1. The Value of Coverage Debra Judy and Matt Valeta
Colorado Consumer Health Initiative
Colorado Community Health Network
September 29, 2014

2. Why do we have health insurance?

3. Creating a Culture of Coverage
It’s the Law.
Health Insurance = Financial Security.
Health Insurance = Better Health?

4. The Cost of Non-Compliance
2014: the greater of 1% of income or $95/adult ($47.50/child) up to family maximum of $285
2015: the greater of 2% of income or $325/adult ($162.50/child) up to family maximum of $975
2016: the greater of 2.5% of income or $695/adult ($347.50/child) up to family maximum of $2,085
Indexed to inflation in subsequent years.
Penalty capped at average cost of bronze plan.

5. Financial Security No. 1 cause of bankruptcy: Medical Debt In 2012:
41% of adults (19 to 64) reported problems paying their medical bills or said they were paying off medical debt
42% of those individuals received lower credit rating due to unpaid medical bills
Insurance reduces financial strain.

6. Better Health Individuals with health insurance are more likely to
Have a regular source of care
Be up to date on prevention screenings
Report overall better health

7. Why Not Alternative “Coverage”?
Colorado Indigent Care Program (CICP)
Charity care and financial assistance programs

8. CICP Not insurance Not available at all hospitals Limited services
Not available to individuals eligible for Medicaid or CHP+

9. Financial Assistance Programs
Eligibility set by hospitals
Limited services
Lowest negotiated rate may still be pricey

10. Purchasing the “Right” Plan
Catastrophic: 3%
Bronze: 41%
Silver: 46%
Gold: 9%
Platinum: 1%

11. 2015 Plans and Networks EPO v PPO v HMO?
Upfront affordability v at the time of care
Emergency costs
Continuity of care
Churn?

12. Tools

13. Tools

14. Tools

15. Definitions Defining key words in context Predicting coinsurance costs
Associating images with key terms

16. Tools

17. Deductibles

22. Self Advocacy Ask about costs
Make sure you understand your provider’s instructions
Interact with administrative staff
Know when a copay is required
Preventative v. diagnostic?

23. Questions?
Debra Judy, Matt Valeta,