In early 2013, we worked with a client shortly after he had received a sales pitch for what sounded like a very sketchy health insurance product. We followed up on the issue, talking with an agent for the carrier in question, as well as the Colorado Division of Insurance. At that time, full ACA implementation was still […]
Search Results for: employer plan access
Exchange Subsidy Eligibility Impeded By High-Priced Group Health Insurance Access
July 30, 2013 By
We were talking with a client last week about her health insurance situation, and it inspired me to do a little more digging around to see how eligibility for subsidies could be impacted by the availability of employer-sponsored health insurance. In our client’s situation, she’s a homemaker and her husband makes about $20,000 per year, working for a small business. They also have a child, who is currently covered by Medicaid. Her husband can get health insurance from his employer for $75/month. But if he adds his wife, the cost goes up to $500/month. $6,000 per year for health insurance when you earn $20,000 isn’t really a viable option. Fortunately, as of January 2014, Medicaid will be available in Colorado to families with household incomes up to 133% of FPL (in 2013, that’s almost $26,000 for a family of three).
But let’s consider a hypothetical family that makes a little more – say $28,000/year – and has the same option for employer-sponsored health 
insurance. They would be above the cutoff for family Medicaid, but well below the 400% of poverty level that determines eligibility for premium assistance tax credits (subsidies) in the exchange (400% of FPL for a family of three is a little over $78,000 in 2013). And I think we can probably all agree that spending $6000 a year on health insurance would be a significant burden for a family that earns $28,000 a year.
We’ve all heard lots of talk about how subsidies are available in the exchanges for people who don’t have access to “affordable” employer-sponsored health insurance. I think most of us take that to mean that for families who earn less than 400% of FPL, subsidies are available both to those without an option to purchase employer-sponsored health insurance, and for families that have the option to do so but at a prohibitively high premium. You’ve probably also heard that the cutoff for determining whether employer-sponsored health insurance is “affordable” is 9.5% of the employee’s wages.
Unfortunately, it’s not as simple as it might sound, and the official rules might leave some families without a lot of practical options. I discussed this scenario last week with the Colorado Coalition for the Medially Underserved (CCMU). Gretchen Hammer is the Executive Director of CCMU, and she’s also the Board Chair of Connect for Health Colorado (the state’s exchange), so there’s a good flow of information between the two organizations. CCMU (and Connect for Health Colorado, via CCMU) responded to my questions quickly and thoroughly, and I highly recommend both sources if you’re in Colorado and curious to see how your specific situation will be impacted as the ACA is implemented further (here’s contact info for CCMU and Connect for Health Colorado).
My concern in the case of our hypothetical family was that the employee’s contribution for his own health insurance is $75/month, which works out to only 3.2% of his income – well under the threshold for “affordable,” based on the 9.5% rule. And as […]
Access To A Mini-Med Group Plan Does Not Prevent CoverColorado Enrollment
December 14, 2011 By
[…] The person I spoke with at CoverColorado checked with a supervisor and then told me that mini-meds are an exception to CoverColorado’s rule banning eligibility for people who have access to group health insurance. In order to qualify, the applicant has to provide the usual proof of eligibility along with proof that their employer’s group health plan is a mini-med. This can be the declarations page from the policy or marketing materials for the plan (which now have to include language indicating that the plan has been granted a waiver by HHS and does not meet the minimum benefit requirements defined by the PPACA).
Hopefully this will clarify things for others in a similar situation. Normally, access to a group health insurance policy (even if it’s one you don’t like or your doctor isn’t on the network, etc.) makes a person ineligible for CoverColorado. But if that group plan happens to be a mini-med and you also meet the other eligibility criteria for CoverColorado, you can submit an application to CoverColorado.
Access To Healthcare In Colorado Worsening
November 26, 2011 By
The Colorado Health Access Survey results were released earlier this month, and the results aren’t particularly surprising given the state of the economy for the past few years. The total number of uninsured Colorado residents is now 829,000 – up from 678,000 in 2009. The survey also counts the number of “underinsured” residents (those who aren’t able to afford their out-of-pocket expenses that total more than 10% of their income, or 5% for those below the poverty line). The two categories – uninsured and underinsured – amount to 1.5 million people, which is about a third of the Colorado population.
The 22% increase in the number of uninsured residents came despite strong efforts in Colorado to expand access to Medicaid and CHP+ over the past few years. Without the expansion of those programs, the numbers would undoubtedly be even more bleak. […]
AHCA: The Aye or Nay? Edition of the Health Wonk Review
March 23, 2017 By
Seven years ago today, President Obama signed the Affordable Care Act into law, ushering in a host of reforms for the U.S. health care system. And today, House Republicans are planning to vote on the American Health Care Act (AHCA), which would repeal many of the ACA’s spending-related provisions and implement replacements for some aspects of […]
Healthcare Reform: The Path Forward
February 24, 2016 By
Welcome to the Health Wonk Review! It’s been nearly six years since the ACA was signed into law. And although most aspects of the law have now been implemented, the debate over its merits have not let up. In this election year, healthcare reform continues to be a hot topic, even dividing Democrats in terms […]
Would ColoradoCare be an adverse selection magnet for people moving to Colorado?
