Reprinted from the Health District's quarterly publication mailed to district residents (Fall 2010)


TOPIC: Health Plan Targets Those with Pre-existing Condition
new program accepting applications
 
by richard cox

People unable to get health insurance because of a pre-existing condition may be able to find coverage through a new program now available in Colorado.

GettingUSCovered is a comprehensive health plan for Colorado residents who have a pre-existing medical condition and have been uninsured for at least six months. It’s one of the high-risk pools established as part of the Patient Protection and Affordable Care Act of 2010 signed into law last March.

The new plan has been accepting applications since July.

GettingUSCovered is expected to provide coverage for up to 4,000 currently uninsured individuals until 2014, when insurers will be required to accept all people with pre-existing conditions.

There is no waiting period for qualified applicants to GettingUSCovered; coverage begins immediately after a person is accepted into the plan. Once enrolled, participants have coverage for primary and specialty care, mental health services and prescription drugs.

Monthly premiums for GettingUSCovered are similar to what healthy people would pay in an individual health plan. Rates are determined by age, the county of residence and whether or not someone is a smoker.

An 18-year-old non-smoker living in Larimer County would pay $122 per month for coverage, $146 for a smoker of the same age. Other sample premium rates for Larimer County: $275 for a 40-year-old non-smoker; $481 for a 55-year-old non-smoker; and $646 for a 55-year-old smoker.

These rates are generally lower than premiums for the state’s existing high-risk plan, CoverColorado. People who are currently enrolled in CoverColorado do not qualify for GettingUSCovered because applicants must have been without any insurance coverage for a minimum of six months.

Those already enrolled in CoverColorado are strongly discouraged from dropping that plan in hopes of joining the new plan six months later. They run the risk of experiencing a serious injury or illness while uninsured, or of GettingUSCovered closing to new applicants because it is full.

People enrolled in the new plan have an annual deductible of $2,500 and a $30 copay for most doctor visits. The plan pays 80 percent of costs after the deductible is met. It uses the doctor network of Rocky Mountain Health Plans, a Colorado-based, not-for-profit health benefits provider that is a partner in GettingUSCovered.

The plan has a prescription drug benefit, including a $10 copay for generic drugs that is not subject to the deductible. Preventive care — including routine exams, immunizations and screening tests — also is covered, with patients responsible only for the copay in most cases.

Maximum out-of-pocket expenses, including deductibles and copays, is $5,950 per year per person.

Information on GettingUSCovered — including rates and benefits — is available online at www.gettinguscovered.org or by calling 877-779-0387.