Elevate Questions & Answers

General FAQs

What falls under the preventative care?

Preventive services include immunizations, screenings for infants, mammograms, pap smears, breastfeeding support, supplies and counseling, contraception, HIV screening, STI counseling, HPV DNA testing, gestational diabetes screenings, well-woman visits.

What is Connect for Health Colorado?

Connect for Health Colorado is the online health insurance marketplace and support network, where individuals, families and small employers can shop for and buy health insurance based on quality and price. Under the Federal Affordable Care Act, customers may have access to financial assistance, based on income, to reduce costs when buying on Connect for Health CO.

I don’t have health insurance. What can I do now?

You can buy health insurance from Connect for Health Colorado during the Open Enrollment period. You may also qualify to enroll outside of Open Enrollment if you have a Life Change Event, such as marriage, divorce, the birth or adoption of a child, loss of minimum essential coverage or employer sponsored coverage becoming unaffordable. Please call Elevate for more information at 303-602-2090. Here are some additional resources:

  • The Colorado Consumer Health Initiative offers help for uninsured Coloradans.
  • The federal government has a website to find health insurance options.
  • The Colorado Division of Insurance offers guidance for shopping for insurance in “Health Insurance 101.”Look for the “Shopping for Insurance” tab.
  • At Colorado’s Program Eligibility Application Kit (PEAK), you can determine if you are eligible for Medicaid, Child Health Plan Plus, or other public health programs.

How much will health insurance cost?

The cost of your health insurance will depend on the plan you choose, how much coverage you choose to purchase, and whether you will qualify for tax credits. Our cost calculator can help individuals with an estimate to determine how much an average person will pay for insurance coverage. However, it is important to take the extra step to find out if a subsidy is available to reduce the monthly premium. Please call Elevate for more information or if you would like assistance in determining cost and availability of subsidies.

Do I have to purchase health insurance?

Most people are required to have health insurance or pay a penalty if they don’t. Coverage may include employer-provided insurance, coverage someone buys on their own or Medicaid. Several groups are exempt from the requirement to obtain coverage or pay the penalty, including:

  • People who would have to pay more than 8 percent of their income for health insurance
  • People with incomes below the threshold required for filing taxes 
  • People who qualify for religious exemptions
  • Undocumented immigrants
  • People who are incarcerated
  • Members of Native American tribes

The new health care law does not require employers with fewer than 50 full-time equivalent employees to provide health insurance for their employees. Larger employers with more than 50 full-time equivalent employees that do not offer affordable insurance or offer coverage that does not meet minimum standards will be subject to penalties.

In the Marketplace, will there be a required generic formulary?

Federal regulations for qualified health plans (QHPs) in health insurance marketplaces require them to cover at least one drug in each drug class and category OR as many drugs in each class and category as the Benchmark plan covers (whichever is greater). QHPs are not required to cover a specific list of generics – they just have to offer a certain number of drug options.

Who can use Connect for Health Colorado?

Connect for Health Colorado will be available to individuals and families in Colorado as well as employers with up to 50 employees. Coloradans who have affordable coverage through an employer with more than 50 employees are expected to continue that coverage.

Why did Colorado create Connect for Health Colorado?

Colorado created Connect for Health Colorado to help Coloradans access health insurance. Many uninsured Coloradans work part-time or in places that don’t offer health insurance. About half of the uninsured are part of the small business community. Health care costs have been rising sharply for everyone. As part of Colorado’s ongoing effort to improve our health care system, the Colorado General Assembly passed Senate Bill 11-200 in 2011. This law created a separate, non-profit organization to build a new statewide health insurance marketplace to help people shop for and buy insurance and to take advantage of new tax credits to reduce premium costs. State leaders decided that it was best to create a marketplace that will serve Coloradans and encourage competition in the marketplace, rather than sending Coloradans to a federal marketplace.

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Eligibility FAQs

How can you use Connect for Health Colorado in conjunction with Medicare part A, B, and D?

Connect for Health Colorado will not offer Medicare plans. An individual who is covered, or is eligible to be covered, under Medicare Part A would not be eligible for subsidized coverage through Connect for Health Colorado.

Can I opt out of Medicaid and purchase private health insurance through Connect for Health Colorado?

If you are currently a Medicaid enrollee or you are eligible for Medicaid, you can purchase private health insurance through Connect for Health Colorado, but you will not be eligible for premium assistance.

How will Connect for Health Colorado work with Medicare?

Connect for Health Colorado does not interact with Medicare. More information on Medicare services, including links to Medicare Frequently Asked Questions, can be found on the official medicare.gov website. Please visit https://questions.medicare.gov for further information.

