Working through ObamaCare ‘snafus’
November 21, 2013
The 10 essential health benefits now required in insurance plans
- Prescription drugs
- Emergency Services
- Laboratory services
- Maternity/newborn care
- Ambulatory patient services
- Mental health/substance abuse
- Rehabhabilitative services and devices
- Pediatric services, including oral and vision care
- Preventive and wellness care/chronic disease management
Starting Jan, 1, 2014, most people will be required to buy health insurance or pay a penalty. For those opting out, the penalty phases will be:
- 2014 – 1 percent of income or $95, whichever is more
- 2016 – 2.5 percent of income or $695, whichever is more
- After 2015 – annual increases based on inflation
Useful contact information
Connect for Health Colorado
- Website: http://www.ConnectforHealthCO.com
- Email” target=”_blank”>target=”_blank”>http://www.ConnectforHealthCO.com
- Email: Info@ConnectforHealthCO.com
- Phone: 855-PLANS4YOU (855075206749)
Grand County Rural Health Network
- Website: http://www.gcruralhealth.com
- Email” target=”_blank”>target=”_blank”>http://www.gcruralhealth.com
- Email for health coverage guides: email@example.com or firstname.lastname@example.org
- Phone: 970-725-3477
Health coverage guide local library hours
Day Location Time
- Monday Granby Library 3-7 p.m.
- Tuesday Fraser Library 11 a.m. to 3 p.m.
- Wednesday Grand Lake Library 11 a.m. to 3 p.m.
- Thursday Kremmling Library 11 a.m. to 3 p.m.
- Friday Hot Sulphur Springs Library 11 a.m. to 3 p.m.
- Saturday Middle Park Medical Center 10 a.m. to 4 p.m.
Do I Qualify for a tax credit?
Those making between 1.38 and 4 times the federal poverty level are eligible for tax credits which apply to monthly premiums. Here’s a breakdown of qualifying incomes:
# in Household Annual Income
- 1 $15,856-$45,960
- 2 $21,404-$62,040
- 3 $26,951-$78,160
- 4 $32,499-$94,200
- 5 $38,047-$110,280
- 6 $43,595-$126,360
- 7 $49,143-$142,440
- 8 $54,691-$153,520
Source: Grand County Rural Health Network and Connect for Health Colorado
Like many in the nation, Carolina Thomasson has grappled with insurance glitches as the Affordable Care Act's mandates go into effect.
After welcoming a new baby in September, Thomasson called her health insurance provider, Rocky Mountain Health Care Plans, to add the infant to her plan. She already paid around $800 a month to cover herself, her husband and their two-year-old daughter, and was shocked to learn it'd be another $800 in premiums to add her newborn. When she asked why, her insurer said it was due to new regulations and coverage mandates required by the Affordable Care Act.
"Well, besides being completely hormonal, I freaked out pretty good," Thomasson said. "I was incredibly overwhelmed. I didn't know how we were going to insure our child."
Thomasson said she broke down and cried while speaking with the insurer over the phone.
“People get frustrated. They want it now, we live in a ‘now’ kind of society, and this is not a ‘now’ process.” Jen Fanning, Grand County Rural Health Network
"I really felt like they were just trying to push us out from their coverage," she said. "They assured me that wasn't the case, that it was because of the new regulations they were adhering to."
Thomasson and her husband are drug and alcohol rehabilitation counselors with a practice in Granby, and are on their own to find health care coverage. Through an insurance broker, the family was able to get a temporary plan until health care reforms officially kick in this January. She said if all goes well, her family will be able to afford long-term insurance that is much less than they paid before.
Even with all her insurance coverage snafus, Thomasson is feeling optimistic about ObamaCare.
"I think it's going to do a lot more good than harm," she said. "We work with a population that's medically under-served, and usually people who can't afford insurance or don't have career jobs offering insurance. I'm incredibly excited for our clients, in some cases, to get insurance for the first time in their adult lives."
Still, as national and local headlines continue to show, bumps along the road to affordable coverage aren't uncommon for individuals and families like Thomasson's. Since its rollout last October, the national and state health insurance exchanges have been plagued with problems, from clunky websites to insurers dropping clients. Grand County Rural Health Network is working to help clear up confusion and offer a smoother ride for county locals.
According to Kyle Gateley, a health coverage guide with the Rural Health Network, one of the biggest local barriers is navigating to the right website. Lots of people end up going to the federal government site instead of the local Connect for Health Colorado site, http://www.connectforhealthco.com.
The federal site, http://www.healthcare.gov, has been plagued by problems since it launched in October, with many having difficulty even getting the Webpage to load. But Coloradans don't need to worry about using the federal site. When the Affordable Care Act became law, states had the option to set up their own health insurance exchange marketplace, or default to the federal exchange. About 16 states, including Colorado, opted to run their own exchange. The state's exchange is called Connect for Health Colorado, where residents can shop and sign up for insurance to comply with federal law.
While it isn't riddled with the same bugs afflicting the federal site, the Connect for Health Colorado website still isn't a breeze to navigate.
"It's a little like a labyrinth," Gateley said. "If you don't know it well, it's hard to search around. You have to be computer savvy."
One of the biggest hurdles with the website is figuring out how to apply estimated tax credits to premiums.
"So they just look at the raw number and say, 'this is like regular insurance, if not more expensive,'" Gateley said. "But if the tax credit's applied and they're at the right insurance level, it's usually much cheaper."
