Colorado’s beleaguered Affordable Care Act marketplace still frustrating users | SummitDaily.com

Colorado’s beleaguered Affordable Care Act marketplace still frustrating users

Alli Langley
alangley@summitdaily.com

If you're having problems getting health insurance coverage through Colorado's new marketplace, you're not alone.

Connect for Health Colorado, the state marketplace created by the Affordable Care Act in October 2013, is two months into its second open enrollment period, and local health coverage guides are reporting users are encountering more system glitches than the first time around.

"It was supposed to be so great and so much faster, and it's not working out quite as they had planned," said Karen Seater, a guide with the Family and Intercultural Resource Center in Silverthorne. "It's twice as bad this year."

People are getting stuck in the system and not receiving coverage when they're supposed to, they're not seeing accurate amounts of tax credits they qualify for in real-time, and they're discovering the amount of tax credits they qualify for has dropped, forcing them to switch to cheaper plans, she said.

"I feel frustrated for people and sad for people," she said, especially the ones giving up. "It's like a full-time job trying to keep coming back and checking to see if issues cleared up."

The FIRC will offer free help during walk-in hours from 10 a.m. to 3 p.m. Wednesday, Jan. 14, and three other Wednesdays before the enrollment period's deadline for 2015 coverage.

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Seater explained that tax credits have dropped after a new insurance provider, Colorado Health-Op, entered the market with lower premiums. That caused average premiums to decrease but also shrank the associated tax credits by hundreds of dollars, she said. The Colorado Health-Op plans are now all that's affordable for some Summit County residents.

Her own family of four previously qualified for a $1,300 monthly tax credit that dropped to about $400, she said, and her family plan raised in price from $2,100 a month to $2,400, forcing the family to choose a different plan.

A 58-year-old Summit Cove resident with stage four cancer and an income around $23,000 has struggled with the system after her tax credit dropped from about $800 a month to roughly $200. To keep her same oncologist, she went from paying about $150 a month for insurance to $550.

The woman is exhausted by the whole process and so angry, Seater said.

For people whose incomes qualify them for Medicaid, the marketplace has been beneficial, she said, and the system's tax credits continue to help those who make a little too much money for the federal program.

For those near or just over 400 percent of the qualifying income, however, finding affordable health insurance remains a challenge. Seater believes the fault lies beyond the marketplace and with the greater insurance system.

She had heard of some success stories, of families who learned their children qualify for CHP (Colorado's version of Medicaid for kids) or who have received coverage for the first time in years because of Affordable Care Act changes. Most of the people coming to FIRC for help though have had negative experiences.

About 20 people started the enrollment process in early December and still don't have the coverage they were supposed to receive by Jan. 1. Seater said they are understandably nervous about what to tell medical providers if they need care before the insurance issues are resolved.

Another local woman didn't receive a tax credit, and FIRC was able to help her determine the system incorrectly changed her income from $30,000 a year to $300,000, Seater said. "She would never have known that on her own."

FIRC staff can call or email state marketplace officials and troubleshoot and resolve issues faster than people can by themselves. Over the phone, FIRC employees can walk people through making sure their income information is accurate and the tax credits they qualify for are correct.

"We see a lot of people who are seasonal employees, and the system doesn't really understand that," she said.

Seater said she's also heard of some carriers sending insurance cards and welcome packets to residents' physical addresses instead of their mailing addresses.

"As you know, in Summit County that's a huge problem," she said, encouraging people to make sure they've made their first payments and call their carriers if they believe they should've received their cards by mail.

The enrollment deadline is Feb. 15 for coverage in 2015, and the next open enrollment will begin Nov. 15 for 2016 coverage. Those with qualifying life events, which include an income change, can still enter the system after the February deadline.

For more information, contact Karen Seater at karens@summitfirc.org or call 970-262-3888 to set up an appointment.

IF YOU GO

What: Free health insurance enrollment help through the Family and Intercultural Resource Center during walk-in hours (other days by appointment).

When: Wednesdays, Jan. 14, Jan. 28, Feb. 4 and Feb. 11, from 10 a.m. to 3 p.m.

Where: The FIRC’s office, at 251 W. Fourth St., Silverthorne, CO 80498