New health insurance program taking applications

By Cherry Sokoloski
North Forty News

On July 6, a new health insurance option became available for Coloradans.

The program, called GettingUSCovered, offers health insurance to people who can't find private coverage because of pre-existing conditions. It's part of national health care reform passed in March.

Interest in the new plan has been high. According to Suzanne Bragg-Gamble, who coordinates enrollment, the state web site received more than 6,000 hits in the first two weeks of the program. As of late July, her office had received about 100 applications.

The Patient Protection and Affordable Care Act directs states to set up high-risk pools as a stop-gap measure until other provisions of the bill go into effect in 2014. At that point, insurance companies will no longer be able to deny people coverage based on pre-existing conditions.

To be eligible for GettingUSCovered, a person must meet four eligibility requirements. He or she must be a Colorado resident, must be a United States citizen, must have been uninsured for at least six months and must have a pre-existing health condition.

Patients who qualify for GettingUSCovered pay the same premium as the average, relatively healthy person in the individual insurance market. The premium is based on only three factors: age, county of residence and smoking status.

Insurance rates are affected by one's county of residence because health care costs vary by location. Sometimes that's because of differences in the health of the population, and sometimes there are variations in the prices charged by providers.

Colorado has another high-risk plan, called CoverColorado, but the new one will cost people less. Those who buy insurance through CoverColorado pay about 130 percent of the "healthy" rate.

With the new plan, the federal government will subsidize the difference between the premium charged to consumers and the actual cost of the insurance. As a result, the health care plan will not impact the state budget.

The following are examples of what some Larimer County residents would pay for the new state plan: 18-year-old non-smoker, $122 per month; 18-year-old smoker, $146; 35-year-old non-smoker, $234; 35-year-old smoker, $301; 55-year-old non-smoker, $481; 55-year-old smoker, $646.

Plan features

With the GettingUSCovered plan, patients have an annual deductible of $2,500 and a $30 copay for each doctor visit. Generic prescriptions have a $10 copay and are not subject to the deductible.

The plan includes preventive care, including routine physical exams, routine immunizations and screening tests. Preventive care is not subject to the deductible, and for most preventive care the patient pays only the copay for the doctor visit.

Under the plan, the limit for out-of-pocket medical expenses, including deductibles and copays, is $5,950 per year per individual.

Lorez Meinhold, director of health reform implementation for Colorado, said that even though the new plan will be less expensive for consumers than CoverColorado, premiums will "still be out of some people's reach," so the state does not expect everyone who is eligible to apply.

In fact, there is not enough federal money available to cover all who are eligible. Colorado will receive $90 million to subsidize the program – enough for approximately 4,000 citizens. However, state officials estimate that about 30,000 people will qualify for the new high-risk pool. In all, about 700,000 Coloradans lack health insurance.

The federal money must last for three and one-half years. In 2014, when insurance companies will be barred from denying coverage based on pre-existing conditions, and individuals will be able to buy coverage through health insurance exchanges. The exchanges will replace Getting USCovered.

The insurance carrier for GettingUSCovered is Rocky Mountain Health Plans, an independent, not-for-profit organization based in Colorado. As mandated by the federal health reform bill, administrative costs for the new program must be less than 10 percent. Some private health insurance companies in Colorado have administrative costs as high as 20 percent, Meinhold said.

Many unknowns

Meinhold said the state does not know how many will apply for GettingUSCovered. Another unknown is the health status of those who do apply. As a result, she said, it's too soon to tell how fast the federal money will be spent. If demand is high for the program, she said, the state will likely have to limit the number of people who can enroll.

For efficiency purposes, CoverColorado is handling enrollment in the new GettingUSCovered program. If people are not eligible for GettingUSCovered, they can be directed to CoverColorado as another option. The arrangement "will be more seamless for the consumer," Meinhold said.

People who may still need to take advantage of CoverColorado might include those who have not been without insurance for six months or more but have lost jobs and thus their insurance, or have been cancelled by their insurance companies.

To enroll or get more information about the new high-risk plan, go to www.GettingUSCovered.org. The site explains what evidence is required to prove a pre-existing condition, and it has a calculator for figuring premiums.

Public forums on exchanges

Colorado is in the process of planning for health insurance exchanges, which must be implemented by 2014 under the new Patient Protection and Affordable Care Act. Qualified individuals, families and small businesses may purchase health insurance through the exchanges.

People who do not have access to employer or public coverage will have choices in the exchanges. Cost-sharing subsidies will also be available.

Citizens can have input into this process through a series of public forums. Dates have been set for some forums, but locations have not been determined. Forums will be held in the Denver metro area in August and September, and outside the metro area in October.

To check on meeting dates and locations go to www.colorado.gov/healthreform and click on "Meetings."

The following dates have been set for public forums in the Denver metro area:

• Aug. 12, 9 to 11 a.m.
• Aug. 30, 3 to 5 p.m.
• Sept. 13, 3 to 5 p.m.
• Sept. 29, 9 to 11 a.m.