Those looking for insurance on the exchange website can get an estimate of what tax credits they might receive by entering some basic family and income details. Those credits apply each month to insurance premiums consumers can view by browsing plans on the site.
"There's sticker shock, but a lot of people are getting reverse sticker shock, too," Gateley said. "They see the price without the tax credit, then they see the price with the tax credit and realize it's a good deal."
People are also often under-prepared once they begin applying for insurance coverage, which can cause significant delays.
"People get frustrated," said Jen Fanning, executive director of the Rural Health Network. "They want it now, we live in a 'now' kind of society, and this is not a 'now' process."
To qualify for coverage, applicants need to come prepared with sufficient background information, including social security numbers and income for all members of their household. Consumers seeking tax credits must also first apply for Medicaid and be denied.
"So that's the biggest hoop, right off the bat, that people have to jump through," Gateley said.
As part of the new health care law, Colorado expanded its Medicaid coverage to a larger number of low-income families and individuals. Those who qualify pay no premiums for health care. Those making enough to be above Medicaid qualifications, but are still considered low-income, become eligible for the federal credits.
In some cases, the decisions on Medicaid are made instantly, as long as the applicant has collected enough information and entered it correctly. If not, the application goes to paper processing, which can take up to 45 days. Gateley said to avoid long waits it pays to be thorough.
Once an applicant has been approved for tax credits, or decides to forgo applying for them, it still takes about two days to get fully signed up for insurance while the state runs its income verifications.
There has been plenty of unforeseen fallout as insurance companies bring plans into compliance with the Affordable Care Act's "10 Essential Health Benefits." Some old plans didn't include all the coverage mandated by the law. In some cases, adding these essentials to plans caused premiums to skyrocket, like in Thomasson's case. In others, insurers opted to drop inadequate plans altogether.
Even if customers were allowed to keep their old plans, they wouldn't have been in compliance with federal law. Those customers would've had to pay the same penalty as those who opt out of having insurance.
"I think they realized these people with old plans would have to come back and buy more expensive ones anyway," Gateley said. "So it was a good business move from their perspective to drop those people."
The Denver Post reported about 250,000 Coloradans had their insurance policies canceled as the Affordable Care Act went into effect. Some on those canceled policies will find better plans through the insurance exchange, while others will get covered through Medicaid expansion. But it has still caused annoyance and some outrage over a law with reforms that were controversial since its inception.
"Cancellations are happening and are a huge issue. I don't even think it was something the administration foresaw," Gateley said. "It was a huge mistake."
President Obama announced a new policy last Thursday, Nov. 14, that will allow insurance companies to extend these canceled plans for a year, which might at least buy some customers time as they shop for new compliant plans.
Another issue arising from the health care mandate is the exorbitant costs of coverage in Colorado's mountain communities.
For an individual in her late 30s, for example, plans in Denver range from $186 to $252. In Grand County, they cost between $289 and $328. In Breckenridge, they range from $349 to $437. And in Vail, they cost between $403 and $439.
"Resort communities are higher," Gateley said. "There's less population, there are fewer service providers, and the providers are a little more expensive."
Fanning said insurers are also looking at their insurance pool in mountain communities, which have higher rates of injuries from activities like skiing and mountain biking. Mountain towns might seem riskier to insure, leading to higher premiums.
Gateley and Fanning said the calculations insurers use to come up with premiums are complex, and it's difficult to pinpoint why, exactly, rates soar in the high country.
Even with the marketplace snags, Gateley and Fanning said Colorado is experiencing health care successes.
Fanning noted a study by the Colorado Network of Health Alliances that projected by the year 2016, the number of uninsured residents in Grand County will be 1,309. Right now, the number of uninsured in the county is around 5,000, Fanning said.
"So that will be a significant difference, but there still will be uninsured people," she said.
And Gateley pointed to a New York Times article ranking Colorado as fourth in the nation for health insurance plan enrollments. But that study still shows Colorado falling short, at only 58 percent of its target for enrollments by November. Nationwide, enrollments are at 21 percent of targets.
Health coverage guides
The Grand County Rural Health Network board of directors brought on its two health coverage guides, Gateley and Kim Long, to ensure the community was informed in navigating the Affordable Care Act and its mandates. Their services are free and open to the public.
The guides are county locals, but they received specialized instruction on the new health insurance policies and the exchange marketplace to assist individuals, families and businesses as they look for insurance coverage.
As the bugs are worked out and policies change, the guides receive ongoing training to keep pace.
"The information changes on a regular basis. This is a moving target," Fanning said. "The guides are absolutely the most up-to-date on the Colorado marketplace."
The guides are available to help Grand County locals avoid headaches during their scheduled hours at libraries throughout the county. Visitors shouldn't expect to sign up for coverage during those hours. But they'll be able to speed things up by learning about the process and what information they'll need to collect in order to apply.
"There's a lot of legwork individuals need to do," Fanning said. "It expedites things to learn about what the process is, go home and gather all the data and information, then make an appointment with a health coverage guide to sign up."
County residents can schedule individual appointments with the guides to sign up for plans. They can help residents understand what sorts of tax credits or cost-sharing reductions are available based on their income levels. But their goal isn't to force residents to enroll.
Fanning and Gateley said people might forgo insurance and take the tax penalty for a variety of reasons, including financial and political ones. And they support their right to choose.
"We're just trying to get the information out there so people can make informed decisions," Gateley said.
Leia Larsen can be reached at 970-887-3334 ext. 19603.