Health Insurance Options for Karen Spink, Assistant Director Health District of Northern Larimer County

Transcription

1 Health Insurance Options for 2014 Karen Spink, Assistant Director Health District of Northern Larimer County

2 Today s presentation topics Affordable Care Act Basics Health Insurance Marketplaces Individual and Families Small Business Where to get local assistance Health Insurance in Colorado

3 Why Does Health Insurance Matter?

4 Just the basics...

5 The Law Stops Insurance Companies from Taking Advantage of You TODAY, it is illegal for insurance companies to: Deny coverage because of a pre-existing condition like asthma or diabetes. Put a lifetime cap on how much care they will pay for if you get sick. Cancel your coverage when you get sick by finding a mistake on your paperwork. And more

6 You can get free prevention services that keep you healthy Cancer screenings such as mammograms & colonoscopies Vaccinations such as flu, mumps & measles Blood pressure screening Cholesterol screening Tobacco cessation counseling and interventions Birth control Depression screening And more Visit for a full list.

7 Changes to how carriers use premiums BEFORE, insurance companies spent as much as 40 cents of every premium dollar on overhead, marketing, and CEO salaries. TODAY, the new 80/20 rule says insurance companies must spend at least 80 cents of your premium dollar on your health care or improvements to care. If they don t, they must repay the money. 60% / 40% 80% / 20%

8 Young Adults can stay on their parents insurance plan Until the age of Million young adults Stayed on or joined their parent s health plans between November 2010 and November million of them Likely would not have been able to do so prior to the passage of the affordable care act

9 10 Essential Health Benefits Emergency Services Outpatient or ambulatory services Preventive and wellness services Maternity and newborn care Pediatric services Hospitalization Mental health and substance abuse services Rehab and Habilitative Services Prescription Drugs Laboratory Services

10 Health Insurance Options for Individuals and Families Medicaid Health Insurance Marketplace Private Market

11 Health Insurance Marketplaces

12 What is a Health Insurance Marketplace? The Marketplace is a new way to find quality health coverage. It can help if you don t have coverage now or if you have it but want to look at other options. With a Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options sideby-side, and enroll.

13 Continuum of Exchange Options State Based Exchange State operates all exchange activities State Partnership Exchange State operates plan management and/or consumer assistance activities; may determine CHP+/Medicaid eligibility Federally Facilitated Exchange HHS operates all exchange activities; states may determine CHP+/Medicaid eligibility

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15 Health Insurance options in Colorado New resources available based on income Medicaid will be available to many more Coloradans Individuals earning up to about $15,000 a year New kind of tax credit available to Coloradans who earn too much for Medicaid and up to about $45,000 a year for individuals and $94,000 a year for family of 4 Health insurance plans with lower co-pays and deductibles also available to certain individuals and families who earn too much for Medicaid

16 What is Connect for Health Colorado? Colorado s own competitive marketplace for private health insurance for individuals, families and small businesses Separate from federal website, healthcare.gov Only place to determine eligibility for and access new federal financial assistance with premiums, deductibles, and copays Statewide Customer Support Network

17 Connectforhealthco.com

18 Individual and Family Marketplace

19 Compare Health Plans

20 Carriers offering individual and family plans in Larimer County Access Health Colorado Anthem Blue Cross and Blue Shield/HMO Colorado Colorado Choice Health Plans Colorado HealthOP Kaiser Permanente Rocky Mountain Health Plans

21 Sample Plan Costs* Tier Level Monthly Premium 27 year old Monthly Premium 46 Year old Deductible Out of Pocket Max Office Visit Catastrophic (Kaiser) Bronze (Kaiser) Silver (Anthem) Gold (Colorado HealthOp) $ NOT ELIGBLE $6,350 $6,350 $50 Co-pay $ $ $5,000 $6,350 30% Coinsurance after deductible $ $ $2,000 $6,350 $35 Co-pay $ $ $1,000 $3,750 $30 Co-pay *Without Premium or Cost Sharing Assistance

22 Affordability New tax credit to reduce the cost of premiums Individual earning about $15,000 to $45,500/year Couple earning about $21,000 to $62,000/year Family of four about $32,000 to $94,000/year Health plans with lower co-pays and deductibles Individuals earning about $15,000 to $28,500/year Family of 4 earning about $32,000 to $58,500/year

23 Financial Assistance Application Process Shop and Compare/Apply for financial assistance Medicaid Denial Advance Premium Tax Credit/ Reduced Cost-sharing Pick plan and make payment

24 Colorado Employers and Health Care Reform

25 New Options for Small Businesses

26 Small Business Marketplace For employers with 2-50 full-time employees Small Business tax credit to eligible employers No federal requirement for small employers to provide insurance (no IRS fee) No open enrollment deadlines like the individual marketplace Ability to work with a network of 1,400 licensed agents Additional support from Assistance Sites and Customer Service Center

27 Small Business Marketplace

28 Carriers offering Small Business plans in Larimer County Anthem Blue Cross and Blue Shield/HMO Colorado Colorado Choice Health Plans Colorado HealthOP Kaiser Permanente Rocky Mountain Health Plans SeeChange Health

29 Where do people turn for help? Connect for Health Colorado Online Chat: State Phone Helpline: PLANS4YOU ( ) In-Person Help: 5 fixed sites in Larimer County Trained Health Coverage Guides Other Health Coverage Guides and Certified Application Counselors Brokers

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31 Local, In-Person Assistance Certified Health Coverage Guides can: Help you understand the new health-care law Help you determine your eligibility for Medicaid, CHP+ or financial assistance Assist you in creating an account, finding and viewing health insurance plans and explaining health coverage options and tax credits Assist you with the online enrollment process Inform you of next steps

32 Certified Health Coverage Guides: Providing Local In-Person Assistance at 5 Sites in Larimer County Larimer Health Connect Old Town, 144 N. Mason, Unit 7 Family Medicine Center, Fort Collins Salud Family Health Centers, Fort Collins Larimer County Dept of Human Services, Fort Collins Larimer County Offices, Loveland

33 Health Insurance in Colorado By the numbers....

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35 Larimer County Statistics Total Larimer County Population: 257,365 Uninsured Population: 32,079 (12.5%) Insured after Health Reform: 21,745 (8.4%) Still uninsured after Health Reform: 10,334 (4.0%)

36 A comparison of Marketplace enrollments State Based Exchanges Colorado: 52,773 as of Dec. 31, 2014 State Enrollments State Enrollments Maryland 18,257 Nevada 17,673 Oregon 20,000 Minnesota 25,680 Washington 65,472 Kentucky 33,289 California 400,000 New York 137,783

37 Individual and Family Metrics Through January 15, 2014 more that 165,000 Coloradoans have new coverage in ,407 Coloradans signed up for coverage on the Marketplace 101,730 Coloradans have been approved for coverage in Medicaid

38 Small Business Metrics Through December 31, 2014: 3,683 small businesses created accounts 1,345 small businesses started open enrollment process for employees to sign up for private health insurance 101 small businesses completed enrollment process 1,050 employees and their dependents covered Businesses moving forward with enrollment for February and future months

39 Key Takeaways This is Colorado s own Marketplace separate from the federal insurance marketplace Connect for Health Colorado is the only place to access new cost savings You can get local, in-person help from certified Health Coverage Guides and agents Open enrollment continues until March 31, 2014, and year round for life change events on the individual marketplace Enrollment for businesses and Medicaid are available year round.

40 Upcoming Event for Small Businesses

41 Larimer Health Connect (970)