For veterans, do the medical benefits they receive from the VA count as medical insurance?

Comprehensive VA benefits and TRICARE for life count as coverage toward the individual mandate. You can continue on these programs without interruption.

How will we link uninsured patients who are newly eligible for insurance coverage with the providers they already have relationships with?

The Connect for Health Colorado Customer Service Center will be developing processes, procedures, and training to advise customers to contact their current provider to see what types of health insurance they accept before shopping and enrolling if they want to keep their current provider. Connect for Health Colorado is also building a provider directory into the shopping experience so customers can sort plans based on whether or not their provider is in the plan network if that is a priority for them.

I am currently unemployed, age 62, living at home, have a preexisting condition. My current health insurance will be going up as of 9/2013. How do I see if I am eligible for the new program? I am on social security and my income is $500 /month. What are my options for coverage?

On Connect for Health CO, you can shop for carriers, plans and rates and find the best plan for you. It is possible that you will qualify for premium tax credits. If you haven’t tried our calculator, it is available on our website. This is an estimation of what an average plan might cost and does not include the subsidy you may qualify for. Please call Elevate 303-602-2090 if you would like help determining costs.

I will be turning 26 at the beginning of September and will be aging off my mom’s plan. I do not have access to insurance through my work and do not qualify for insurance on my own. What is the best option for coverage from September to January? Will I be able to get CoverColorado and then transfer to Connect for Health Colorado?

You can buy health insurance from Connect for Health Colorado starting in October, 2013, and that coverage will take effect as early as January 1, 2014. In the meantime, there are other resources available to help you find health insurance. The Colorado Consumer Health Initiative offers help for uninsured Coloradans. The federal government has a website to find health insurance options. The Colorado Division of Insurance offers guidance for shopping for insurance in “Health Insurance 101.” Look for the “Shopping for Insurance” tab. At Colorado’s Program Eligibility Application Kit (PEAK), you can determine if you are eligible for Medicaid, Child Health Plan Plus, or other public health programs. If you are healthy and qualify, you can purchase a private health plan until the new marketplace opens.

I would like more information about how Colorado’s CHP+ children’s health plan will work with the new exchanges. Is it being eliminated? Is it part of the exchanges? Would there be any differences in insuring children through CHP+ and parents through the exchange? Any advantages or disadvantages?

When you enter your financial information into Connect for Health Colorado, our system will be able to check availability for CHP+ which will still exist. Parents can continue through our system and choose a private plan, so we will be able to handle different eligibilities through our system.

I’m concerned, I see there will be a pregnancy question on the app. What if I’m pregnant, will I not be accepted? I’m currently on CoverColorado so I’ll be forced to change.

The pregnancy question has to do with eligibility for Medicaid. Starting in 2014, you cannot be denied or rated up for pre-existing conditions including pregnancy. Coloradans who are currently insured through CoverColorado, the state high-risk insurance program, should come to Connect for Health Colorado to shop for coverage. It is possible that you may qualify for premium tax credits as well.

Read an article saying that if there is a pre-existing condition there is a waiting period of 365 days if there has not been credible coverage in the last 90 days.

There will be no waiting period if you do not have insurance.

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Shopping and Enrollment FAQs

If someone loses their job and is offered COBRA, could that person choose a plan inside the Marketplace instead? Would the client have to wait until open enrollment to apply?

Individuals who lose employer-sponsored coverage may apply and enroll in a health insurance plan outside of the open enrollment period due to the loss of minimum essential coverage and see if they qualify for financial assistance. Individuals do not have to accept COBRA and will be able to choose a health plan through Connect for Health Colorado either during open enrollment or through a special enrollment period.

Is this health insurance rescindable? About 10 years ago I went to a health insurance broker in Colorado to buy health insurance for myself. And he: Did not tell me to bring my medical history, wouldn’t let me choose my carrier, ignored my questions in favor of answering his phone, would not explain the form I had to fill out, told me to lie to avoid exclusions, told me that rescindable insurance was good because the premiums were refunded in the case of a rescission, etc. Do you have any procedures in place to prevent these types of abuses?

You always have the right to cancel coverage. You also have the right to report any abuses by an agent to the Division of Insurance which handles these kinds of complaints. Connect for Health Colorado will be training and certifying all agents/brokers that it is allowing to do business with us. We encourage our customers to report any abuse or irregularities and we will be collecting surveys as well. Every effort will be taken to protect our consumers from fraud and abuse.

What are the different ways I can shop when I get to the website?

