Ray Beck: Understanding how to get health care through new regulations

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Ray Beck

The CLUB 20 Education and Research Foundation, through a grant from the Colorado Trust, has spent the past two years conducting meetings throughout western Colorado to learn about access to health care in rural communities. The meetings helped the CLUB 20 Foundation to engage western Colorado community leaders in the health care dialogue as well as to learn about what is working and what is not in regard to health care in rural Colorado. As a result of these meetings (26 community meetings and 8 regional meetings in all), concerns were raised about the broad-reaching implications of the Patient Protection and Affordable Care Act. In an effort to provide some answers to the many questions and concerns raised about the implementation of the Affordable Care Act, the CLUB 20 Foundation partnered with CLUB 20 to bring in state and national leaders for the annual fall meeting held Saturday.

Ned Colagne, president and CEO of the Colorado Trust, pointed out that the health care law is about more than just Medicaid expansion — it is about emergency care. A number of speakers throughout the day provided a wealth of information about the Affordable Care Act and the requirements we will need to consider during implementation. I can tell you that this bill is very complex and can be complicated for the average individual; it is going to require that everyone get educated and informed. The Affordable Care Act will impact everyone in America. As the day progressed, I found myself becoming more discouraged rather than encouraged. While this national health care reform bill certainly provides some benefits, it will have huge impacts on businesses small and large. It is the law, however, and we need to figure out how we can make the system work for the benefit of our communities and residents.

The law requires every state to set up an insurance exchange, or marketplace, to be available by Oct. 1 so individuals and small businesses can shop for the coverage that will meet their specific needs and budget. Colorado is well on its way to meeting that requirement. Connect for Health Colorado will be open Oct. 1, so people can shop for individual or business insurance plans as well as determine if they are eligible for premium support (tax credit) payments. If an insurance plan is purchased through the Colorado marketplace, the first premium will be due Dec. 15, and coverage will begin Jan. 1. Premium support payments only can be obtained by purchasing insurance through Connect for Health Colorado. The enrollment period will be extended this year to March 2014; after that, the only time you may enroll for health insurance will be during the standard open enrollment period beginning Oct. 1 annually. Of course, major life events like loss of a job, marriage, etc. may trigger the eligibility for enrollment.

There was a good deal of discussion about how individuals and businesses will know about the Connect for Health Colorado marketplace. If you expect that the government is going to send you a notice in the mail, that is not the case. It is up to individuals and employers to get educated, and businesses must provide information regarding the availability of the Connect for Health Colorado marketplace to their employees no later than Oct. 1. This notice must be provided even if a business does not or will not provide health insurance to its employees.

At the Connect for Health Colorado marketplace, there will be 242 health plans to choose from. There will be 150 individual plans and 92 business plans. Individuals are required to purchase health insurance or they will be subject to fines for failure to do so. Employers with more than 50 employees will be required to provide insurance for their employees or face fines if they do not beginning Jan. 1, 2015. Insurance purchased online will require the completion of an application, so be prepared to provide information regarding your household income to determine if you qualify for assistance in paying for your health insurance premium. If you provide false information about your income and the IRS finds out, your insurance will be terminated immediately and you will be required to pay back any premium support (tax credit) payments you may have received.

States that have chosen to establish an exchange have developed them differently — those that have not set up an exchange will default to the model established by the federal government. Colorado’s exchange was developed to provide a competitive marketplace for health insurance providers and has done a good job in preparing for its implementation. Colorado’s ultimate goal in complying with the law is to provide insurance for the 400,000 residents who currently are uninsured. We were told that this is absolutely a necessity because of the continually rising costs of health care as it is consuming the American economy. America spends 18 cents on every dollar for health care while most of the developed world spends significantly less on health care costs.

I would encourage everyone to get informed and educated by seeking out a health care professional who is well informed about the Affordable Care Act and by seeking out an attorney who can help you sort through the provisions of the law. Connect for Health Colorado will have guides available throughout western Colorado to help you navigate the website and apply for premium support if you qualify. While guides cannot advise you about which insurance plan best meets your needs, insurance agents can help you pick the best plan for you and/or your family. For more information, you can call 855-PLANS-4-YOU or 855-752-6749. You also may go online to www.connectforhealthco.com for answers to your questions. CLUB 20 will have all the meeting presentations on its website this week, and you can view them at www.club20.org.

I hope this information will be beneficial to the community, as open enrollment will become available Oct. 1.

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