Affordable Care Act FAQs
Are there deadlines for enrolling in health plans?
So there are a several different deadlines that are worth knowing about for getting new health coverage through Connect for Health Colorado:
- Your next opportunity to enroll in most states will be November 12 – December 10, 2018 (in Colorado you actually have from November 1, 2018 – January 15, 2019) for insurance coverage starting in 2019.
- If you experience some life change event – like getting married, having a baby, turning 26, becoming a citizen, moving to a new area of the state or your employer’s plan has become too expensive for you – you may be able to enroll in a new plan now.
- For Health First (what used to be Medicaid, once you are enrolled you are covered – and you can apply to enroll any time during the year.
Will the Affordable Care Act (ACA) affect my insurance if I’m in college?
College students have several options for medical insurance coverage, and yes, the ACA will affect some of them. The good news is that all of the following options give you coverage for all kinds of great health care services like birth control, cancer screenings and STD testing and treatment at no extra cost to you. Sounds like a deal to us.
- First, some colleges require that students be on the school’s own health insurance plan. These plans do have to follow basic ACA rules, including preventive health services and no cost sharing, but other changes will vary based on your individual plan. To find out if the ACA has changed your coverage, speak to your insurance provider directly.
- Second, the ACA allows young adults (students or not) to stay under their parent’s plan until they’re 26 years old. If your parents are insured and your school does not require you to be on its specific plan, this is another awesome option.
- And third, if you are a lawful Colorado resident who is not considered anyone’s dependent, you are eligible to purchase coverage through the online Colorado Marketplace or you may be able to be covered by Health First. Visit Connect for Health Colorado to learn more about the plans available to you.
How long can I stay on my parent’s insurance?
Good question. You can now stay on your parent’s plan until you are 26 years old. This rule applies even if:
- You are married (though your spouse is not eligible);
- Not living with your parent(s);
- Attending school (or not);
- Not financially dependent on your parent(s); or,
- Are eligible to enroll in your employer’s plan.
Still want to learn more? You can find lots of additional details here.
Can I get help paying for insurance? How does it work?
There is a tax credit that helps reduce the cost of buying insurance, and it is available to hundreds of thousands of individuals, couples and families across Colorado. That could mean you (sweet!) as long as you are a U.S. citizen or are legally present in the country, are a Colorado resident and are NOT eligible for Health First (Medicaid) or Medicare or have affordable coverage through an employer.
These tax credits are designed to help you cover some or all of your premium costs (that’s the amount you pay each month to keep your coverage). You can choose to take the money up-front, or wait until tax time and deduct it then, so they’re pretty flexible.
To get the credit, you have to buy health insurance through the online marketplace known as Connect for Health Colorado. Eligibility is mostly based on your household income, which is sometimes called Modified Adjusted Gross Income (MAGI). The amount of assistance will be determined on a sliding scale, which means the amount of the tax credit gets smaller the more money you make.
- Individuals earning about $16,000 to $29,000 a year will be eligible for some level of tax credit.
- Couples earning between about $22,000 and $40,000 a year will be eligible.
- And families of four earning between $33,000 and $60,000 a year will be eligible.
- If you need help calculating your Modified Adjusted Gross Income, call the Market place Customer Service Center at 855-PLANS-4-YOU (855-752-6749).
The amount of your tax credit is the same regardless of the health plan you choose in the marketplace. Therefore you save more money if you choose a less expensive plan. That said, the ACA requires that ALL the plans offered in the marketplace meet certain minimum standards, including providing birth control, certain cancer screenings and STD testing and treatment at no additional cost to you, so those are a few less things you have to worry about regardless of the plan you pick.
If I can’t afford the insurance offered by my employer, can I get financial assistance toward another option?
Yes. If you are an employee and you pay more than 9.5% of your household income for your employee-only health plan—that means just your plan, not the coverage you have for kids, spouses, partners, etc.—you could be eligible for a more affordable plan through the online marketplace.
To see if your employer-sponsored plan is affordable and adequate, download this Employer Coverage Tool. If your employer-sponsored plan does not meet the new standards of minimum essential coverage, you may be eligible to purchase a different plan. Just click to Connect for Health Colorado to find out.
What is considered an annual household income?
You annual income is based on your Modified Adjusted Gross Income (MAGI), which includes wages, salaries, tips, business or self-employment income, rental income, interest received or accrued, lottery and gambling income, pensions, social security retirement benefits, foreign-earned income, and bartering income (i.e., trading goods or services without exchanging money). This number is used to determine if you’re eligible for financial assistance through Connect for Health Colorado.
Who is eligible for Health First (Formerly Medicaid) insurance coverage in Colorado?
The State legislature passed a law to expand Health First eligibility for adults and families starting in 2014. About 1.3 million Coloradans have health insurance coverage through Health First. Healthy people, healthy state. Gotta love that.
To be a bit more specific on the numbers: an individual earning up to about $16,000 a year, a couple earning up to about $21,600 a year, and a family of 4 earning up to about $32,720 a year may be eligible for Health First. Plus, children now have continuous coverage throughout the year in the Health First program—even when income or other life-change events in the family may have previously disqualified them.
How do I find out if I am eligible for Health First?