You will have 4 ways to begin the shopping experience:

  • You can answer a few questions and browse health plans prices and features.
  • 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 to reduce the cost of health insurance.
  • You can fill out the application for financial help, which includes the new kind of tax credit and reduced co-pays and deductibles. The application will take time – at least 30 minutes. You’ll need to be prepared to provide many pieces of information about yourself and your household, including your tax filing status, income, and the members of your family seeking coverage.

What if I have questions or can’t decide?

Connect for Health Colorado will offer you many ways to get expert help:

  • You can ask questions by online chat.
  • You can call the Customer Service Center.
  • You can go to a local Assistance Site and sit down with a Health Coverage Guide to help you understand your options.
  • And if you need professional advice about which plan to choose, you can find a licensed agent/broker who has been certified to serve customers of Connect for Health Colorado.

What if I already have health insurance?

If you already have health insurance provided by your employer that is affordable, you do not need to do anything. If you are paying more than 9.5 percent of your household income toward insurance premiums, then you may be eligible for financial assistance through Connect for Health Colorado. If you have insurance from your employer and apply for financial help, Connect for Health Colorado will determine if that health plan is affordable and provides adequate coverage. If that coverage is determined to be affordable and adequate, then you cannot receive  financial assistance for new insurance.

How will payment be accepted for the Marketplace? It is my understanding that the first payment can be made with a card but after that a check must be used. How will people without checking accounts make payments?

For individuals and families, payment options will vary based on the health insurance carrier they select and their preference. Some health insurance carriers may allow cash, check, debit, or credit cards, while others may only allow checks. The Marketplace will facilitate the initial payment to the carrier, but the payment is processed by the carrier and handled directly with the applicant after initial enrollment.

Can I search for plans based on my doctors?

Yes. You can look for health plans that include your doctor or medical facility in the provider network.

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Health Plans/Carriers FAQs

I am looking for health insurance and I was wondering what your prices are?

Connect for Health Colorado will be open in November for January effective dates. At that time, you will be able to compare rates and benefits and pick a plan that is best for you.

What are the general guidelines for the Silver Plan? I used your calculator tool and based on my income/age and figuring in the federal tax credit, my monthly premium for a silver plan would be $65. What type of deductible, out of pocket totals, and wellness coverage the silver plan would include.

A Silver Plan needs to have an Actuarial Value of 70%. This means that out-of-pocket costs should not exceed 30% of the total expenses. There is flexibility in how carriers can design plans to meet this requirement. For instance, you can have a $1,000 deductible and the plan pays 70% after that OR you can have a $2,600 deductible and the plan pays 100% after that. These are estimates, but both scenarios could possibly qualify as a silver plan as long as they meet the Actuarial Value of 70%. Preventative care would be paid at 100% for all plans bronze through platinum.

Where can I obtain information for my company regarding all reporting requirements for QHPs approved to join Connect for Health Colorado, also where can I obtain a companion guide?

All rate and plan information is currently being reviewed by the Colorado Division of Insurance. We have not received approvals as of yet. You can contact them at www.dora.state.co.us.

Is pediatric dental coverage a required essential health benefit?

The Marketplace is required to offer pediatric dental benefit to all consumers, but consumers are not required to purchase the pediatric dental benefit. If a plan chosen by the customer doesn’t include pediatric dental coverage and there is someone identified in the application seeking coverage under the age of 19, then a pop-up window will be displayed to the applicant telling him or her to consider buying separate pediatric dental coverage.

What is the coverage provided by the different levels of insurance, i.e. platinum, bronze, etc.?

There are going to be four metal tiers available on our plans:  Bronze-60%, Silver-70%, Gold-80%, Platinum-90%. This means that carriers will pay those percentages, on average, of all costs in the plan. There are creative ways to meet that actuarial value, however. For instance, it is possible that you can have a high deductible plan of $3,000 and then the plan pays 100% and it could be a bronze plan.

Will a consumer be able to compare benefits provided by the different plans in the Marketplace before enrolling?

Yes, the consumer will be able to compare plans side-by-side, sort, and filter plans based on different factors prior to selecting a health plan.

What do the private health insurance plans offered by Connect for Health Colorado cover?

All health plans offered by our marketplace will include a comprehensive set of benefits, as required by federal regulations. All health plans offered in the individual and small group markets must provide a comprehensive package of items and services, known as Essential Health Benefits. Health plans can offer additional benefits as well. These benefits fit into the following 10 categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

If I decide to cover my employees, how does Connect for Health Colorado help me?

