1. AAFP 2013 State Legislative Conference
November 2, 2013
Lindy Hinman

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
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3. Colorado’s Health Reform Story
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Passed in May 2011
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SB 200 establishes the
framework for the state
Exchange
Governed by a Board of
Directors
Legislative Implementation
Review Committee
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• Mission is to increase
access, affordability, and
choice for individuals and
small employers
purchasing health
insurance in Colorado.
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4. 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
A combination of high-technology and human network to assist
Coloradans in finding health insurance
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5. Connect for Health Colorado is NOT
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A replacement for the current market or brokers
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Engaged with negotiating rates between carriers and providers
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Part of Medicaid
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A new government health care system
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A State agency or regulatory body
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An organization that pulls funding from Colorado General Fund
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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)
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8. Individuals and Families
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The Marketplace is for Coloradans who:
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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
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Online shopping, with assistance by phone and in-person
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Insurance carriers compete for your business:
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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
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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
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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
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12. Get Started: Quick Estimate of Eligibility
and/or Browse Plans
www.prd.ConnectforHealthCO.com
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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
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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
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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
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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
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17. How it Works
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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
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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
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Adjust the monthly tax credit to take less per month if income
fluctuates
Report changes in income or household size to Marketplace
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18. Adjust the monthly tax credit to take less per
month if income fluctuates
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19. Financial assistance application process
Shop and
Compare
Advance
Premium Tax
Credit
Medicaid
denial
In October,
finish
enrollment
through
Customer
Service Center
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20. Health Plan Shopping
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21. Compare Health Plans
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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
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23. Benefits for Consumers
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Makes comparing and purchasing health coverage more
convenient and competitive
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Provides broad array of choices in one place
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Helps you make an informed decision by creating transparency
about your options
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Only place to check eligibility for new tax credits and apply them
right away to reduce your costs
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Offers a statewide network of trained professionals to assist
consumers
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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
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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
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26. Contact
• Website: www.ConnectforHealthCO.com
• Email questions: Info@ConnectforHealthCO.com
• Toll-free help by phone: 1-855-PLANS-4-YOU (855752-6749) 7 am to 8 pm Monday to Saturday
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