies were there, but not one person or agency was sent there to address the Affordable Health Care Act. Hundreds of people attended, and it was a missed opportunity.
    Good job guys. Way to get the word out.

  119. I need assistance! I signed up for a group policy through my employer, which I thought was a good plan. Nope! They are charging me 18% of my income for the plan. I am a single mom and simply cannot afford this insurance. Also, after signing up of course I am still under my mom’s group insurance since I am 25 and my son is covered under his dad’s group insurance. The company tells me that being covered already in not an applicable qualifying event and won’t let me cancel, continuing to take my money automatically. How do I get out of this insurance plan? Please help

    • You should be able to drop out of the insurance plan by giving notice to the company that you want the benefits to end at the end of a current month. Insurance companies are prohibited by law from back dating employee terminations. Your company’s HR department should help you with this.

  120. The Affordable Care Act says that all states must have Health Care Exchanges operational by 1/1/2014. It’s only been 3 1/2 years since the law passed. Why isn’t Colorado going to be ready by 1/1/2014 and hence be in compliance with federal law?

    • Colorado’s health insurance exchange opened on time and according to schedule on Oct 1st, 2013. While open enrollment started on Oct 1st, the coverage start dates are January 1st, 2014, also in accordance with the Affordable Care Act.

  121. Our son moved to Colorado for a little over 6 mos. in 2012, then came back again to look for work in August and is now doing temp work. What is the residence requirement for him to sign up for the Affordable Care Act in Colordado. He turns 27 this month and is no longer on our insurance.

    • It’s my understanding that you just need to live in Colorado and have an address and that there’s no minimum timeframe one has to live in Colorado. Please note that the ACA plans will not begin until 1/1/14, so you may want to purchase a temporary insurance plan to bridge the coverage.

  122. I want to be like the other Coloradans that are very good at whining when things aren’t perfect and sunny. Lived all over the world, all over the country, and it’s increasingly evident that people all along the front range are self-interested and spoiled brats that drive aggressively, put themselves above others, and expect the world to provide for them. In the end, I am happy to have access to insurance if I choose, I am happy to have access to medical care if I choose. We all have choices but for most people commenting, they forget that the rest of the world is far worse off and can’t even afford a tube of Neosporin. But heck, let’s keep complaining about what perceived hardships decision-makers impose upon us. A hundred years ago none of this existed. Meanwhile, short-sighted Coloradans come from short-cited cohorts…and it will never improve. Time will provide increasingly short vision as we woo ourselves with highly valuable activities like driving clean cars thru Starbuck’s drive-thru. I am disappointed in the people of the Front Range, a couple million self-interested people that really really need things to be their way.

  123. We have a high deductible plan through United Health Care (10K per individual) that we like because we can afford the monthly premiums and can afford the deductible If needed. We used to put money into an HSA but started losing he deductions on that. I just checked prices on this site and the guaranteed coverage plans for us including our grown son are a lot more expensive. We are both self employed and have used this strategy for many years. Now your cheapest plan on this site is 60% more per month than we pay now (550 to 864). Will we be able to keep the health insurance we have (that is what the president said and we believed him) or will this plan go away because it doesn’t meet some kind of minimums? Basically this Affordable Heathcare Act isn’t so affordable for us, but we have family members who don’t work as hard as we do so they don’t make as much money who will have a better deal than we are being offered. Do we get to keep our plan?

    • You will want to check with your insurance company to see if your current coverage is “grandfathered.” Grandfathered plans were in force before President Obama signed the Affordable Care Act into law on 3/23/2010. If your plan pre-dates that you very well may be able to keep it. If it’s not grandfathered, some carriers are allowing their clients to keep their non-ACA plans through most of 2014, after which they’ll be forced onto an ACA plan.

  124. Every time I have had medical care of any kind, I have paid the entire bill my self. When I had insurance it just took longer for the bill to get to me. usually after it has already gone to collections. So if I am already paying the hospital, Doctor, facility, nurses, drugs, and yes they all bill separately, What exactly is the insurance for? The copay is what you pay at time of service, the rest comes much later, after they add it all up.

    • Insurance is meant to assist with the bills that people can not pay for themselves. This is why we insure our homes, cars and bodies. Most people don’t need insurance for the odd doctor visit, but when a single day in the hospital can run upwards of $5000+, most people require insurance to pay for those bills beyond their means.