Connect for Health Colorado’s Small Business Marketplace lets you easily compare and contrast a variety of Qualified Health Plans offered by private insurers that will be rated and underwritten by a new set of consumer-friendly rules. Everything you need is available online, by phone or in person. You’ll be able to provide a broader range of health plan choices for your employees, which you can’t do today. Connect for Health Colorado also will provide expert counsel to help small businesses identify the policies that work best for them and their employees.

Are you accepting providers in your health network or do you just manage contracts for existing insurance networks?

We are not an active purchaser of plans, so networks are handled by the individual carriers. You should contact them directly.

How many health plan choices will I have and how much will it cost?

Connect for Health Colorado will offer consumers a large number of choices from many insurance companies. We will know more details in August, after the State finishes a review of health insurance company filings. Preliminary filings show that 10 insurance companies intend to provide about 150 health plans to individuals and families. Final premium costs also will not be known until August. But the early information shows a wide range of prices, depending on your age, tobacco use and where you live.

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Income Calculations FAQs

I am a 36 year old living at home with my parents. I have been unemployed for the last 5 years without insurance and have had no income since my unemployment insurance ended. Do I need to use my parents income since I live with them?

You should apply based on your tax household – so whoever is claimed as a dependent on taxes should be included together. If you are a separate tax household and only file your own information and are not listed as a dependent, then you should only include information on yourself.

I just wanted to clarify income eligibility guidelines for subsidies on the exchange. Are the income amounts that you’re quoting gross income or a person’s adjusted gross income?

Here is some additional information on MAGI income:  Based on the 1040 tax form : Income-add lines 7-22 which include wages, salaries, tips, alimony received, capital gains, pensions, rental real estate, farm income, social security benefits, unemployment benefits, etc.;  Adjusted gross income-subtract deductions in lines 23-36 which include tuition and fees, student loan interest, self employment deductions, health savings account deductions, moving expenses, alimony paid, etc.;  modified adjusted gross income-add back in:  Any foreign earned income excluded from taxes, tax-exempt interest, tax exempt social security income.

What is considered income?

Connect for Health Colorado uses Modified Adjusted Gross Income (MAGI) to calculate a taxpayer’s “household income” to determine eligibility for financial assistance (premium tax credits). MAGI means adjusted gross income (AGI) plus any tax-exempt income, such as social security benefits, if applicable. And, household income means the sum of a taxpayer’s MAGI and the MAGI of all the taxpayer’s dependents. An eligible individual for purposes of premium tax credits is an individual whose household income is between 133 percent and 400 percent of the federal poverty level (FPL) for the appropriate family size. For individuals and families who qualify for a premium tax credit, their share of the premium cost is set by their household income on a sliding scale ranging from 2% to 9.5% of their household income. For taxable years after 2014, and again for any calendar year after 2018, these applicable percentages (2%-9.5%) will be adjusted to reflect any increases in incomes and premium rates.

If my income changes, will my tax credit change immediately?

If your income changes over the year, your tax credit will be adjusted accordingly. If your income increases, you may have to pay the difference at tax time to the IRS. It will be important for you to contact Connect for Health Colorado if you have received financial assistance and your income changes.

What period of time would a person’s income be considered when making an application for health insurance using the Exchange/Marketplace website?

The Advance Premium Tax Credit or APTC, uses your estimated earnings for the current year. So you are projecting your income for 2014. For some people that is hard, so they can choose not to take all of the offered credit in case their income is higher than they expected. At any rate, they will have to reconcile on their taxes when they file for 2014.

What is a tax household?

Everyone you claim on your taxes, including yourself, your spouse and dependents.

What information should I include in calculating income?

You will be asked for estimated household income for the coming calendar year. Generally, you would include the adjusted gross income that you report on the 1040 tax form, with some additional forms of income. Assets, such as property, are not included in a MAGI income calculation.

What happens if my projected income is much less than I currently make?

If your estimated income for the coming year is much lower than tax information from previous years, we will ask you questions about your income and/or household situation, including whether you stopped working at your job, your wage or hours changed, you had a change in employment, or if you recently got married, legally separated or divorced or there was a death in your family. We can accept income estimates based on reasonable explanations and other documentation.

What happens if I don’t have a bank account?

You can pay for your health coverage by check, credit card or electronic fund withdrawal based on the rules set by carriers.

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Tax Credit FAQs

Even though I will receive help with my premium from the government, can that portion I am responsible for paying toward my health insurance still be paid with pre-tax dollars?

You cannot receive both Advance Premium Tax Credits and a pre-tax benefit for your premium costs. You will have to choose one.

