Make sure to know about cost sharing reduction plan eligibility

We’re more than two weeks into open enrollment now, and things are humming along – certainly compared with the first couple weeks of open enrollment last year.  In the first two weeks, the exchange has enrolled nearly ten thousand people, including renewals and new enrollees.  But keep in mind that the time frame is shortened this year.  Open enrollment is a total of three months this year instead of six, and I highly doubt we’ll see the sort of widespread extensions that were granted last spring.  Also, for people who want their new coverage to be effective January 1, the deadline to enroll is December 15 (this is true in Colorado and most of the rest of the country – only four states have later deadlines).

We all know this can be a crazy busy time of year, and it’s not the end of the world if you don’t get your plan selection made by mid-December… you can still enroll in a new plan anytime until February 15, but your coverage won’t be effective until February or March if you enroll after December 15 (March effective dates apply to people who enroll after January 15).

cost sharing reductionAlthough things are working fairly well with Connect for Health Colorado (our state-run exchange), there’s a glitch that we want to make sure our clients are aware of.  If your household income is between 138% of poverty and 250% of poverty, you’re eligible for cost sharing reduction (CSR) Silver plans, as well as premium subsidies (under 138% of poverty, you’re eligible for Medicaid in Colorado).  For reference, 250% of poverty is $29,175 in annual income for a single individual, and $59,625 for a family of four – more details here, with numbers for various family sizes.

Silver plans are more expensive than Bronze plans in terms of the monthly premium, but if you’re eligible for CSR plans, you get much better coverage with a Silver plan (a Silver plan always offers better coverage than a Bronze plan, but that’s especially true if you’re eligible for CSR).  The CSR plans have lower out-of-pocket maximums than a regular Silver plan, and they also have lower costs from the get-go, with lower deductibles, copays, and coinsurance.  For a lot of people with CSR-eligible incomes, Silver plans present the best value.

Connect for Health Colorado displays the CSR plans with a little green dollar sign icon – it’s grey on most plans, but switches to green for the Silver plans if you’re eligible for CSR (if you’re not eligible for CSR plans, you’ll just see regular Silver plans, without the green icon).

But in Connect for Health Colorado, the CSR plans don’t show up in the browsing or quoting systems if you’ve got children on your plan.  Jay has had numerous phone conversations with the exchange about this, and our assumption is that the glitch is being caused because the children are eligible for CHIP (eligibility for CHIP in Colorado is up to 260% of poverty, so no kids are eligible for CSR plans here… they’re eligible for CHIP instead).  The glitch doesn’t happen if you’re browsing or getting quotes for adults only, which is why we assume CHIP eligibility is causing the problem.

Long story short, if a family with kids and a CSR-eligible income is shopping for coverage, they’re not going to see CSR plans in the browsing tool – even if they use the feature that lets you put in your income – and they’re not going to see CSR plans in any quotes that are generated by navigators or brokers in advance of enrollment.  That makes it tough to compare plans prior to enrolling, since the CSR plans offer such a good value and definitely need to be considered by anyone eligible for them.

But if a family with kids goes on to complete the full enrollment process, including a PEAK application to determine financial eligibility, and then gets to the plan selection portion of the enrollment, the CSR plans will be available for the parents to select.  So if you’ve got kids and you’re CSR eligible, don’t make a final decision about what plan to choose until you’re actually doing your enrollment.  If you’re working with a navigator or broker, they’re likely aware of the fact that the CSR plans won’t show up until you’re enrolling, and they’ll be able to walk you through the whole process.

And remember, you never pay anything to get assistance with the enrollment process – there are navigators and brokers all over the state who can help you in person or over the phone, and your premiums are the same whether you seek out that help or not.  If your income makes you eligible for CSR plans, don’t make a plan selection until you’re sure you’ve seen the CSR plans.  And ask for help if you need it.

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP, and Gusto. Follow on twitter and facebook.

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