Welcome to Colorado Health Insurance Exchange News. This website helps Colorado health insurance consumers understand what their options will be as the various tenets of health care reform are rolled out.
Colorado’s health insurance exchange will be called Connect for Health Colorado will be a government-run entity which is to be in place no later than January 1st, 2014. Health Insurance Exchanges are part of the Affordable Care Act that President Obama signed the into law on March 23rd, 2010 and upheld by the US Supreme Court ruling on June 28th, 2012. The Obama administration gave conditional approval to Colorado’s health insurance exchange on December 10th, 2012.
The Affordable Care Act (ACA) creates state-based health insurance exchanges. Individuals and families and businesses with fewer than 100 employees can buy insurance through the state based exchanges. The Affordable Care Act hopes to lower health care costs for Colorado families and small businesses, potentially reducing the cost of family health insurance premiums by $1,510 – $2,160.
View sample rates for the Colorado Exchange’s Silver plans for individual/family plans or use the new premium subsidy calculator to see if you qualify for federal subsidies to reduce your premium costs for exchange plans. Subsidies are applied immediately so you only pay the net amount after the subsidy.
Colorado’s health insurance exchange should be operational this October of 2013. In the interim you can get instant online quotes, so you can easily see and compare rates on Colorado health insurance plans from all of Colorado’s leading health insurance companies.
Why is Colorado waiting until 2014 rather than being proactive and establishing exchanges earlier?
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.
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.
Great question. Politicians tend to have more legal training than knowledge of the principals of economics.
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.
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?
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.
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.
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
Keeping calm and adapting to change is always good advice!
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!
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.
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.
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.
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.
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.
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.
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
My pleasure Chris!
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.
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.
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!
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?
I’m not sure who would be able to best address your concerns, but the phone number for the exchange is 720-496-2531. You can see the exchange’s board members at: http://www.getcoveredco.org/About-Us/Board. The exchange also has Advisory Groups, and if you wish to be involved or have a question you can email info@cohbe.org or call 720-382-7083.
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?
Hi Rollie,
Excellent question.
The money will be paid out in the form of a tax credit. Here is a great article on Health Insurance Subsidies that explains the complexities of how the subsidies are calculated and paid out.
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.
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.”
Is the colorado exchange only going to be available online or will there be offices or phone numbers to call?
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.
Per Affordable Care Act, Each exchange needs to provide navigator/assister program in some form to help consumers educate and select health plans from exchange. California seems to be already having this in place. When can we expect this from colorado?
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.
Cool, this is great, thanks for the info.
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.
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.
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.”
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.
When will we see what the rates will be for the exchange? Oregon has a rate calculator on the state web site.
That’s a good question. We should know the rates by October, but there isn’t a rate calculator or anything like that in Colorado yet.
My rates have already increased 50%
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.
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
How will the coverage that is offered with the exchange work for us that live in CO part time and in Fl part time?
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.
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.
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.
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.
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.
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.
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.
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.
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.
Thanks for your replies.
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.
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!!
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.
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!
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.
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 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.
Would this be by chance the VA picking some of the costs not covered by the insurance I buy on the exchange?
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.
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
Sure, follow this link.
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.
You can also search for more comprehensive rate filings at the Colorado Division of Insurance website.
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.
So what will the 2014 rates be for us that are 60? I looked at the new rates, but its all Greek..
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.
My question is whether these rates will be higher for me since I have medical conditions.
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.
Rates will only be higher if you smoke.
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.