It’s pretty straightforward. Just go to Colorado.gov/PEAK, click on Am I Eligible and fill out the info – it should take about 10 minutes. You’ll can do this part using a nickname and with some basic info about the number of people in your household, how much you earn, what you have in savings, and housing expenses. This tool will help you find out if you are eligible.
If you are, then go ahead and fill out an application online – it should take about 45 minutes. This time you’ll really be filling the application out as you and need to provide the most accurate information possible. You can start an application and save it to come back to later to finish, if that works better for your schedule or to find the info you need. Once your application is done, State officials will review it and determine whether or not you qualify for Health First or CHP+ coverage and they’ll notify you by mail.
What kinds of health plans are offered through Connect for Health Colorado?
Connect for Health Colorado offers a wide range of health plans from at least a dozen carriers, so you have a lot of options to choose from. Choices, choices.
All the plans have quality ratings and are organized into four tiers (bronze, silver, gold and platinum) related to how much cost they cover and how much financial responsibility falls on you.
- Bronze plans cover the cost of about 60% of medical services and have the lowest monthly premiums.
- Silver and gold plans cover 70 and 80% of costs, respectively, and premiums are higher than bronze plans but lower than platinum plans.
- Platinum plans cover the cost of about 90% of medical services and have the highest monthly premiums.
Keep in mind that all plans have to cover certain health services like birth control, preventive health visits and STD screening at no additional cost to you, and that applies to ALL plans and ALL tiers.
How do I shop for a plan on Connect for Health Colorado?
There are actually four different ways for you to shop for coverage on Colorado’s online marketplace. Here’s the info:
- You can answer a few questions and browse health plans prices and features. You do not need to create an account to browse plans.
- You can create an account and shop for health plans without applying for financial help.
- You can answer a few questions and get an estimate of your potential financial help. You do not need to create an account to get an estimate of your eligibility for financial assistance.
- You can create an account and fill out the application for financial help, which includes the new kind of tax credit and reduced co-pays and deductibles. Keep in mind that the application will take time—at least 30 minutes—and you’ll need to be prepared to provide lots of info, including your tax filing status, income and which members of your family are seeking coverage.
Can I apply for insurance if I’m pregnant? Will being pregnant affect how much I pay for insurance?
Yes, you can apply if you’re pregnant. And no, it will not affect how much you pay. Pregnancy is considered a pre-existing condition, so no company can deny you coverage for this, or any other pre-existing condition. And when the Affordable Care Act was passed it became illegal for insurance companies to charge women more because they are pregnant. Fair’s fair.
Just remember that there is an open enrollment period for 2019 coverage that begins in November, so if you have plans to get pregnant, that’s a great time to enroll. Once you have health insurance, it will help cover pre- and post-natal care, including screening for gestational diabetes, delivery of your baby, breastfeeding support, supplies and counseling, and newborn health care.
Insurance speak can be confusing. What are the top terms to know?
Ask and you shall receive. Here’s a short list of key words that will help you understand the ACA and your health care coverage a whole lot better.
- Health insurance is a way for individuals to reduce the financial impact of wellness, illness, surgery or accidents over time. Typically, you sign up for a plan and pay a monthly fee so that most of your health care costs will be covered by insurance when you need it.
- Premiums are the fees, typically billed monthly, that you pay to insurance companies to have your coverage.
- Copays are predetermined amounts of money you need to pay for a doctor’s office or emergency room visit or for prescriptions. Copays are usually around $10–30 (sometimes more for hospital visits or special tests like MRIs or x-rays) and are due at the time of your visit. Then your insurance covers the rest of the cost of the visit or drugs. And then there’s even more good news: the new health care law (the ACA) requires that insurance companies offer lots of great benefits that do NOT require copays.
- Deductibles are the minimum amount a patient must pay before an insurance company will pay anything toward health care costs. When you are signing up for a health care plan, you’ll have different deductible options. Typically, the higher the deductible, the lower the cost of insurance, but you’ll need to balance that out for yourself thinking about how much you’re willing to pay before the insurance kicks in. What’s more, similar to how it handles copays, the ACA requires that insurance companies offer all kinds of great health care that you can receive without having met your deductible.
- Open enrollment is the timeframe in any given year when you can sign up for or change health care plans. If your employer doesn’t cover your health insurance and you’re thinking about signing up for a plan (and perhaps some financial support) on the online insurance marketplace, the open enrollment begins in November for insurance starting in 2019.
- Insurance exchanges aka insurance marketplaces are basically websites that allow you to shop and compare health insurance plans. It’s sort of like Travelocity for shopping flights and hotels…but for health insurance instead. The ACA established “ these marketplaces and requires each state to have one. Colorado’s insurance exchange is called Connect for Health Colorado.
- Medicaid (or Health First in Colorado) is a joint federal and state program designed to, among other things, cover health care costs for people who don’t earn enough to pay for health insurance and premiums. Health First eligibility depends on how much you earn and how many people are in your family: a single person earning less than $16,000 a year or a family of four earning about $33,000 a year typically qualify. Under the ACA, more people than ever can use Health First for health care coverage and enrollment can happen any time (there is no open enrollment period).