Does the tax credit calculator display a yearly estimate or a monthly estimate?

The tax credit calculator displays a monthly estimate. You can choose to take that tax credit immediately and the federal government will send that amount to the carrier monthly and it will be applied toward your premium, or, you can pay the entire premium and reconcile on your yearly tax return. If your income is stable, it might make more sense to take it immediately. If your income is more variable, it might make sense to reconcile at the end of the year.

How will consumers get the credit delivered to them if they are eligible – via a check?

The tax credit is sent directly to the health insurance carrier from the IRS if the customer chooses to use the tax credit when purchasing coverage. If the person chooses not to use the tax credit at time of purchase, the person can claim the credit on his/her taxes when filing taxes.

How will the subsidy provided to a client be repaid by the client when a churn occurs? For instance, when a client moves from a 90% subsidy to only a 40% subsidy or from subsidy to Medicaid?

The Advance Premium Tax Credit is paid directly to the health plan from the federal government. Connect for Health Colorado customers whose income increases or decreases should report the change to the Marketplace to have the Advance Premium Tax Credit for the rest of the year appropriately adjusted to avoid having to pay back excess advance payments to the IRS when they file their taxes. All tax credit reconciliation will occur between the customer and the IRS at the time of tax filing.

What do I do if I cannot afford the monthly payments for health insurance?

A new kind of tax credit to reduce the cost of buying insurance will be available to hundreds of thousands of individuals, couples and families across Colorado. Eligibility is based on your household income. Individuals earning about $15,000 to $46,000 a year will be eligible for a tax credit. Couples earning between about $20,000 and $62,000 a year will be eligible. And families of four earning between $31,000 and $94,000 a year will be eligible. The amount of assistance will be determined on a sliding scale, which means the amount of the tax credit gets smaller the more you make in income. This program is not for individuals who are eligible for Medicaid or Medicare or have affordable coverage through an employer.  Eligible individuals must be a citizen or lawfully present, not incarcerated and be a Colorado resident. Medicaid will also be expanding to include additional people.

What happens if services were used within those conditional 90 days of eligibility and the individual was ultimately determined ineligible for that Marketplace plan? Will services used still be covered from that time period?

The eligibility that is being verified is for the Advance Premium Tax Credit and cost sharing reductions (reduced co-pays and deductibles). If after the 90 days the individual is ineligible for those benefits because requested documentation was not submitted in the time frame, he/she is still enrolled in the health plan but will have to pay the full amount of the premium each month and the plan’s standard cost sharing requirements. As long as he/she is enrolled in their plan and paying the premium, the health plan will continue to cover the services in accordance with the deductible, co-pays, and co-insurance identified in the contract.

How can I submit my application for financial assistance?

You will be able to submit your application online, by fax, over the telephone, or by mail.

Will I be eligible for a tax credit?

The new kind of tax credit to reduce the cost of buying insurance will be available to hundreds of thousands of individuals, couples and families across Colorado. Eligibility is based on your household income. Individuals earning about $15,000 to $46,000 a year will be eligible for a tax credit. Couples earning between about $20,000 and $62,000 a year will be eligible. And families of four earning between $31,000 and $94,000 a year will be eligible. The amount of assistance will be determined on a sliding scale, which means the amount of the tax credit gets smaller the more you make in income. This program is not for individuals who are eligible for Medicaid or Medicare or have affordable coverage through an employer. Eligible individuals must be a citizen or lawfully present, not incarcerated and be a Colorado resident.

How will the tax credit work?

Consumers who come to Connect for Health Colorado will be asked to provide household income estimates for the year they plan to purchase coverage and then will learn how much financial assistance they can receive. When you choose a health plan, you can use the tax credit up front to reduce the cost of the premium – the monthly amount you need to pay to have insurance. You can also choose to take a portion of the tax credit up front, or to use none of it up front and deduct it from your taxes later. The amount of your tax credit will be the same regardless of the health plan you choose in the marketplace. Therefore, you will save more money if you choose a less expensive plan. In addition, eligible older Americans, ages 55 to 64, will receive a larger tax credit to help offset higher premiums.

What if I get insurance through my employer, but it’s really not affordable for my family. Could I be eligible for the tax credit?

Yes. If you are an employee and you pay more than 9.5% of your household income for your health plan, you will be eligible to use Connect for Health Colorado to find a health plan. Also, if the coverage your employer offers does not meet the new standards of minimum essential coverage, you will also be eligible to purchase a plan and see if you are eligible for the new tax credit and out of pocket reductions through our website.

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Source: ConnectforHealthCO.com