Under the Affordable Care Act (ACA), individuals and families may purchase private insurance coverage through new state-based exchanges (or "marketplaces"), which are set to open in October of this year for coverage beginning Jan. 1, 2014. Regardless of whether an exchange is state-run or federally facilitated, enrollees with family incomes from one to four times the federal poverty level (about $24,000 to $94,000 for a family of four) may qualify for tax credits that will lower the cost of coverage through reduced premiums and, in some cases, also be eligible for subsidies to reduce their out-of-pocket costs.
Insurers must cover a minimum set of services called essential health benefits and must organize their plan offerings into five levels of patient cost-sharing (catastrophic, bronze, silver, gold and platinum, ranging from least to most protective). Also starting in 2014, insurers will be prohibited from denying coverage based on pre-existing conditions and will be able to vary premiums only by age (to a limited extent), tobacco status, geographic region and family size.
Benefits will be extended in many cases to cover services typically now excluded, such as maternity and mental health; and reinsurance, risk adjustment and risk corridor programs will be in place to help compensate for the enrollment of high-cost individuals. Participating insurers generally will offer a number of plans at various tiers of coverage, and they also typically offer more than one plan option within a given coverage tier. As a result, the number of plans available to consumers will be significantly greater than the number of insurers participating.
Bronze plans (which cover 60 percent of health-care costs when averaged across all enrollees) have the most cost-sharing and represent the lowest level of coverage generally available through exchanges. Silver plans have lower cost-sharing than bronze plans (covering an average of 70 percent of enrollees' health-care costs on average), and will therefore generally have higher premiums.
COLORADO (DENVER)
State Exchange Overview
10 insurers participating in exchange (statewide)
10 insurers offering coverage in rating area 3 (Denver)
53 silver plans offered in rating area 3 (Denver)
43 bronze plans offered in rating area 3 (Denver)
Unsubsidized Monthly Premiums Silver and Bronze Plans
Kaiser Foundation Health Plan of Colorado - KP CO Silver 1750/25 percent/HSA: Age 25, $192; 40, $245; 60, $520 monthly.
Humana Health Plan Inc. - Humana Connect Silver 4600/6300 Plan: 25, $196; 40, $250, 60, $531.
Lowest Cost Bronze Plan
Kaiser Foundation Health Plan of Colorado - KP CO Bronze 5000/30 percent/HSA: 25, $146; 40, $186; 60, $395
Monthly Premiums Before and After Tax Credits
Second-lowest cost silver plan
Age 25 single, $25,500 income, 218 percent of the federal poverty level: $196 premium; tax credit, $52; premium after tax credit, $144.
Age 40, family of four, $60,000 income, 255 percent of the federal poverty level: $748, tax credit $339; premium after tax credit, $409.
Age 60, couple, $30,000 income, 193 percent of the federal proverty level: $1062 premium; tax credit, $912; premium after tax credit, $150.
Lowest cost bronze
Age 25 single, $25,500 income, 218 percent of the federal poverty level; $146 premium before tax credit, $94 premium after tax credit.
Age 40, family of four, $60,000 income, 255 percent of the federal poverty level: $557 before credit; $218 after.
Age 60, couple, $30,000 income, 193 percent of the federal proverty level: $790 before credit; $0 after.
The full Kaiser Family report is at: http://kff.org/health-reform/issue-brief/an-early-look-at-premiums-and-insurer-participation-in-health-insurance-marketplaces-2014/ Data was not listed for area 10 Mancos.
Premium data were collected from health insurer rate filing submitted to state regulators.
These submissions are publicly available at: http://cdn.colorado.gov/cs/Satellite?c=Page&childpagename=DORA-HealthIns%2FDORALayout&cid=1251643290088&pagename=CBONWrapper
Chip Tuthill lives in Mancos. www.factcheck.org, www.politifact.com.