Medical Moment: The Health Care Act & You

04 Oct Medical Moment: The Health Care Act & You

Telluride Inside… and Out is proud to feature the Telluride Medical Center’s MEDICAL MOMENT, a weekly column that answers common medical questions in pop culture.

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Answer by:
Guest Medical Moment by Adrienne Christy Certified Health Coverage Guide Tri-County Health Networ

Adrienne Christy, Certified Health Coverage Guide, Tri-County Health answers this week’s question: What does the Affordable Care Act mean for me and my family?

Like most Americans, residents of Telluride have found themselves eager to learn more about the new healthcare reform act. As the implementation date was October 1st, we are are all asking ourselves:

What does the Affordable Care Act mean for me and my family?

Tri-County Health Network is right here to educate and assist Telluride residents, so that you all may feel empowered and informed as you move forward in this new healthcare landscape.

We encourage you to ask us questions: stop us on the street, email us, and call us, text us, we are here to help! Below we have outlined some basic information on the Affordable Care Act.

We realize that this information may lead to more questions, please keep an eye out for more information about venues we will be holding around town and we encourage you to attend any and all of these events. Also, if you would like us to deliver a presentation to your group, please call us-we would be delighted!

So, what does the new federal law mean to me and my family? If you are covered under a health plan offered by your employer, or if you are currently covered by a government program such as Medicare, you can continue to be covered under those programs.

Since I am required to buy my own health insurance, how do I do that? The federal law established the ability of states to create their own health insurance marketplaces. If a state decided not to create their own, then they would be part of the Federally Facilitated Exchange. Our state took the lead, and has established Connect for Health Colorado.

What is Connect for Health Colorado? Connect for Health Colorado is a non-profit, competitive marketplace where Coloradans can compare prices and purchase commercial insurance; view a broad choice of health plans; check eligibility for new tax credits and apply them to reduce the cost of coverage; and take advantage of the statewide network of trained professionals to assist in the enrollment process.

You mentioned tax credits, what are they and how do I get them? Advance Premium Tax Credits (APTC) are a way for individuals, families and small businesses (2- 50 employees) to reduce the cost of health insurance. The APTC, or tax credits, are based on the Federal Poverty Level (FPL). Individuals and families are eligible for these tax credits if their income is between 133% and 400% of FPL. To give you an idea, an individual making $15,282 to $45, 960 per year or a family of four with a household income between $31,322 and $94,200 per year, would be eligible for a tax credit. These tax credits are only available through Connect for Health Colorado and may be used in advance to reduce the up-front cost of health care. In addition to tax credits, individuals and families between 133% and 250% of FPL will be eligible for cost sharing reductions (CSR), which will reduce the out of pocket expense a person will be required to pay. Again, these are only available to those that purchase their health insurance through Connect for Health Colorado.

What if my annual individual or family income is lower than 133% of FPL? Due to Colorado expanding its Medicaid eligibility, beginning January 1, 2014, individuals earning up to 133% of FPL will be eligible for Medicaid. In the past, Medicaid has had complicated and confusing enrollment criteria and a lengthy application form. This has been simplified to four eligibility criteria and a more user friendly form.

I am still not sure where I and/ or my family fit into these affordability programs, is there anywhere I can go to see numbers specific to my situation? Currently, the Connect for Health Colorado website has a calculator that will help you determine what new cost reductions you could qualify for.

Now I know I will be able to afford it, what kind of plan options will I have? Within the exchange there will be four tiers of plans, bronze, silver, gold and platinum. Each of these plans will offer different cost sharing percentages, deductibles, etc. The following carriers will offer coverage through Connect for Health Colorado:

• All Savers
• Colorado HealthOP (CoOp)
• HMO Colorado
• Humana Insurance Company
• New Health Ventures
• Rocky Mountain Health Plans
• Time Insurance Company

What does October 1, 2013 really mean? On October 1, 2013, Connect for Health Colorado opens for business! Individuals and families will be able to shop for health plans and determine what is best for them and their families. However, individuals must keep in mind that health plans purchased between October 1, 2013 and December 31, 2013, will not go into effect until January 1, 2014.

Who can help me if I have more questions? Tri- County Health Network has received grant funding through Connect for Health Colorado to be part of their In-person Assistance Network.

There will be two people in Telluride who are responsible for assisting community members. Adrienne Christy is a Certified Health Coverage Guide and Leo Peralta is a certified Entitlement Enrollment Navigator. Both Leo and Adrienne will be holding community forums, office hours at various locations around town and will be available for individual and family specific assistance.

Editor’s note: The Telluride Medical Center is the only 24-hour emergency facility within 65 miles. As a mountain town in a challenging, remote environment, a thriving medical center is vital to our community’s health.

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