January 12, 2016 By
Colorado will certainly be a state to watch in 2016. Not only is Colorado up for grabs in the presidential election, it’s also the only state in the country – so far – where voters will be asked to decide whether the state should switch to a single payer healthcare system, dubbed ColoradoCare. I explained […]
Summertime! Health Wonk Review
June 3, 2015 By
Another school year has come to a close, it’s still daylight well into the evening these days here in the northern hemisphere, and I’ve got summer on the brain. So welcome to the Summertime! edition of the Health Wonk Review! Since King v. Burwell is on a lot of minds these days, I thought we’d […]
Cost of Obamacare is 20% less than we thought
January 27, 2015 By
Good news! The cost of Obamacare is less than we thought. Yesterday, the CBO released their comprehensive ten-year budget and economic outlook report. It’s 177 pages, and addresses all aspects of the federal budget and deficit, including Obamacare. Back in 2010, the CBO predicted that the the ACA would cost the federal government $759 billion in […]
The five improvements I’d make to the ACA and its implementation
November 18, 2014 By
It’s open enrollment time again, and happily, this one is certainly off to a better start than last year. The downside is that there’s only a month between the start of open enrollment and the December 15 enrollment deadline for people who need their new coverage to be effective January 1 (this is the case […]
Colorado’s Senate Candidates Mark Udall and Cory Gardner on Contraceptives
October 14, 2014 By
Mark Udall and Cory Gardner are in a tight senate race right now, and one of the issues that has come up in several ads is contraception. Here’s what women in Colorado need to know about the two candidates and how their positions would impact our access to contraceptives: Udall supports the ACA. One of […]
Lost your job? Apply for Medicaid ASAP to have a qualifying event when you get another job
July 30, 2014 By
Job loss and short periods of unemployment are a relatively common part of life. But with the new open enrollment rules in the individual health insurance market, it’s important that people understand exactly how the system works in order to avoid finding themselves stuck without health insurance. Recently we’ve had several clients in this position, […]
Combining rating areas in Colorado to bring down mountain premiums
June 4, 2014 By
Even before the ACA, individual health insurance in Colorado’s mountain towns was more expensive than in most of the rest of the state. The ACA makes health insurance much more affordable for most people earning up to 400% of poverty level (especially in states like Colorado, where Medicaid has been expanded… we have no coverage gap). And […]
Reference pricing: Not as scary as it sounds
May 21, 2014 By
Several times in the last few days, I’ve seen versions of an article titled something like this one – “New Obamacare loophole shows failure of for-profit health system.” Another is titled “In health care, ‘reference pricing’ could end up costing unwary consumers thousands of dollars.” Scary stuff, huh? Except really, it’s not. Here’s the FAQ […]
Ways the ACA Could Be Improved Edition of the Health Wonk Review
April 24, 2014 By
In Colorado, the snow is melting and the flowers are blooming. The health wonks around the blog world have given us an excellent collection of articles this week, many with suggestions of ways the ACA could be improved. Our favorite part of hosting the HWR is reading all of the different perspectives that the writers […]
Health Wonk Review at Wright on Health
March 13, 2014 By
Brad Wright hosted the most recent Health Wonk Review at his excellent blog, Wright on Health, and it’s a must-read. Or in some cases, a must-watch. Check out healthpolicy.tv, a resource submitted to the HWR by Jared Rhoads. Plenty of good stuff on there, with viewpoints from a variety of political perspectives. And also don’t […]
Pediatric Dental on 2014 Individual Health Insurance Policies in Colorado
December 16, 2013 By
If you’re confused by the new pediatric dental requirements, you’re not alone. Here’s a rundown of how the ACA and HHS regulations impact pediatric dental coverage, with Colorado-specific details: The ACA defines pediatric dental coverage as one of the ten essential health benefits (EHBs) that must be covered on all new individual and small group […]
Thanksgiving Cavalcade of Risk
November 27, 2013 By
Happy Thanksgiving and welcome to the 197th Cavalcade of Risk! If you’re a brave soul who relishes the thought of a family dinner filled with spirited debates about healthcare reform, insurance and risk, we’ve got plenty of fodder for your conversations. Just don’t steer the conversation over the line into politics, especially after a glass […]
The Public Should Be Aware Of Actual Health Insurance Premiums As Well As Subsidized Rates
October 26, 2013 By
Jaan Sidorov hosted this week’s Health Wonk Review at his most excellent Disease Management Care Blog – be sure to check it out if you haven’t already. One particularly interesting post in this edition comes from Hank Stern, writing about how one of the widely-criticized flaws in the HHS-run exchanges was actually an intentional part […]
Getting ACA Information and Ignoring “Obamacare” Misinformation
September 30, 2013 By
One of the major hurdles for the ACA has long been a lack of public understanding about the basics of the law. This is significantly exacerbated by the blatantly false information that has been circulated by many “Obamacare” opponents over the last few years. That’s not to say that the ACA is perfect – it definitely has its flaws. But public understanding of the law has been greatly hampered by people whose sole purpose is to defeat it. If you’re trying to learn about the ACA and how it will impact you and your family, you’re probably better off getting your information from a source that isn’t hell-bent on doing away with the law (and if that’s their intent, they probably have zero interest in your family’s access to healthcare, which is one more reason to ignore them).
