Summit County has state’s highest percentage of uninsured adults eligible for Medicaid | SummitDaily.com

Summit County has state’s highest percentage of uninsured adults eligible for Medicaid

Alli Langley
alangley@summitdaily.com
This map shows what the regions used by the state health insurance exchange now look like after Summit, Eagle, Pitkin and Garfield counties merged with the west region, enlarging the pool of plan participants and lowering premiums for residents in the resort region.
File photo |

HEALTH INSURANCE SHOPPING TIPS

Is your doctor or hospital of choice included in the plan’s provider network? Seeing an out-of-network doctor typically is more expensive.

Lower premium plans often mean it will cost you more to receive care. Find out if there is a deductible and how much it is, as well as the out-of-pocket maximum. Determine what you would have to pay for a doctor’s visit.

Find out about prescription coverage, especially if you need specific medications.

Check to see if the plan covers procedures you may need some day, such as back surgery, ambulance service, MRI scans or knee replacement.

Colorado’s health insurance marketplace experienced so many glitches during its first enrollment period that many people gave up on buying insurance.

Now local and state officials are assuring people the system will work and encouraging those without insurance through their employers to sign up once the next open enrollment period starts Saturday, Nov. 15.

“The biggest financial struggles that people come in here with start from medical bills,” said Anita Overmyer, development and volunteer director at the Family and Intercultural Resource Center in Silverthorne, which offers free help with the enrollment process.

Often troubles could be avoided if people had health insurance coverage, she said.

Not only does Summit County have the state’s highest percentage of uninsured adults eligible for Medicaid but not enrolled, said Rob Rumrill, FIRC community support manager, but it also is home to people who participate in more extreme sports than most.

“People play hard and get hurt hard,” he said.

He added that just like people wouldn’t ski or snowboard without their helmets these days, “why would you go to the mountain without your health insurance?”

Locally, residents should see lower insurance costs after officials pushed the state to combine the resort region — the most expensive place to buy health insurance in the country — with the west region.

On average, premiums for individual plans in the new consolidated region will drop by 7.4 percent.

“Our region is seeing the largest percentage decreases for the state of Colorado, so I’m really excited about that,” said Summit County Commissioner Dan Gibbs.

“I’m really encouraged by these lower rates,” he said. “However, there’s a lot of work that needs to be done.”

He said county government officials are continuing to meet with local health care providers and other organizations to try to lower costs in the High Country.

Lower local premiums aren’t the only big changes for 2015.

The enrollment period is now three months long instead of six, and the penalty for not having insurance has increased significantly.

MORE OPTIONS

The state marketplace, Connect for Health Colorado, is a public nonprofit entity established in law by the General Assembly in 2011.

It opened for business on Oct. 1, 2013, and in 2014 the marketplace enrolled more than 148,000 Coloradans in private insurance and helped nearly 100,000 access new tax credits that made their health coverage more affordable.

After the last enrollment period ended in March, the Colorado Division of Insurance reviewed and approved 1,072 health insurance plans from 20 carriers, including three new companies, that offer health coverage to individuals and small businesses for 2015.

Though not every plan is available in every region, division officials say all consumers will have a wide range of plans to choose from, with variations across plan types and premiums.

“We are pleased to see that our health insurance market is so competitive, especially compared to the other states,” said Colorado Insurance Commissioner Marguerite Salazar. “With so many options, people in Colorado will need to spend time shopping to find the plan that best fits their needs, as well as consider that it’s not just about what you pay, it’s about what you get for your money.”

While individual plan premiums in the region that now includes Summit should decrease, small group plan premiums will increase by 1.12 percent on average.

That number is on par with the rest of the state.

On average statewide, plan premiums will increase 1.18 percent over 2014, though premiums vary by carrier, age, geographic area and plan type.

Connect for Health Colorado is the only place for Coloradans to qualify for financial assistance in the form of tax credits to lower their monthly insurance costs.

Regardless of which plan individuals or families choose to buy, the amount of financial assistance they qualify for is calculated based on the price of the second-lowest-cost silver-level plan in their geographic rating area, as well as their household income and size.

BETTER WEBSITE

On the updated and improved enrollment site, applicants will find a simplified, single-application process that directs them to enroll with either a private health insurance company on the marketplace or with Medicaid, depending on the applicant’s financial situation.

The two entities have been collaborating for months to make the enrollment process easier.

Other improvements include:

A virtual assistant named Kyla who can help customers through some of the key steps in the enrollment process.

A medication look-up tool, which enables customers to compare prescription coverage under various policies.

An enhanced provider directory to help customers see if their doctor is in the network of the health plans they are comparing.

HIGHER PENALTIES

The penalty for those who forego insurance will jump from $95 to $325 for most people in 2015.

The penalty is the greater of two amounts: a specified percentage of income or a specified dollar amount.

The income percentages are phased in over time at 1 percent in 2014, 2 percent in 2015 and 2.5 percent in 2016.

The dollar amounts are also phased in at $95 in 2014, $325 in 2015 and $695 beginning in 2016 (with annual increases after that). The penalty for children is half the cost of that for adults.

For those uninsured for part of the year, the penalty will be pro-rated. Those uninsured for less than three months won’t have to pay a penalty.

GET HELP

Most people won’t have trouble enrolling online.

However, seasonal jobs and variable incomes can make the process more difficult to navigate for some, and those who want help can meet locally with trained guides for free.

The guides can help explain the differences in plans, benefits and costs and guide people through the financial application and enrollment processes.

Across the state, more than 1,550 independent brokers and agents and more than 400 coverage guides and application counselors are trained to help consumers buy insurance under the new law. To find one nearby, search by ZIP code at connectforhealthco.com/help-center.


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