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Colorado health care exchange set to open Tuesday
9/30/2013 By: Carole McWilliams
News update: Former Bayfield Marshal in critical condition
Jim Harrington, retired Bayfield Marshal, was involved in a horse accident Sept. 26 at the Pine River Trail Head and was evacuated to Denver. His wife, Robin Harrington, is reporting that he is in critical condition and on life support in Denver.
Robin and family members wrote the following on Caring Bridge.com:
Thanks to our son Luke who was with him performed CPR was able to save his fathers life.
Jim's injuries include, broken right collar bone, serious head injuries, punctured lung, 10 broken ribs in his back, 8 broken ribs on his right front and 5 on the left. He has a flaying chest which means the rib cage is floating free and when he attempts to breathe it works opposite and pushes the rib cage in instead of out. Jim is currently on life support.
Jim is a fighter and acknowledges his family and doctors with thumbs up or down when he is coherent. I'm very thankful for each small or large progress that we can get. Prayers requested.
Health insurance enrollment starts Oct. 1
By Carole McWilliams
Times senior staff writer
Enrollment starts Oct. 1 for health insurance under the Affordable Care Act, commonly called Obamacare.
So who is supposed to sign up, and how do you do it? What does it cover, and how much does it cost?
In Bayfield and Ignacio, Eileen Mathy can help answer those questions and guide people through the process, including determining their options and what they will cost. She described the coming changes to the Pine River Centennial Rotary Club on Aug. 19.
Mathy is one of the health coverage guides trained through Connect for Health Colorado to help people sort through this process.
She is at the recently opened Bayfield Family Center office on Tuesdays and Thursdays to do that. The Family Center is in the Aspenwood Building at the east end of Bayfield Center Drive.
Connect for Health Colorado came out of health care reform efforts that started in the state back in 2006 and became the state�s insurance marketplace for the Affordable Care Act.
People can sign up through Connect for Health or through a private insurance agent, Mathy said. But if they want to qualify for premium subsidies, they need to go through Connect for Health.
Enrollment for 2014 runs from Oct. 1 through March 31. Coverage will start on Jan. 1 for those who have enrolled by Dec. 15.
Price ranges for insurance premiums in Colorado were released in mid-August. Mathy said there are a lot of variables that will determine someone�s actual premium, such as age, income and number of people in the household (for subsidy or Medicaid eligibility), where you live, and the plan and level of coverage you choose.
Smokers will pay four times as much as non-smokers.
Every plan must include 10 items: preventative care, maternity and newborn care, ambulatory (outpatient) care, emergency room, hospital stays, lab services, rehabilitation, mental health care, prescriptions, and pediatric care, including dental and vision.
Mathy said there are fewer companies offering plans on the Western Slope, and premiums tend to be higher than on the Front Range.
There is a separate set of options for businesses with fewer than 50 employees, if they choose to provide insurance for employees. ACA does not require them to do that.
ACA includes premium support for people under certain income levels � for individuals earning between $15,856 and $45,960 per year; and a family of four making between $32,499 and $94,200.
�There are advance premium tax credits based on income and family size,� Mathy said. It is paid monthly to the insurance company, and the individual pays the rest. Or the person can get the premium support as a tax refund later.
�You can shop on-line. You can figure your tax credit,� she said. The web site is www.ConnectforHealthCO.com. People can do this on their own or with the help of a navigator or private agent. They should plan on at least 90 minutes to get through the process.
Mathy clarified, �This isn�t for anyone with insurance at work or if you are on Medicare or Medicaid. � You can shop on the market if your employer�s insurance (your share of the cost) is more than 9 percent of your income.�
Around two-thirds of workers in Colorado have employer-sponsored health insurance, Mathy said.
Individuals who aren�t exempt from the ACA requirement and who don�t sign up for an insurance plan for 2014 will face penalties. Mathy said the first year penalty will be $95 per person or 1 percent of income, payable to the IRS in 2015.
The penalty increases to $325 per person or 2 percent of income in the second year. In the third year it will be $695 per person, she said.
Medicaid eligibility has been expanded as an option for some people who won�t be able to afford insurance premiums even with the tax credits. �You don�t have to have a small child to get Medicaid,� Mathy said. �We estimate at least 4,000 people in La Plata County will qualify.�
In Colorado, anyone earning up to 133 percent of the Federal Poverty Level might be eligible for Medicaid under more generous income caps. For an individual it�s $15,856. For a family of four, it�s $32,499 a year. That application period also starts on Oct. 1.
As of 2015, the expanded Medicaid will include dental care, Mathy said.
Colorado is one of 17 states that have set up their own health care exchanges. �I think Colorado has done the best of all the states, but insurance companies are still in charge,� Mathy said. �The idea is to get them to compete for business and lower their premiums.�
Connect for Health is not a stage agency, Mathy said. It is supposed to become self-funding.
Mathy said she can help people who don�t have access by computer. �I can guide you and show you the process, but it�s up to you which plan to get.�
She can be reached at 749-4553
Kevin O�Connor is Mathy�s counterpart at San Juan Basin Health Dept. He also can help people through the sign-up process. He can be reached at 335-2021.
The local e-mail address is email@example.com.
On-line information is at www.ConnectforHealthCO.com. For Medicaid go to www.Colorado.gov/PEAK.
Connect for Health has a call center in Colorado Springs at (855) 752-6749.
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