Colorado’s public health insurance more affordable, better coverage for kids than marketplace plans
August 3, 2014
Affordable Care Act health insurance exchange marketplaces have fewer child-specific benefits and dramatically higher out-of-pocket costs than the Children's Health Insurance Program coverage, according to a new report.
Jointly funded by the federal government and states, the Children's Health Insurance Program (CHIP) provides health coverage to nearly eight million children in families with incomes too high to qualify for Medicaid but who can't afford private coverage. The program's funding is set to expire Oct. 1, 2015.
Since it was created in 1997, CHIP has cut the uninsured rate among children in half, and the share of children who are uninsured today is lower than before the recession began in 2007, according to an announcement from First Focus, a bipartisan advocacy organization dedicated to prioritizing children and families in federal policy decisions.
A report released Tuesday, July 29, by Wakely Consulting Group compared out-of-pocket costs and coverage under CHIP and marketplace plans in 35 states. The report includes state-specific analyses for Colorado, where CHIP is called CHP+.
"CHP+ is a bipartisan health plan that works for children, and affordability is a big part of that success story," said First Focus president Bruce Lesley. "But if Congress fails to extend CHIP funding, Colorado parents' out-of-pocket costs could increase by nearly 600 percent."
The comparison finds that a family of four with an annual income of $50,085 (210 percent of the federal poverty level and below the U.S. Census Bureau's reported median household income of $51,371) has average out-of-pocket costs of $161 a year through CHP+. That same family would face costs of $960 under average marketplace plans.
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For families with children who have conditions like asthma or other special health care needs, out-of-pocket costs could be even higher. While CHP+ caps those costs for special-needs children at no more than $1,970, the analysis found that annual costs for those children could rise as high as $4,750 under marketplace plans.
The analysis also compared the coverage of child-specific services, which include routine care like eyeglasses and hearing exams, as well as specialty care like speech or physical therapy.
The comparison found significant differences in coverage and limits for specialty care. For example, while both CHP+ and marketplace plans cover speech therapy, CHP+ has no restrictions for children under age 3 on children's access to speech therapy, while marketplace plans restrict the number of therapeutic visits a child may have each year to 20 per type of therapy.