  125. Chad,
    If you do not have insurance you do not benefit from NEGOTIATED fees by the insurance companies. It means that the same service fee is 300$ if you do not have insurance but 100$ if you have. That is the deal between the hospital and the insurance company. And of course in addition the insurance pays 80$ and you are left with 20$ to pay. You can try to negotiate with the doctor but you do not have the power of a big insurance company.
    People who are insured can see on the invoice “the doctor fee”, “the negotiated fee” , “the amount insurance pay” and the “amount patient has to pay”. You will shocked to see the differences between “doctor fee” and “negotiated fee”. Two to five times more.

  126. Does someone know how the income was verified ? Do they ask for 2013 income?
    Or do they ask for income reported to IRS in 2012?
    The new bill just passed today includes a new verification of income.
    thanks

  127. What if a family has Obamacare with a $8,000 deductible. One of their kids has a bad accident and is hospitalized and needs emergency surgery. Let’s put the hospital bill at $25,000.

    So time to check out and the family does not have the $8,000 deductible. Who pays it? Do the doctors and hospitals get stiffed?

  128. What if your deductible is 8,000 and you get hurt or hospitalized the last few days of Dec and are there through the new year, is your deductible now 16,000 before insurance pays?

  129. We pay car insurance because it is a choice and a privilege to afford to drive. We pay property/house insurance because it is a choice and privilege to own a home. We pay property taxes because those who choose to have children need to have them educated (I went to public school), and we need fire departments, and other services — but again, you can get out of paying property tax by not choosing to own a home. We pay into Social Security because it is THE LAW, and most of those aren’t already there will work longer for reduced benefits, or no benefits at all. Health insurance is not like Social Security — the concept was that if you pay in, you’ll have retirement later. Health insurance is you pay and pay, hoping you won’t have to use it, but there is nothing left in reserve if you want to use it for your health — it’s gone, and someone else decides if you are worthy of treatment and what kind of treatment you qualify for. There is no provision for vitamins, supplements, preventive, or holistic medicine. There is no choice about what kind of treatment you will get…it’s a “take it or leave it” dictate. Health insurance money is spent long before the insured ever needs it.

    I’m 60, and I’m OK with not being treated…if it is more than I can afford, I’ll pass on to my next adventure. It appears that health insurance if really fear insurance, as most insurances are. You are not protecting your health just because you have insurance. At least with your home you are protecting your investment.

    And why is it that certain religious groups do not have to comply? Because insurance is a form of ‘gambling’, and they don’t believe in that sort of thing? If it is good for us, it should be just as good for ALL the government officials, elected officials, government employees, and all religions. This plan specifically calls out exemption for certain religions.

    Come on, don’t try to sell me on Obamacare by saying it is protection for the future. You will not be spending money that is in some ‘reserve’ for your health. And don’t try to sell me on a program that is not good enough for ALL those LIVING in the U.S…it seems it is only good enough for those of us who maintain a job and pay taxes!

    Hopefully, before we all go broke trying to pay for it, it will collapse on itself. Ask the young man in Canada how long he is waiting for his knee surgery, or the Italian that goes into the ER for treatment how many days of waiting. These sophisticated socialized programs are not a success, they have their own BIG problems. Ask an Italian how he likes paying 55-60% taxes. It’s not free! Those societies have just been born into it, so it is ‘normal’, and they accept it as the way it is. As with all entitlement programs, there will be a few that truely benefit…there will be many more that just pay for it.

      • Don’t get defensive.That is not an answer to the questions posed to you. Why do the Washington politicians not have this insurance? Why were so many exemptions given to large companies so they do not have to participate? Unions in particular. Why when the majority of Americans do not want this type of healthcare was it pushed through? Do you think the rates posted for these plans are anymore affordable for the people who cannot afford health insurance in the first place? If these people could afford insurance, they would. More government subsidies. Luckily I have health insurance through my employer, but my rates will go up in Jan. I really would like some answers for these legitimate questions. Thank you

        • I try to refrain from commenting on political questions, as the intent of this website is not to defend or attack the Affordable Care Act, but to help people with the myriad of questions associated with the new system.

  130. What about Americans who are living out of the country? Are they required to purchase insurance even though it is of no benefit in another country?

  131. CforHC website says that if you buy insurance by 12/15/2013 it will be effective 1/1/2014. If you call the 855-752-6749 number, the hold message says if you buy by 12/15/2013 it will be effective 1/15/2014. Confusing.

    • I believe the correct answer is that if you buy on 12/14 or before you get a 1/1/14 effective date. If you buy on 12/15 or later in december then it will be 1/15/14 effective date. This was on the CforHC website today.

  132. New question. I am the supervisor for a group of physicians (specialists). I would like to know, just because we are a participating provider ,say with Anthem, dose this automatically make us a participating provider for the Anthem plans on the exchange? I also would like to see ANY education for the providers.

