Lindy Hinman's 2013 SLC Presentation


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  • Public non-profit – to be self-sustaining by 2015
  • Lindy Hinman's 2013 SLC Presentation

    1. 1. AAFP 2013 State Legislative Conference November 2, 2013 Lindy Hinman
    2. 2. Key Changes • Starting in 2014, you cannot be denied health coverage based on a pre-existing condition or your health history • Health history or medical needs will not affect your ability to apply for health insurance or the cost (except tobacco use) • Free preventive services, including screenings and annual exams • 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 o You can sign up at other times with qualifying event 12 2 2
    3. 3. Colorado’s Health Reform Story • Passed in May 2011 • SB 200 establishes the framework for the state Exchange Governed by a Board of Directors Legislative Implementation Review Committee • • • Mission is to increase access, affordability, and choice for individuals and small employers purchasing health insurance in Colorado. 3
    4. 4. What is Connect for Health Colorado? An open, competitive marketplace for individuals and small employers to: • • • • • • 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 A combination of high-technology and human network to assist Coloradans in finding health insurance 4
    5. 5. 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 • A new government health care system • A State agency or regulatory body • An organization that pulls funding from Colorado General Fund 5
    6. 6. Getting Help • Customer service center: 1-855-Plans4You o Call us o Online chat • Assistance Sites and Health Coverage Guides • Brokers and Agents • Certified Application Counselors (26, vast majority are provider organizations) 6
    7. 7. 7
    8. 8. Individuals and Families • The Marketplace is for Coloradans who: o o o o Currently buy insurance on their own, Are uninsured, Are not eligible for Medicaid, CHP+, Medicare, or Don’t have access to affordable coverage through their employer • Online shopping, with assistance by phone and in-person • Insurance carriers compete for your business: o o o o • 10 carriers in individual market 150 health plans available 6 carriers are offering 22 dental plans Health plans will provide more comprehensive coverage Customers can access and apply for new federal financial assistance to lower premiums, co-pays and deductibles 8
    9. 9. 9
    10. 10. Small Employers • Small group market for small employers with 2-50 employees. o Various options for employers to provide coverage to their employees • 6 carriers offering 92 small group health plans • 7 carriers offering 45 small group dental plans o Available small business healthcare tax credits for small businesses and non-profits with up to 25 employees and less than $50,000 in average wages • Employers with up to 100 employees can be served in 2016 • Defined contribution and decision support tools available online • Employers can choose 1 plan, 1 carrier, multiple carriers, multiple plans 10
    11. 11. Affordability • New resources available based on income • Medicaid will be available to many more Coloradans • Individuals earning up to about $15,000 a year • Advance Premium Tax Credits (APTCs) available to Coloradans who earn too much for Medicaid and up to $45,000 a year for individuals and $94,000 a year for family of 4 • Tax credit can be used on a prospective basis to offset monthly premium costs or deducted at the end of the year • Health insurance plans with lower co-pays and deductibles also available to certain individuals and families who earn too much for Medicaid 12 11 11
    12. 12. Get Started: Quick Estimate of Eligibility and/or Browse Plans 12
    13. 13. Premium Tax Credits for Individuals & Families Financial help to reduce the cost of premiums (tax credits) • 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 can be applied up-front by IRS o “Reconciled at” the end of the year o Tax credit is higher for older Coloradans, especially for those ages 55-64 13
    14. 14. Cost Sharing Reductions for Individuals & Families Financial help to reduce out of pocket costs (such as co-pays and deductibles) • Individuals earning $15,856 to $28,725/year • Family of 4 earning $32,499 to $58,875/year o Enrollee cost sharing charges are automatically reduced when an eligible person or family enrolls in a silver plan o People do not have to keep track of their spending or get reimbursed o Not provided as a tax credit o Not “reconciled” at the end of the year 14
    15. 15. Maximum Income Eligibility for APTC FAMILY SIZE YEARLY INCOME 400% FPL 1 $45,960 2 $62,040 3 $78,120 4 $94,200 5 $110,280 6 $126,360 15
    16. 16. Maximum Income Eligibility for CSR FAMILY SIZE YEARLY INCOME 1 $28,725 2 $38,775 3 $48,825 4 $58,875 5 $68,925 6 $78,975 16
    17. 17. How it Works • • • Apply using the single streamlined application Calculate tax credit and cost sharing reduction eligibility and amount based on income (Marketplace determination) Choose a health plan o Tax credit amount is the same regardless of the cost of the health plan o Cost sharing reduction benefits only applied to Silver Level Plans • Decide to claim the tax credit right away or later on taxes o The tax credit may be applied up front on a monthly basis, paid by the IRS directly to the carrier lowering customer’s monthly premium • • Adjust the monthly tax credit to take less per month if income fluctuates Report changes in income or household size to Marketplace 17
    18. 18. Adjust the monthly tax credit to take less per month if income fluctuates 18
    19. 19. Financial assistance application process Shop and Compare Advance Premium Tax Credit Medicaid denial In October, finish enrollment through Customer Service Center 19 19
    20. 20. Health Plan Shopping 12 20 20
    21. 21. Compare Health Plans 12 21 21
    22. 22. Individual Marketplace Open Enrollment Open Enrollment Begins Oct. 1 Deadline for enrollment to have coverage Jan. 1, 2014 Dec. 15 Coverage begins Jan. 1, 2014 Individual Open Enrollment Ends March 31, 2014 Shopping starts October 1, 2013 Coverage Begins January 1, 2014 22
    23. 23. Benefits for Consumers • Makes comparing and purchasing health coverage 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 a statewide network of trained professionals to assist consumers 23
    24. 24. Medical Providers • No impact on agreements between carriers and providers • New carriers entering market in Colorado • Medicaid expansion/Guaranteed Issue = More demand for health care services • Network adequacy considerations • Provider groups assisting with obtaining health coverage o Hospitals (incl critical access hospitals) o FQHCs o Safety Net Clinics 24
    25. 25. Spreading the Word! • Marketing campaign: light rail, billboards, t.v., print ads, street teams (grassroots), focus on colleges and universities • Ancillary campaigns • Materials available on website • Request a speaker • Order brochures and other materials at our online store • Refer people to website and Customer Service Center 12 25 25
    26. 26. Contact • Website: • Email questions: • Toll-free help by phone: 1-855-PLANS-4-YOU (855752-6749) 7 am to 8 pm Monday to Saturday 12 26 26