Transcript Document

Individual Marketplace
Overview
Date or subtitle
What is Connect for Health Colorado?
An open, competitive marketplace for individuals and small employers to:
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Compare information regarding cost and quality
Shop health plan features containing the same base benefits
Determine eligibility for and access new federal financial assistance,
based on income
Call, chat or sit down with trained representatives for help
Enroll in a health plan
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Connect for Health Colorado is NOT
• A replacement for the current market or brokers
• Engaged with negotiating rates between carriers and
providers
• Part of Medicaid
• Offering Medicare or supplemental health plans
• A new government health care system
• A State agency or regulatory body
• An organization that receives funding from Colorado
General Fund
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What is the Individual Marketplace?
• One of two shopping paths offered by Connect for Health
Colorado (other is for small employers)
• A new resource for Coloradans seeking health coverage
• Providing individual and family health plans that take effect
starting Jan. 1 2014
• Online shopping, with assistance by phone and in-person
• The only place where Coloradans can access new federal
financial assistance to lower premiums, co-pays and
deductibles
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Who can shop?
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Coloradans who currently buy insurance on their own
Coloradans who are uninsured
Coloradans who are self-employed
Coloradans who don’t have access to affordable coverage
through their employer
• Coloradans with legal immigration status
• Family members/dependents of employees who are offered
employee-only coverage by employer
• Not for those eligible for Medicare or seeking supplemental
plans
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Ways to shop
• Starting October 1: go to www.ConnectforHealthCO.com
• Answer a few questions and browse health plan prices and
features
• Answer a few questions and get an estimate of eligibility for
new financial assistance
• Shop for commercial health plans without financial
assistance
• Fill out the application for new financial assistance and
insurance affordability programs (Medicaid and CHP+) and
find out what you are eligible for
• Enroll in health coverage that takes effect starting Jan. 1
2014
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What can you shop for?
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New health plans (Qualified Health Plans) that all include a
comprehensive set of medical services and benefits
Health plans offered by a wide range of carriers*:
o All Savers Insurance Company (part of UnitedHealthcare), Anthem Blue
Cross and Blue Shield, Cigna, Colorado Choice, Colorado HealthOP,
Denver Health, Humana, Kaiser Permanente, New Health Ventures, Rocky
Mountain Health Plans
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PPO, HMO, HSA, CYA (high deductible plans for young adults)
Health plans with dental coverage and without
Separate dental plans
Find out eligibility for Medicaid and CHP+ and enroll
A link to vision plans
* These companies have requested permission from Colorado Division of Insurance to provide plans, final
information will be known in August
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Who can help you use the Marketplace?
• Customers can get help online, over the phone and inperson
• Online chat and decision-support tools
• Help over the phone by Customer Service Center
Representatives through toll-free number
• Impartial help in-person by trained and certified Health
Coverage Guides located at over 50 community-based
Assistance Sites statewide
• Help in person and by phone by licensed and certified health
insurance agents and brokers located statewide
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Key changes
• Starting in 2014, you can not be denied or cancelled for
health coverage based on a pre-existing condition or your
health history
• You will not be asked about your health history or medical
needs when you apply for health insurance (other than
pregnancy, tobacco use and disability status)
• Starting in 2014, about 160,000 Coloradans will be newly
eligible for Medicaid because of a state law passed this
year; adults earning up to about $15,000 a year, couples
earning up to about $21,000 and families of four earning up
to about $32,000 will be eligible for Medicaid and the
Marketplace will help you access Medicaid and CHP+
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Other facts to know
• There will be set open enrollment periods for commercial
health plans that will provide coverage for the calendar year
o Oct. 1 2013 to March 31 2014
o Oct. 15, 2014 to Dec. 7, 2014 for future years
• Customers who sign up by the 15th of the month will have
coverage begin on the first of the next month; if you sign up
after the 15th, you will wait until the following month
• There will be ways to sign up for coverage outside of open
enrollment periods (loss of job, marriage or divorce, move
into the state, birth of child, change in income, etc)
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Comprehensive Coverage
Health plans will provide, at a minimum, the following categories of
services, also known as essential health benefits:
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Ambulatory patient services
Emergency Services
Hospitalization
Maternity/newborn care
Mental health/substance abuse
Prescription drugs
Rehab/habilitative services and devices
Laboratory services
Preventive and wellness care/chronic disease management
Pediatric services, including oral and vision care
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How much will I pay?
