Cover: Covering Colorado

Sunday, September 01, 2013 12:01 PM

Connect for Health Colorado opens in October

Kate Alfano, CMS contributing writer

Click here to download CMS’ physicians’ guide

The countdown is on for the launch of Connect for Health Colorado, the state’s new health insurance marketplace. Starting Oct. 1, the nonprofit will offer a place for individuals, families and small businesses to shop, compare and purchase private health insurance with benefits starting Jan. 1, 2014 for those who sign up by Dec. 15. They’ll also provide assistance for Coloradans to find the best health plan for their needs through customer service center representatives, health coverage guides and licensed agents and brokers.

As authorized by the Affordable Care Act, federal financial assistance will be available to individuals or families who need health insurance, who are not eligible for public health coverage through Medicaid or Medicare, and who do not have access to affordable coverage through a large employer. In general, this includes individuals earning between about $15,000 and $46,000 a year, couples earning between about $20,000 and $62,000 a year, and families of four earning between about $31,000 and $94,000 a year. Essentially, financial assistance begins where public health coverage ends in terms of income level. And those earning above the threshold for assistance can still shop for and purchase private health coverage through the marketplace without financial help.

Employers who have fewer than 25 employees and who pay average annual wages below $50,000 and provide health insurance may be eligible for a small business tax credit to offset the cost of premiums.

Gretchen Hammer is the executive director for the Colorado Coalition for the Medically Underserved and chair of the 12-member board for Connect for Health Colorado. She spoke at CMS’ Spring Conference in May.

“We believe that competition is a good thing. Customers will have the opportunity to shop for and compare health insurance products for the first time in an organized fashion. They’ll be able to be better informed and they’ll have the ability to really consider health insurance plans and pick the one that’s going to meet the needs of their small business or those of their family.”

Open marketplace
Connect for Health Colorado is an open marketplace model exchange, which means that health plans that make it through the Division of Insurance regulatory process have the ability to sell their products through the exchange. “It is a much more competitive marketplace than perhaps some of the other models will be as they begin to crop up around the nation,” Hammer said.

“This really will be a new way of purchasing health insurance,” she continued. “It will work in concert with the current marketplace. It does not replace the current marketplace but rather will be a new pathway to coverage.”

States had the option to set up their own exchange or to let the federal government facilitate an exchange for them. The District of Columbia and 16 states, including Colorado, chose to establish a state-based exchange; seven are pursing a state partnership exchange; and 27 declined to set up an exchange and will default to have a federally-facilitated exchange.

Hammer said Colorado should be proud of our approach. Five years have passed since the Blue Ribbon Commission for Health Care Reform, or 208 Commission, released recommendations to expand health care coverage and reduce health care costs for Coloradans. One of the recommendations was to create a “Connector” to help individuals and small employers understand and choose among insurance options. This concept recognized the high proportion of small businesses in the state and the struggle of individuals to find affordable coverage on the private market, Hammer said.

Legislation authorizing the Colorado Health Benefit Exchange was passed by the General Assembly and signed by Gov. John Hickenlooper in 2011. The exchange re-branded itself as Connect for Health Colorado in May 2013. Because elected officials enabled the state-based exchange, Colorado stakeholders have had the opportunity to tailor the marketplace to meet the needs of the population. Hammer said this allows Connect for Health Colorado to focus on rural areas of the state, where a disproportionate number of uninsured Coloradans live and where many small businesses are located. Additionally, Colorado’s exchange will offer more choices for small businesses than the federally-facilitated exchanges when they are launched.

“The opportunity to have had this conversation for the last three years is perhaps something that we don’t necessarily recognize as a gift because the conversation has been long and at times difficult, but it really is a gift that we have been able to come together as a state, think about this, talk about it, recognize the needs of the current players in the marketplace, and recognize and understand the needs of our potential customers,” Hammer said. “I would argue that we would probably not feel as comfortable with that being handled at the federal level.”

Lorez Meinhold, deputy executive director of the Colorado Department of Health Care Policy and Financing, who also spoke on the panel at Spring Conference, added that having a state-based exchange allows Colorado Medicaid to have a closer relationship with Connect for Health Colorado, particularly when it comes to the question of “churn,” when beneficiaries’ income level shifts their eligibility between public assistance and the private market.

