Understanding the new health insurance landscape
November 7, 2014
Mention the words "health insurance," and most people's eyes glaze over.
It's never been the most riveting subject, and most of us try to deal with it as little as possible. In the past, we've been taught to find a decent plan and hang on to it for as long as we can.
But the rules have changed with the passage of the Affordable Care Act in 2010, and to find the best health insurance plan for ourselves and our families, our approach also must shift.
Open enrollment for 2015 health insurance plans begins Nov. 15. The Craig Daily Press is pleased to offer a three-part series demystifying the new health insurance system, the enrollment process and how it is affecting people in Northwest Colorado.
Part 1: Getting ready for open enrollment for 2015 health insurance plans
There are multiple ways for Coloradans to catch a lucky break on health insurance costs, including tax credits and state aid programs such as Medicaid and Child Health Plan Plus.
Paired with the fact that health insurance plans and premiums in each region are reformulated each year, that means that you could be missing out on better coverage and big savings by not looking into your options come Nov. 15.
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The new health insurance system operates on a yearly cycle, with an annual renewal and enrollment period offering consumers the opportunity to sign up for a new plan.
This year's open enrollment period is from Nov. 15 to Feb. 15, only half the length of time it was last year.
This is the only time of year consumers can sign up for regular health insurance, excepting those with qualifying life events such as marriage or having a child or those who qualify for state aid programs.
"If people want health insurance effective Jan. 1, they need to have everything finished by Dec. 15," said Erin Gleason, community health insurance coordinator at the Northwest Colorado Visiting Nurse Association.
The same deadline holds true if you want to change your plan for the coming year.
"If they pay their January premium, they essentially effectuate their same policy for the rest of the year, but there are potentially better deals available to people," Gleason said.
In other words, once you've paid that premium, whether you sign up for a new plan or allow your old plan to roll over, you are locked in for the year.
The past method of buy and hold is no longer the most advantageous when it comes to health insurance, according to Gleason.
"People need to come in every single year and re-evaluate the policies that are offered," Gleason said. "There's something there for everyone."
One of the biggest changes to health insurance as a whole is that no person can be denied coverage because of a pre-existing condition.
"Everyone has access to insurance plans now, everyone," said Suzi Mariano, director of communications at the VNA.
Something for everyone
In Colorado, consumers can choose between a private health insurance provider, the federal health insurance marketplace — http://www.healthcare.gov — or Colorado's own health insurance marketplace, Connect for Health Colorado — http://www.connectforhealthco.com — which has 176 plans to offer this year.
Connect for Health Colorado is a nonprofit organization that was established by the Colorado state Legislature in 2011 to offer a "one-stop online marketplace" for individuals, families and small businesses across the state, according to the Colorado Department of Regulatory Agencies.
Furthermore, "It is the only place where Coloradoans can access financial assistance to help with the cost of health insurance," according to the DORA website.
Tax credits are available to consumers, based on income level, who do not have health insurance through their employer. By offsetting your total monthly payment, the tax credit serves to lower your monthly out-of-pocket costs.
You can find out if you qualify for tax credits using the Tax Credit Estimator tool on the Connect For Health website or by meeting with a health coverage guide at the VNA.
"It's absolutely worth coming and talking to someone one-on-one to see what you might qualify for," Mariano said.
Gleason described the story of one Craig couple in their 60s that was paying $1,200 per month for catastrophic coverage. After sitting down with someone at the VNA, they discovered they qualified for $1,100 in tax credits and found a health insurance plan with significantly better coverage that cost them only $79 per month.
"Financially, it makes sense and it’s well worth the time spent," Gleason said. "We help people get tax credits of hundreds of dollars a month. … Now, there's just so many more opportunities for people than before."
Those who lack a qualifying health insurance plan under the ACA for more than three consecutive months will face a penalty when they file their taxes, equaling 1 percent of an individual's adjusted gross income per uninsured member of the household (or 0.5 percent for children younger than 18), according to Gleason. The penalty will increase to 2 percent in 2015.
To get free one-on-one help from a health coverage guide, visit http://www.nwcovna.org/healthinsurance.php or call 970-824-8233 to set up an appointment starting Nov. 15.
Contact Lauren Blair at 970-875-1794 or lblair@CraigDailyPress.com.