By Marguerite Salazar
The Colorado community will celebrate the one-year anniversary of the establishment of the GettingUSCovered health plan on July 1. GettingUSCovered is a Colorado-specific program under the Affordable Care Act of 2010 that provides comprehensive health insurance for eligible uninsured Coloradans with a pre-existing condition who have gone without coverage for six months.
This new health plan is designed to act as a temporary bridge to 2014 when Americans will have access to affordable health insurance choices through a competitive marketplace called an exchange. Also, in 2014, thanks to the new consumer protections in the Affordable Care Act, insurance companies will not be able to deny coverage to adults based on a pre-existing condition.
GettingUSCovered has already proven to be successful in the Colorado community by making access to health insurance easier than ever before. Today, GettingUSCovered has increased access to care for 830 previously uninsured Coloradans, making this new health plan a welcome option to receive the much-needed care of Colorado residents.
Early last fall, I was lucky enough to speak with a man from Colorado who enrolled in this new insurance program. Working in the service industry, he was not provided health insurance through his employer. When he tried to purchase it on his own, he was denied because he needed two hip replacements. Working as a bartender, he was on his feet for several hours a day, and without the surgery, he would have been forced to quit his job, and file for disability. Today I can happily report that both surgeries were successful, and this man continues to be a working, contributing member of our community.
We underestimate the importance of access to care, and how critical it is to help people lead healthy and productive lives. This new plan in Colorado, GettingUSCovered, offers a broad range of health benefits, including primary and specialty care, mental health coverage, nationally recommended preventive care services, and prescription drugs. These benefits apply to those with a pre-existing condition without the imposition of a higher premium. Eligibility is not based on income allowing denied individuals access to one of the largest networks of physicians in the state. This network includes more than 2,500 primary care physicians, 9,000 specialists and 99 hospitals statewide.
Also, this program encourages individuals to take advantage of the age and gender specific screenings offered as preventative services, which are covered 100 percent after a physicians office co-pay. Some of the covered preventative care services include:
- Adult routine examinations
- Smoking cessation programs and patches
- Pelvic exams
- Pap smears
- Prostate exams
- Flu shots
People struggling with pre-existing health conditions need affordable and accessible medications to help manage individual illness. The GettingUSCovered pharmacy benefit plan encompasses a statewide network including King Soopers, Safeway, and Walgreens allowing individuals to choose a pharmacy based on convenience while providing a comprehensive benefit to cover medications.
GettingUSCovered is funded by enrollee premiums and federal funding, and the rates do not change because of individual health conditions. An enrollee would not be subject to pay more than the rate a person without any health conditions would pay. Rates are based on age, county of residence and smoking status. Premiums range from $115 to $601 a month for non-smokers. A tool for determining individual rates is available at the website listed in the tab Check Rates.
In order to be eligible for the GettingUSCovered Plan, a Colorado resident must be a U.S Citizen (or have a lawful presence in the U.S), have been uninsured for the past six months (excluding individual receiving COBRA benefits) and have a pre-existing condition.
An applicant must submit all requested information by the 15th of every month to be considered for the first of the following month. However, if the 15th falls on a weekend or a federal holiday, then the application is due to the office the Friday prior to the 15th. Applicants are also required to submit a voided personal check (no business or temporary checks accepted) along with the application. It takes approximately two weeks to process an application. Individuals will be notified regarding their application status.
We are lucky that Colorado has such a robust program in place, and we look to this as just one of the many successful new opportunities available through the passage of the new federal health care law, the Affordable Care Act.
Marguerite Salazar is the regional director of the U.S. Department of Health and Human Services.
For more information, including eligibility, plan benefits and rates, as well as information on how to apply, please visit www.gettinguscovered.org. Or call 303-749-1109 (Denver metro) or toll-free: 877- 397-1109 (8am- 5pm M-F).