“We know that people’s incomes are going to change and they’re going to move between systems,” Meinhold said. “We can work very collaboratively to make that as seamless as possible so someone has a medical home and, regardless of the payer, that continuity of coverage continues. So the close working relationship we have both from an IT system and an appeals system is important, and we would lose that if we had a federally-run exchange.”

“In the IT system, we want people to have a common application that determines whether they’re eligible for Medicaid. If they’re not, we pass that information to Connect for Health Colorado, which determines their level of financial help and gets them enrolled,” she continued. “In the appeals system, we want to make sure people don’t get caught between an appeal, where we say they’re not eligible for Medicaid and Connect for Health says they’re not eligible for financial help. The melding of public and private insurance has never been done before to the level required by the Affordable Care Act so partnership and collaboration will continue to be key.”

With less than two months remaining before Connect for Health Colorado opens for consumers to shop for and enroll in insurance plans, there are a few things stakeholders can do to help ease the transition. Of the 125,000 uninsured children in Colorado in 2011, 89,200 were eligible but not enrolled in Medicaid or the Child Health Plan Plus (CHP+), Hammer said. And there were 47,000 parents who were eligible to participate in Medicaid because they have a child who is enrolled in Medicaid, but who were not enrolled.

“We could all put our shoulders to the boulder and try to get those enrolled who are currently eligible but not enrolled,” she said. “This would be helpful for a couple of reasons: It would help those patients and families immediately, it would help providers who are struggling to balance uninsured and patients with a payer source, and it would help the system to get moving a little bit so we don’t have as big of a rush in 2014.”

Physicians will undoubtedly receive questions about the exchange from patients. Connect for Health Colorado encourages health professionals to refer patients to the organization’s website at www.ConnectforHealthCO.com, where they can get more information and an estimate of potential financial assistance to reduce the cost of insurance. Patients can also call the exchange’s toll-free number, 1-855-PLANS4YOU (855-752-6749), with general questions.

Physician’s guide to health insurance exchange

Connect for Health Colorado, the state’s new online health insurance marketplace called for by the Affordable Care Act and approved by state law, will go live in October and may have a big impact on your practice. That’s why Colorado Medical Society has developed a new resource to help physician members understand and prepare for up to 240,000 newly insured patients that are projected in 2014 thanks to the exchange. Connect for Health Colorado: A Physician’s Guide to the State’s Health Insurance Exchange covers important topics including:

• Participating health plans;
• Patient churn between these new marketplace products and Medicaid;
• 90-day grace period and how your practice may not be reimbursed for services delivered to patients that don’t pay premiums; and
• Impacts of patient cost sharing.

Click here to learn about these issues and more with A Physician’s Guide to the State’s Health Insurance Exchange.

Connect for Health Colorado to offer 242 insurance plans from 13 carriers

The Colorado Division of Insurance (DOI) has reviewed and approved a number of new health insurance plans for consumers and small businesses starting Jan. 1, 2014. Division of Insurance actuaries made sure that the new plans met the federally defined coverage levels: bronze (60% of costs paid by the plan), silver (70%), gold (80%) and platinum (90%).

Of the 541 plans authorized by the DOI to do business in the state, Connect for Health Colorado will offer 242 plans from 13 carriers:

• All Savers Insurance Company: 9 individual plans
• Cigna Health and Life Insurance Company: 11 individual plans
• Colorado Choice Health Plans: 12 individual, 10 group plans
• Colorado Health Insurance Cooperative Inc.: 8 individual, 6 group plans
• Denver Health Medical Plan Inc.: 4 individual plans
• HMO Colorado Inc. (Anthem): 14 individual plans, 3 group plans
• Humana Health Plan Inc.: 7 individual plans
• Kaiser Foundation Health Plan of Colorado: 27 individual plans, 24 group plans
• New Health Ventures Inc.: 6 individual plans
• Rocky Mountain Hospital and Medical Service Inc. (Anthem): 2 group plans
• Rocky Mountain HMO: 52 individual plans, 30 group plans
• Rocky Mountain HealthCare Options Inc.: 14 group plans
• SeeChange Health Insurance Company Inc.: 3 group plans

Source: “Division of Insurance Approves Final 2014 Health Insurance Rates.” DORA press release, Aug. 16, 2013.