In addition to a widespread lack of understanding about the law, there’s also a significant gap between how people expect to learn about the law and how they probably actually will learn about it. A recent AFLAC survey found that 75% of employees think that their employer is 
going to educate them about changes to their health insurance as a result of the ACA, but only 13% of employers indicated that was a priority for their company (more info from the AFLAC study available here).
This comes in conjunction with the announcement that employers should communicate with their employees about the health insurance marketplace (exchange) by October 1, 2013, but there is no fine or penalty for employer who don’t. Of course some employers will provide information and support to their employees. But some will not. In the latter group, you’ll have a combination of employers who lack understanding themselves about the ACA and the marketplace, and those who simply forget or are too busy to deal with it. But there will also be employers who are actively opposed to the ACA and choose not to inform their employees about the marketplace or changes to health insurance as a result of the ACA.
Ultimately, a lot of people, including the self-employed as well as employees who don’t have access to employer-sponsored health insurance (keep in mind that the employer mandate that requires employers to offer health insurance only applies […]
Your Health Insurance Will Probably Change in 2014
August 19, 2013 By
I frequently come across FAQs on various websites with a question along the lines of: “Do I have to switch to a new health insurance plan if I like my existing one?” And almost always, the answer is something like this: “No. The ACA allows grandfathered health insurance plans to continue unchanged, so if your plan was in effect when the ACA was signed into law on March 23, 2010 and has not been significantly changed since then, it will be considered “qualified coverage” and you can keep it”.
This is frustrating to read, because I’m sure that people who aren’t familiar with the details of health care reform might just see that first word – no – and not pay attention to the significant caveat that follows it. Adding to the confusion is the partially true statement President Obama made in 2009, saying “If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”
The problem is that people who currently have health insurance might think that they can keep their plan – even if they’re not on a grandfathered plan – because there’s a lot of confusion about what exactly a grandfathered plan is. In 2012, just under half of people who get their health insurance from an employer were on a grandfathered plan, but that number is dropping and will continue to do so as plans change. There’s no way to know whether your health plan is grandfathered without calling your carrier and asking. A plan that was grandfathered as of 2011 might not be so today, since changes to the plan can happen at any time and can cause a plan to lose its grandfathered status.
The really bad health insurance plan that I wrote about earlier this year might be a grandfathered plan that was in effect when the ACA was signed into law. Insureds may have joined after that date and still be on a grandfathered plan. (although that still doesn’t explain the $5 million lifetime max that was being marketed on that plan as of this year – even grandfathered plans are not allowed to have lifetime maximums).
But especially in the individual market, health plans are constantly being redesigned. The way the process works in Colorado – and in many other states – is that existing plans are retired, or “sunset” and new ones are introduced. In most cases, insureds are allowed to remain on the sunset plan. If the carrier does away with the plan completely, they have to offer the plan’s insureds the option to 
purchase any of the other plans the company offers, guaranteed issue. So most carriers have traditionally let insureds remain on sunset plans, but the plan becomes a closed block, which means that no new insureds are being added to the pool. The result is usually that over time, premiums within a closed block start to rise faster than premiums in other plans that are enrolling new members (keep in mind that in the individual market, medical underwriting has long been used to make sure that new members are relatively healthy. So for individual plans, members who have been on the plan the longest tend to have higher claims expenses than new members). This leads healthy insureds who are on sunset plans to seek coverage in another plan in order to lower their rates.
There are lots of reasons for new plan designs: It’s a way for carriers to create product differentiation (especially true in robust markets like we have in Colorado). New plan designs also allow carriers to create products with lower premiums, as they’re well aware that price is one of the most important factors when consumers are shopping for coverage (a good example is the trend over the past decade towards health plans with separate prescription deductibles instead of integrated Rx deductibles or Rx coverage with traditional copays). New plan designs also […]