July 28, 2013 Updated: July 28, 2013 at 3:05 pm
In a few months, Coloradans will be able to buy major medical insurance plans the same way they buy books, televisions and other products: online, and with customer support.
The Connect for Health Colorado health care insurance exchange opens its online marketplace Oct. 1, giving consumers the opportunity to compare health insurance plans, buy one that suits them and find out if they qualify for federal credits under the Affordable Care Act.
The state has continued to move forward with the exchange, despite recent attempts in Congress to delay federal mandates requiring businesses with fewer than 50 employees and individuals to buy coverage before Jan. 1.
Even if Congress delays or changes what is called Obamacare, it would not affect the establishment of the state's exchange, said Myung Kim, director of communication and outreach for Connect for Health Colorado.
The state has established a call center in Colorado Springs to help people choose coverage, and several walk-in sites will also open in Colorado Springs to help people buy federally backed health insurance and apply for tax credits.
Some advocacy and nonprofit groups have published estimated costs of upcoming health plans on their websites. But actual plan prices won't be know until after Thursday. And there are several factors, such as a person's age, that will affect the costs of each plan price once listed on the official state website.
Meanwhile, here are some important facts about how the exchange will work, who can qualify for future tax incentives and other information.
Q: When can I buy insurance through the exchange?
A: The exchange is scheduled to open Oct. 1. Those who enroll in plans before Dec. 15 will have health care coverage starting Jan. 1. Those who do not buy coverage before Jan. 1 still can enroll in a plan until March 31. After that, however, the next chance to enroll will be Oct. 15, 2014.
Q: What if I am laid off, fired or quit my job during a non-enrollment period?
A: Then you can apply for insurance coverage through the exchange at that time.
Q: OK, but if I buy health insurance through the exchange after Dec. 15, when does my coverage begin?
A: Those plans bought after Dec. 15 will take effect on the first day of the next month. Coverage bought between Dec. 16 and Dec. 31 takes effect Feb. 1. Starting in January, health plans bought after the 15th of any month will not go into effect on the first day of the second month after the purchase.
Q: Can I still buy insurance through a private insurance company or broker?
Q: Am I required to buy health insurance?
A: Yes and no. The law says everyone, with some exceptions, must be insured or face a fine - maybe. Members of certain religious organizations, members of a federally recognized tribe, those who cannot find an affordable plan and people who are not lawfully present in the United States are not subject to the mandate. President Barack Obama recently said the federal government will not enforce the mandatory penalties on certain employers who do not provide health insurance for workers for at least another year. On July 18, the House passed a resolution stating the penalties won't be enforced on individuals who fail to buy insurance for the same amount of time. The resolution must still pass the Senate.
Q: What areas of coverage will plans provide?
A: Each plan will cover at least 10 major medical areas, such as: doctor visits, hospitalizations, maternity care, emergency room care and prescriptions.
Q: How much coverage will each plan offer, and what is my responsibility?
A: The bronze plan will cover 60 percent of medical costs, while the patient will pay 40 percent. For the silver plan, insurance covers 70 percent of medical costs, and the patient picks up 30 percent. Gold plans are 80/20, and platinum plans are 90/10. None of those plans fall under the federal government's term of "Cadillac Plans," which require a penalty when purchased, Kim said. The cost to buy insurance from the state exchange doesn't include co-pays, any deductible and yearly maximum out-of-pocket expenses.
Q: Who is eligible for the tax credits intended to reduce the cost of obtaining insurance?
A: Individuals earning $15,856 to $45,960 annually, and married couples earning $21,404 to $62,040 annually. A family of four is $32,499 to $94,200.
Q: Are the plans being created by private insurers for the exchange the same as those offered by insurance companies now?
A: Some will be the same, others won't. But no one really will know until after Thursday, when the state is expected to make the final decision on which health insurance plans it will offer.
More than 150 insurance plans are being reviewed by the state that, if approved, will be sold through the exchange.
Q: Which insurance companies are providing insurance through the exchange?
A: Again, that will not be known until after Thursday when the state chooses which plans will be offered.
Q: Can I get advice through the exchange on what coverage each plan offers, the cost of the plans, how the plans work and which is best for me and my family?
A: Yes and no. The exchange has a website that explains the basic cost and coverage of each plan.
But exchange representatives are not allowed to steer you to a certain plan, explain plans, offer advice or tell you which plan might offer better coverage for the cost. All exchange representatives are allowed to do by law is help you apply for insurance and see if you qualify for federal assistance.
Q: What factors will influence the cost of coverage that could make my price different than what is shown on websites?
A: Age, where a person lives and if the insured is a smoker are three of the factors that will influence insurance prices.
Q: Can I use money from my Health Savings Account to pay for insurance premiums?
Q: Can I buy insurance coverage through the exchange, if I can get coverage through my employer?
A: Again, it's a yes-and-no answer. If you have a job that provides insurance, you can only buy coverage through the exchange if the premium costs for your employer provided insurance is more than 9.5 percent of your total annual adjusted household income.
If the cost of employer provider health insurance is 9.5 percent or less than your annual adjusted household income, you must acquire your health insurance through your employer.
Contact Ned Hunter: 636-0275