TMH Living Well: Tips on navigating the Health Insurance Exchange

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With the enactment of the Affordable Health Care Act on Oct. 1, many people have questions on what it all means. Will you be forced to buy health insurance? Will it cost more or less? For whom is it designed? We spoke with Keith Velardo, patient financial counselor for The Memorial Hospital in Craig to get some answers to common questions.

Q: What is the health insurance exchange?

A: The online health insurance exchange essentially is a marketplace where private health insurance companies offer insurance options via state and federal programs to individuals and small businesses. The idea is that competition will bring down the price of health insurance and provide better coverage without limitations such as preexisting conditions. Several states have their own exchange. In Colorado, it’s called the Connect for Health Colorado, and it can be viewed at www.connectforhealthco.com. “It’s fairly simple to navigate and only requires a few details to start a search for plans and rates,” Velardo said.

Q. Does everyone have to buy health insurance on the exchange?

A: No. The exchange really is designed for people who do not have insurance, or have trouble affording insurance. If you qualify for Medicaid, you will not need the exchange. Also, if you have a plan through your employer, you most likely will not use it either — unless you currently are paying 9.5 percent or more of your gross income toward premiums.

“If you don’t have insurance, I would definitely recommend looking into the health exchange. But if your employer offers insurance, I’ve found that almost every time you will pay less taking your employer’s plan,” Velardo said.

Q. Will the exchange replace programs like Medicaid, Colorado Indigent Care Program and CHP+?

A: No. These programs still will exist. In fact, Medicaid eligibility will increase from 100 percent to 133 percent of federal poverty guidelines under the new law. This means more people will qualify, and it may especially help seniors. The CICP assists those who are at or below 250 percent of federal poverty guidelines and will continue to do so; however, it is not insurance and will not fulfill the 2014 Federal requirements. “CHP+ — Child Health Plan Plus — assists children with parents making at or below 250 percent of the federal poverty level,” Velardo said.

Q: What types of plans are offered on the health exchange?

A: In Moffat County, we currently have five participating insurance companies, including United Health Care and Blue Cross Blue Shield. There are four levels of plans, from bronze to platinum. The more you spend, the more coverage you get, ranging from insurance payments of 60 percent to 90 percent of cost. “Silver — at 70 percent payment — is the most beneficial plan as far as balancing cost and coverage,” Velardo said.

Q. How does the tax credit for healthcare insurance premiums work? Is everybody eligible for that?

A: No. Only those people who buy a plan through the health exchange are eligible for the tax credit. It’s designed to help those who have trouble affording premiums by essentially paying a portion of their premiums. Therefore, the amount of credit is based on a sliding scale, according to your household income. For example, individuals earning between $15,000 and $46,000 per year will be eligible for a tax credit, and couples earning between $20,000 and $94,000 also will be eligible. Of course, the lower you are on the scale the more credits you will receive. The established federal tax deduction for everyone (deductions start when medical expenses exceed 10 percent of adjusted gross income) will continue.

Q. Where can I learn more about Connect for Health Colorado or receive help signing up?

A: The best place in Moffat County to get answers is the Northwest Colorado Visiting Nurse Association at 745 Russell St. in Craig. They can be reached at 970-824-8233. “The association received a federal grant to help county residents understand and enroll in the exchange. So they have several people that can help,” Velardo said. Residents also can get information at Moffat County Social Services at 595 Breeze St. in Craig.

If you are a recent patient of TMH with outstanding bills that you are having trouble paying, you can make an appointment with Keith Velardo, Patient Financial Counselor at the hospital. He will help you determine what assistance is best for you, or help you establish a workable payment plan. Often, he starts by determining if patients are eligible for Medicaid. If not, he moves on to programs such as CICP and the health exchange to help patients resolve their bills.

Q: What’s the deadline for signing up for the exchange?

A: Open enrollment runs from October 2013 through March 2014. Signing up before the 15th of the month ensures coverage will start the 1st of the following month. For example, to begin coverage by Jan. 1 you must sign up by Dec. 15.

This weekly article with tips on living well is sponsored by The Memorial Hospital at Craig – improving the quality of life for the communities we serve through patient-centered healthcare and service excellence.

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