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Carriers submitted proposed rates to the Colorado Division of
Insurance (DOI) in May
DOI reviewing carrier filings and final rates are expected to be
known in August
Prices depend on age, the region of the state in which you live,
how many people are in your family, and whether you use tobacco
products
Prices will not be affected by your health needs or history
Preliminary filings show a wide range of prices:
o Rates for a 21-year-old living in Denver from the majority of carriers range
from $146 to $234 a month for bronze plans and from $192 to $279 for
silver plans, before cost-reductions based on income.
o Rates for a 40-year-old living in Denver from the majority of carriers will
range from $186 to $299 for bronze plans and from $245 to $357 for silver
plans
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How can I organize my options?
• Health plans will be organized by coverage levels based on
how much of the services, on average, are paid for by the
carrier and how much are paid for by the customer
o Bronze (60% paid by carrier/ 40% paid by customer)
o Silver (70/30)
o Gold (80/20)
o Platinum (90/10)
• You can look for health plans by
• medical provider and facility
• Carrier
• Coverage level
• Premium
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Cost reductions for Individuals & Families
New financial help to reduce the cost of premiums
• Individual earning between $15,856 to $45,960/year
• Couple earning between $21,404 to $62,040/year
• Family of four earning $32,499 to $94,200/year
o Tax credit applied up-front by IRS
o Tax credit is higher for older Coloradans, especially for those ages 55-64
New financial help to reduce out of pocket costs (co-pays and
deductibles)
• Individuals earning $15,856 to $28,725/year
• Family of 4 earning $32,499 to $58,875/year
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Example of Cost Reductions*
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Bill is a 40-year-old male making $30,000 per year
Bill enters the marketplace through the website and applies for
assistance paying for his coverage.
Bill qualifies for $166 per month in premium reduction (tax credit).
Bill shops for and compares health plans with the same base
benefits.
Bill finds a plan that costs $375 per month. The tax credit brings his
total cost to $209 per month.
* Estimate not based on actual prices
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How does the new tax credit work?
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Customers will fill out the financial assistance application,
providing information about future income, tax household,
identity and other details to determine eligibility
Customers will learn how much financial assistance they can
receive
Customers will choose a health plan and decide how much of
the tax credit to use right away to reduce the monthly premium
vs. claiming the credit on taxes
The amount of tax credit will be the same regardless of the
health plan you choose
Customers will need to report change in income to Marketplace
to re-determine eligibility for financial assistance
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How do the new cost-sharing reductions
work?
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Customers will fill out the financial assistance application,
providing information about future income, tax household,
identity and other details to determine eligibility
Customers will learn how much financial assistance they can
receive with the tax credit and reduced co-pays and deductibles
It is possible for customers to receive both forms of financial
assistance, based on income
If eligible, customers can enroll in health plans that have lower
co-pays and deductibles – like an upgrade
Eligible Native Americans can enroll in health plans that have
no co-pays and deductibles for in-network services
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Financial Assistance Application
How Can the SSAp* be
filed?
Who Can file a SSAp*?
The SSAp* will be used to
determine eligibility for…
• Via web site
• An applicant
• Enrollment in QHPs
• By telephone
• An adult in the applicant’s
household or family
• Advance payment of the
premium tax credit
• Authorized representative
• Cost-sharing reductions
• If the applicant is a minor
or incapacitated, someone
acting responsibly for an
applicant
• Medicaid and CHP+
• By mail
• In person
• * Single Streamlined Application is the
formal name for the new financial
assistance application
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Application Process
Create Account
Income
Privacy/Getting
Started
Special
Circumstances
(e.g. disabilities &
pregnancy)
Help Paying for
Coverage?
Gather
Household size
& demographic
info
Program Specific
Questions
Review & Sign
- Eligibility Results
- Required Documents
Needed
- Provide Signature
Plan enrollment
(if applicable)
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Information for financial application
• Estimated household income for coming year (adjusted
gross income reported on 1040 with some additional
information, not including assets such as property)
• Identity info, such as Social Security numbers, for each
person to be covered
• If you have other coverage through an employer, Medicare,
Medicaid and/or pediatric dental through a separate policy
• Info about tax household, Colorado residency status,
immigration status
• Other questions specific to public programs and specialized
populations such as Native Americans
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Benefits for You
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Makes comparing and purchasing commercial health insurance
plans more convenient and competitive
Provides broad array of choices in one place
Helps you make an informed decision by creating transparency
about your options
Only place to check eligibility for new tax credits and apply them
right away to reduce your costs
Offers you statewide network of trained professionals to help you
access the new financial help and find the health plan that is right
for you and your family
A new service operated by a non-profit with the mission to help
Coloradans
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Contact
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Website: www.ConnectforHealthCO.com
Questions: [email protected]
Consumer questions: 855-PLANS4YOU (855-752-6749)
Social Media:
@C4HCO (consumers)
@COHBE (stakeholders)
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