Colorado is one of several states that has published the prices of insurance available in October on the health insurance exchange. This means you can now guess what to expect. If you have NO insurance available through work (or the insurance for the employee only costs more than 9% of your total income) you will qualify for a subsidy if you buy your insurance on the exchange.
First: Go to Connect for Health Colorado and calculate your expected subsidy.
If you have kids, see if you qualify for CHP+. (If you don’t, I have no idea how much insurance will cost through the exchange…less than for a 40 year old, anyway.)
Finally, do your math.
So, let’s say you are a stereotypical family of two children and two parents (both age 40 just because that’s the information we have). If you gross under $32,500 annually (or a little over $2700 a month, based on this year’s data), you will qualify for Medicaid. So let’s say you make $40,000 (or $3333 a month).
You calculate your federal subsidy, which comes to $572 monthly if you are only buying insurance for the adults (and putting the children on CHP+) or $938 if you are buying insurance for the whole family.
Your children qualify for CHP+ so you pay the enrollment fee of $35 for two children (it’s $105 for two kids if you make over 200% of the federal poverty level). The two adults can choose a bronze level plan that starts at $186 per month per person up to a gold or silver plan that costs at least twice that. To understand the different plan levels, look at page 2 of this link, which shows samples. For instance, a bronze level plan might have a $5950 deductible. A gold level plan might have a $640 deductible with a 20% coinsurance once your deductible is met (meaning you pay the first $640 in medical bills and after that your insurance pays 80% of the bill and you pay 20% of the bill until you reach your maximum out of pocket).
Let’s say you choose the gold level plan from Rocky Mountain HMO that costs $412.81 a month for each of the two adults. You use your federal subsidy and end up spending a total of $253.62 a month on insurance for the parents plus $35 annually for the kids. You still have to meet a deductible and pay co-insurance for everything that is not preventative but for under $300 a month, you have what most people would consider “good” insurance.
Let’s say instead that you choose the Rocky Mountain HMO bronze level plan for $296.41 per person. You are now paying $20.82 a month for the parents’ insurance plus $35 annually for the kids. You know your kids are covered. The parents’ insurance doesn’t provide much beyond your annual exam until something terrible happens…but once something terrible happens, you don’t risk bankruptcy. It may take a long time to pay off bills in the thousands, but at least it is possible. I’ve seen patients have a completely unexpected medical bill leave them with hundreds of thousands or even a couple million dollars in bills. For twenty bucks a month, that’s pretty good.
If you make more money, you’ll be paying more for the insurance, but everyone making under 400% of the federal poverty level will qualify for some subsidy if they do not have insurance available at work.
What if you do have insurance available at work but you don’t like it? Or what if it’s cheap to buy insurance for the worker but most of your paycheck to insure the rest of the family? Anyone can use Connect for Health Colorado to shop for health insurance, you just don’t get a subsidy. So let’s say you are that same family but Mom has a job that provides her with okay insurance for $300 a month but would cost $2000 a month to insure the family. Technically this counts as “affordable” according to the laws and so the family does NOT qualify for a federal subsidy (yeah, stupid, but there it is). This family can still get the kids on CHP+ for the same $35 enrollment fee. The parents can then look at their options on Connect for Health Colorado and choose anything from the Kaiser bronze plan, which would cost $372.40 a month for both of them up to a ritzy $800-1000 a month option at the higher levels (which would still come out to less than buying a family plan through work).
What does this mean for my patients? First, according to federal law, everyone in the country will be required to have insurance in January unless you have Medicaid/Medicare/Tricare, a religious exemption (such as a Christian cost sharing plan), or certain other exemptions. So get some. Second, if you end up with a high deductible, it still makes sense for most people to keep seeing me…you’re paying out of pocket anyway unless something really terrible happens. I’ll help keep your bills down in the meantime. Finally, if you end up with really good insurance and go elsewhere, I won’t get my feelings hurt. Congratulations on hitting the health insurance jackpot. I want everyone to be able to have coverage that good but until that happens, I’ll keep doing what I’m doing.
Any questions? Yeah, we’re all a little confused at this point. But we’ll work together to figure out the new system. It’s not perfect, but it’s a huge improvement over what we have right now. Please contact me if you have any questions.