Here’s a rundown on the changes of keenest interest to insurance advisors...
May 11--Come next fall, residents can start tapping into a new health insurance option, which is set to be one of likely many for residents to comply with before the January 2014 requirement for mandatory insurance under the Affordable Care Act.
Colorado HealthOP, the state's first nonprofit health insurance cooperative, will begin enrolling residents in October, to help people meet that federal deadline. It is a nonprofit health insurance cooperative, which touts itself as an affordable option for individuals, families and small employers and groups.
"Health insurance has gotten less affordable for people over time, so a lot of what we're doing is working to bend the trend and put healthcare decision-making back in hands of healthcare providers," said Julia Hutchins , CEO of Colorado HealthOP.
"We hope it will allow people of all incomes to afford insurance and to be able to have insurance that's a partner with them and improving health in their community."
According to the U.S. Centers for Medicare and Medicaid Services, there are approximately 37,842 uninsured people in Weld County. Across the state, it's estimated that 829,000 residents are uninsured.
The Affordable Care Act, among several health care reforms, requires most residents to buy health insurance, beginning in January. Those who have a religious objection, are undocumented immigrants, are incarcerated, are members of a Native American tribe, or make less than the threshold to file federal taxes, or who would pay more than 8 percent of their income for health insurance, are exempted.
Those who don't meet those exceptions will be required to find insurance or face a penalty that rises ever year. The penalty starts at $95 per adult and $47.50 per child next year, and rises to $325 per adult and $162.50 per child in 2015. The penalty in 2016 and beyond rises to $695 per adult and $347.50 per child.
People can look at the Health Insurance Marketplace for insurance options that best suit their pocketbooks. The Colorado HealthOP was one of 24 cooperatives across the country that received start-up funding under the ACA to get started.
Hutchins said the Colorado HealthOP will offer insurance with several products to match their budgets and focus on keeping them healthy.
Actual costs of the program are still being reviewed and will be announced later this month.
"The benefit structure is unique in that it rewards for prevention and primary care," Hutchins said. "We'll have ways for people to go in and get screenings, and to be financially rewarded for doing that."
Hutchins said the Colorado HealthOP program can help small businesses finally offer insurance to their employees. She said that 63 percent of small businesses in Colorado don't offer insurance.
"We'll stand out because we're new, and we are a nonprofit, we're local, and our benefit designs will be uniquely focused on helping members stay sustainable and healthy," Hutchins said
Hutchins said benefits under the insurance program will be tailored to the individual and work with primary health care providers to provide more management and coordination of the many complexities patients with multiple conditions have.
"A lot of the care coordination work we offer will help people avoid unnecessary visits to the ER, which is part of a bigger recipe to reduce health care costs," Hutchins said.
While consumers will have to comply with the mandatory insurance requirement, hospitals are gearing up for the myriad changes they will see.
Starting in 2015, hospitals' Medicare and Medicaid reimbursement funding will be based on keeping people from repeat visits to the ERs, and even patient satisfaction surveys. Hospitals across the country are now revamping their entire systems.
North Colorado Medical Center, as an example, is working to cut $30 million in costs in the next two years to comply with the coming provisions, as well as prepare for reduced reimbursements from the Medicaid and Medicare systems, which essentially make up about half of their budget.
Consumers who opt into the cooperative also will have a voice in their coverage. Hutchins said consumers also will be rewarded under the Colorado HealthOP plan for certain preventative health steps.
"Most of the plans also have a health incentive account attached, so when someone goes in for a health checkup, they could get some additional money on a health credit card to help pay other health costs."
The cooperative is structured so that if revenues exceed costs, the surplus will be given back to members through lower premiums, expanded benefits and quality improvements.
"We're really excited," Hutchins said. "There's a lot of interest in thinking of new ways for insurance to function as a vehicle to support health as opposed to something that's there only when you're sick."
(c)2013 the Greeley Tribune (Greeley, Colo.)
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