    • You’ll want to contact Anthem and ask about their new Pathways network, as that’s the new network that I understand they are using for many of their exchange plans.

  133. Re:subsidy calculator on c4hco. If I say 2 people are living in the household, it provides a subsidy dollar amount. It doesn’t say if this subsidy is for insurance for 2 people or 1. However, it offers insurance for 2.

    One person is on Medicare and doesn’t need insurance from the exchange. Does the second person get all the subsidy? It doesn’t say.

    • Great question! The subsidy amount will be reduced according to the number of people from the household enrolling in the plan.

      • That doesn’t jive with the initial subsidy estimates. It’s about half. Gonna keep my old insurance till all this gets straightened out.

  134. How long will the monthly rates for a newly obtained health insurance policy purchased on the exchange remain the same? When it is determined in a few months that the risk pools are out of balance is it not foreseeable that the monthly rates will increase…possibly dramatically?

    • Yes they may increase. And you will pay for these rates later in life as I pay now for the police and army and firefighters that protects you while you are in school.
      I can afford two bodyguards but I bet you do not. Still I am paying for you to be safe.
      We as a society we should take care of all the people.

  135. I finally got some time to go look at the plans, and I must say I’m quite pleased. I dropped my health insurance at the end of 2011 because my monthly rate (with COBRA) was going to change from $439/mo to $526/mo – unaffordable for me. I’m happy to report that I can now get an equivalent plan for $299/mo. And an important bonus in my view – there are THREE providers that are NOT-FOR-PROFIT. It’ll be good to be insured again. I’m a healthy person for the most part right now, but my family health history has some bad stuff in it.

    • Well it’s a good thing you’re not old or poor. If you’re old, insurers in CO can charge you up to 3X what a 40 year old would pay.

      If you’re poor, you have to apply for Medicaid to get subsidy. That involves detailing your entire net worth to the government. Hours of paper work.

      In any case, to buy the insurance on the exchange, you must sign a waiver saying you agree to share any of your information with any state or federal agency. Not sure why Homeland Security wants to know about your health? I guess criminals need health care too. :-)

      • I’m not sure what your grumble is about. I’m not rich or poor. I’m not young or old. I’m UNINSURED. And come January, I won’t be. Because of Obamacare. It’s that simple.

          • Fair enough. I’m allowed to be happy about being insured again. I increase my chances to not be poor when I am old, or worse, poor before I am old. Take care.

    • FWIW: I got an email from the PEAK folks today saying that they would remove the Medicaid asset questions from the website for people applying for ACA assistance in the “next few months”.

      • I heard from another person that the asset tests may be removed after Nov 15th, 2013. I guess it depends on who you talk to. I guess we’ll have to wait and see, but the fact that yours is in writing gives it more credibility.

  136. Your reply to Fred on April 3, 2013 suggests that he may get a better deal by buying a policy on the exchange in the case his existing policy is not grandfathered and he is forced to get a replacement policy. Even though we are still watching the “launch” struggle to get functional, it seems there is enough information out there (who knows, some of it may actually be true!!) that suggests that not everyone who is forced to get a replacement policy is going to get a better deal.

    Using Kaiser’s calculator, I was able to determine that my 63 year old wife would have to pay between $100 and $240/month more for a replacement policy. Even if we qualified for the maximum subsidy of $90/month, she would be worse off. I say this with knowledge that ACA “improvements” such as maternity care and abortion services (see Kaiser’s plan offerings if in doubt) are worthless to her.
    My understanding is that younger people have to pay a lot more than my wife would.

    Question: are you able at this time-for those who currently have policies that are not grandfathered and will be forced to get a replacement policy-tell our readers which groups will have to pay more than they are currently paying and which will not have to pay more?

    The government wants us to believe that lots of people will be better off, though reality seems to suggest otherwise.

    Thanks for your contribution to helping us understand this mess.

    • FWIW:

      1.) In Colorado, “old people” can be charged as much as 3X more for health insurance as “young people”. For example, if I make myself 20 years younger on the exchange, the cost of insurance is cut in half.

      2.) Reuters is reporting that people that don’t qualify for a subsidy on the federal site are going “off exchange” to buy their insurance. That is, directly to the insurers. Many insurers have policies that are not offered on the exchange. You might want to call your provider and see what they offer.

      3.) The Kaiser calculator assumes you’re buying a silver plan. You may not need that if you wife is good health. A bronze plan may do.

      • Fred,
        Regarding #2. People who do not qualify for subsidies… are they forced to go off the exchange ?
        Because if they are , then they can miss the subsidy in case their income will be lower. No one can predict the income especially if you are self employed for example.

