Understanding Health Care Reform

Colorado’s health insurance exchange, called Connect for Health Colorado is a government-run entity opening in October where individuals, families and businesses with fewer than 100 employees can shop for health care plans. Health insurance exchanges are part of the Patient Protection and Affordable Care Act (PPACA) that President Obama signed the into law on March 23rd, 2010 and upheld by the US Supreme Court ruling on June 28th, 2012. The Affordable Care Act is also know as “Obamacare” or “ACA”.

The Biggest Health Care Reform Changes Include:

 

EVERYONE MUST HAVE INSURANCE. Starting January 1, 2014, there is a legal requirement for everyone to have health insurance. The only individuals exempt from purchasing health insurance are: those with certain religious beliefs, members of Native American tribes, undocumented immigrants, those who are in prison, and those whose income is below a certain level. If you are not insured through your employer, you have options! You may qualify for Medicaid or for tax credits or federal subsidies that will help you pay your monthly premiums.

NO MORE DELIAL FOR PRE-EXISTING CONDITIONS. Starting January 1, 2014, all health insurers must sell coverage to everyone who applies, regardless of their medical history or health status. At that time, insurers will not be allowed to charge more to individuals with pre-existing conditions, nor will they be able exclude coverage of those conditions from the insurance plans they sell.

SUBSIDIES ARE AVAILABLE. Many people may qualify for new federal financial assistance, based on income, which will reduce the cost of monthly payments and out-of-pocket expenses, only available through Connect for Health Colorado. You must buy your health insurance through Connect for Health Colorado to get the tax credit.

OPTIONS OUTSIDE THE MARKETPLACE. Those who do not qualify for a subsidy, can compare plans outside the Marketplace to see where they can get the best policy for their needs. Those with higher incomes may have better options outside the Marketplace.

DIFFERENCES INSIDE VS OUTSIDE THE MARKETPLACE. There may be differences in plan networks offered outside the MarketPlace. For example an insurance company may offer the same benefit plan both inside and outside the MarketPlace: however the plan offered inside the MarketPlace may only allow access to providers within a strict HMO to keep premium cost lower, while the same benefit plan outside the MarketPlace may offer access to a larger, referral-free PPO network.

PLANS MUST COVER ESSENTIAL HEALTH BENEFITS. The plans offered through Connect for Health Colorado the Colorado must include the following Essential Health Benefits: Hospitalization, emergency services, maternity and newborn care, mental health and substance use disorder services, prescription drugs, laboratory services, pediatric services, preventative management services, ambulatory services, and rehabilitative services.

 

 How Does Health Care Reform Affect Me?

 

Self-insured1        Employed    Not-insured          Medicare

 

Employers