        • No, you’re not forced to go off-exchange if you don’t qualify for the subsidy. You can still apply through the exchange at the full non-subsidized rate. Also, you can report mid-year changes in income to the exchange.

          • Without the subsidy … why would you want to? Would you not have access to the same as well as other less constricted network plans outside of the exchange.

            You are doing a great job of staying neutral!

    • Yes, some will pay more and some will pay less with the new ACA plans. There definately are winners and losers with the healthcare changes.

      However, I can’t make a blanket statement about any groups of people who will pay more or less than what they are currently paying, as what people are currently paying varies depending on deductible, carrier, if it’s COBRA, Group or individual, etc. However, it’s reasonable to say that the lower the subsidy amount the greater the odds that they’ll be paying more for a new 2014 plan, on or off-exchange.

      • It is reasonable to expect “regardless” of subsidy amount … a higher premium at their next renewed date. They will be buying qualifed health coverage in the exchange as all policies sold within the exchange go into effect on or after Jan. 1, 2014 and will be subjected to all the ACA mandates. Outside the exchange … No subsidies and higher rates. For those who have no insurance … rates wil be 100% higher than current.

  137. I am 57, single, self employed & earn around 32k a year. I can lower my Modified Adjusted Gross Income to 11k a year when I deduct 1/2 of my self employment tax, Self Employed health insurance premiums (6k for 2013), and by maximizing my IRA and SEP IRA contributions. If I do all this, it looks as I will be eligible for Medicaid.

    I do not want to be on Medicaid though. I think I’d feel too humiliated to bring a Medicaid card to the few doctors offices in my rural area who accept it.

    I would prefer to use cost sharing subsidies. As I understand it, that would allow me to select from any Silver Plan available to me on the Exchange. If I have this right I’d receive financial help through Premium Subsidies (not tax credits), and help with out of pocket expenses through other cost sharing subsidies.

    Two questions:

    1. Do I have the option of turning down Medicaid & using Cost Sharing subsidies instead?

    2. Based on the limited information you have, how much help financial help might I receive with a Silver Plan policy that costs $900/month? (Area 11)

    • Please see this web page for the income calculations for your situation. If you are eligible for Medicaid and don’t take it, you can not get a subsidy.

    • Betsy,
      Lowering your income will place you into the Medicaid and no right to subsidy. Better keep your income (MAGI) around 22 to 25k if you want to avoid Medicaid. Then you can get almost all covered by subsidy.

  138. Info on the Tax penalty:

    How exactly will the penalty be assessed? If you don’t have sufficient health coverage by the deadline, the “IRS will hold back the amount of the fee from any future tax refunds,” according to HealthCare.gov, the government’s marketplace website.

    But what if you don’t get a tax refund? The only way that they can collect the penalty or the fine is by taking money from your refund. If you are not owed a refund, they cannot get money from you.

    If you don’t get a refund next year, the IRS could carry over the sum due and apply it against any refunds in future years. On a joint return, the penalty of one joint filer could be applied against the refund due to the other joint filer. If you don’t pay it, all they can do is wait until they owe you some money and take that.
    Or probably just send you a letter every now and then reminding you that you owe money to the IRS. Once the IRS assesses the penalty, they’ve got 10 years to collect,

    The law also prohibits the IRS from using liens or levies to collect any payment you owe related to the law, That means the IRS cannot go into someone’s “checking accounts anyway and just take the money. There are no criminal penalties for not paying up. You can’t go to jail.

    Unless the law boosts the IRS’s power to collect these fines, it is, indeed, possible for one to go on without obtaining health coverage and never be financially penalized.

  139. If my employer (Denver Public Schools) offers employees health coverage, am I automatically disqualified from these federal plans?

  140. Just out of curiosity, I call my health insurance company to ask what a bronze plan would cost off the exchange. This for someone my age and living in my county…

    My insurance company (off exchange) Bronze plans = $672 – $701 / month

    Colorado’s exchange Bronze plans = $504 – $804 / month

    Looks like you can find cheaper bronze plans on the exchange. But I could see why someone would want to stick with their current insurer.

  141. I’m a veteran so I don’t have to deal with this but my husband isn’t and I can’t figure out what I should put in things. Is there a way to get a quote for health insurance for him?

      • It doesn’t seem to help me. Do I put us down as 2 people or 1. I’m covered by the VA but there are 2 of us in the home and he’s the only one that works. Didn’t it occur to anyone that there might be households like us?

        Why is tobacco the only question they can ask? After all Colorado took money from the tobacco companies to pay for smokers health care. Shouldn’t we be getting a subsidy for that money???

        • Pre-existing conditions no longer apply, so the only health question they ask about is for tobacco use. Tobacco users pay 15% more than non-tobacco users due to increased health risk. The subsidy will be based on the number of people in your household (2) and the total household income. However, since only one of you will be enrolling in the plan, the amount of the subsidy will be reduced. I hope that makes sense.

          • Yes, you’ll get less than half the subsidy the website quotes you if only one buys insurance.

          • Let me get this straight. Colorado accepted money from the tobacco companies for health problems that smokers will encounter yet we’re being penalized because my husband smokes. If he doesn’t smoke (he stopped for 2 years and we almost got divorced) he’s impossible to live with. I think we’re really getting screwed here. I would have preferred a single payer system like they have in Europe. I’ve used their system and it’s pretty good. Seems like the insurance companies have once again gotten to force us to have insurance and making us pay through the nose for it.

          • So why doesn’t the Colorado website have this calculator?

            There is no way we can pay what they’re asking for a single person plan.

            When do we get the subsidies and what happens when they go away in 2 years?

            I’m not real happy about all the time I’m having to waste on this.

            And I’m afraid we’re still not going to have health insurance that will help us. If we have to pay a $6,000 deductible we might as well not have any insurance. I’d rather put the money in a health savings account.

  142. My rates have gone up by 90% with Kaiser over the last 7 years. 7 years ago my company of 3000 had 48% of are staff with Health Care. Today we are at 12% of are staff has Health Care. I have talked to some of the staff about enrolling with the Colorado exchange. Most all of the staff are telling me it cost way to much and they are going to pay the fine this year… Cost have to come down by 40% by 2015 and the Health Insurance out of pocket needs to go way down. $5000.00 deductible and $10,000,00 max a year. Your really selling that crap.. Your saying if you get sick we will not pay until we drain your accounts. Any one that has worked in Health Care knows high out of pocket delays care. These also have to drop to $500.00 max out of pocket a year by 2015. By the way I am paying $7,969.00 a year and my company is paying $7,969.00 a year, total $15,938.00 for a family of four. Can you bet that?? $20 to see the Doc, $20 meds, and $1,000.00 max out of pocket a year. would love to see but I’m not going to put all my important info into the computer just to find out. That need to change to. People should be able to shop on your sight with out putting in all of there important info like there ss# ect until they are ready to buy.

    • Have you looked at the exchange? I heard many people saying ti was too costly when they hadn’t even bothered looking. Instead they were going by what they had heard on TV and the radio. It might be a good idea if you look and print out some things that might work.

      • Hi Fred –
        Maybe you could lead us through this, since I cannot find a “Browse Plans” link, and neither does the search bar reveal anything.
        Thanks

        • 1. Go to http://connectforhealthco.com/
          2. Click on the picture of individuals and families. The scrolling stops and you can click on “Shop Now” above the pictures.
          3. A new window opens. On the right hand side is a box that says “Browse Plans”. Click on “Find a Plan”.
          4. You get a box that asks for zip code, birth date, and some other stuff. Fill that in and click on “Browse Plans”.
          5. Then you get pages and pages of plans. (I get 56.) They are sorted from cheapest to most expensive. You can sort the plans in different ways or compare any three of them.

          HTH

  143. Exactly how is a policy that costs $1,09043 per month for 2 people affordable when in addition the Deductible is $6,30000/ Person & 12,600.00 Family
    Annual Max. Costs $6,30000 That 1434516 per year and that’s before the policy kicks in and pays one cent!!!!! Are you people crazy????????? It would have been better to give us medical saving accounts that roll over every year. If this is affordable health care then KEEP IT!

  144. Charli…
    I am running into the same situation. Thankfully, my husband and I are both health, and have no prior health related issues. I haven’t met a deductible for over 45 years — we are 54 and 60 years old. Thankfully, we are both employed and make more than allowed for any subsidies.

    In my opinion, there is only one way to fight it, don’t join. If the only people enrolling are those that are medicare/medicaid, or subsidized — and they don’t have the ‘healthy ones’ enrolling to cover all the costs, the law will have to be modified (better yet aboloshed). When every government employee, from the President to the janitors, all teachers, all public workers, are forced to enroll in the ACA, then there might be a shift. What do ya think?

  145. I see articles indicating that state pools will permanently close individuals ability to enroll on their health exchange pool by the end of the year. I thought open enrollment was allowed through March 2014

  146. i live part time in Colorado and part time in another Midwest location. How do I determine eligibility for Colorado exchange and any advise deciding to purchase in colorado or other state?

    • Apply in the state you have residency in. I would assume that would be the state where you spend the majority of your time.