Tr-County enrollment fairs

Tri-County Health Network is currently holding a series of open enrollment fairs. The next sessions are scheduled for Saturday from 9 a.m. to 3 p.m. at the Ridgway Public Library; Wednesday from 10 a.m. to 2 p.m. at the Lone Cone Library in Norwood; and Dec. 14, 10 a.m. to 4 p.m. at the Wilkinson Public Library. (Courtesy photo)

A statewide reinsurance program announced earlier this year predicted lower health insurance premiums in the individual marketplace starting in January, with a Colorado Division of Insurance report estimating potential savings for individual policyholders on the Western Slope of up to 30 percent.

Now, with open enrollment underway, locals are getting their first glimpses of their 2020 premiums and whether those estimates apply to them. The verdict? It depends on who you ask.

Accommodations in Telluride owner Lee Zeller, for instance, has an individual policy that covers just herself. After she saw a small drop in her premium from 2018 to 2019, Zeller this year saw her premium go from $1,319 in 2019 to $990 per month in 2020, a decrease of 25 percent.

Zeller said that while she is pleased with the lower price, she remains frustrated with the system.

“I do think that the insurance rates are set unfairly,” she said. “What are they based on? On age? On overall health? Do they even know that I can run a half marathon? I have had so few health issues my entire life.”

For locals Robbie and Jill O’Dell, who are self-employed and have two school-aged children, the path to lower premiums was not straightforward. Jill O’Dell said that for many years they purchased their insurance from Cigna. When the insurance giant pulled out of the area about three years ago, she shopped through Connect for Health Colorado. The only remaining provider, Anthem Blue Cross, quoted her $2,400 per month with a $15,000 deductible.

“At that point, we went with Altrua Healthshare, which was $600 per month, but not real health insurance,” O’Dell recalled, referring to healthshares, which are programs where groups of like-minded people share the cost of their medical expenses. These groups typically have shared ethical or religious beliefs, and agree to follow certain guidelines like a code of conduct. Although healthshares are cheaper than traditional health plans, there are no guaranteed payments for procedures and no coverage for pre-existing conditions.

“While I have not been dissatisfied with Altrua and we have saved money, it felt like a big financial risk if something serious were to happen,” O’Dell said. “I have been following Gov. Jared Polis’s promises to lower premiums on the Western Slope, so figured I would check in again. The cost for the same plan I looked at three years ago went down to $1,700 per month with a $15,000 deductible for the family and $8,000 for an individual. I felt like I had taken my chances long enough with a healthshare and needed to get back on real insurance.”

The decrease between Anthem’s three-year-old estimate for the O’Dell family and the 2020 quote was 30 percent.

O’Dell added that once again she shopped through Connect for Health Colorado, which is “pretty easy as there are no other insurance providers in our area.”

In addition to the still-costly premiums, high deductibles and co-pays and lack of competition among providers in San Miguel County, there are some locals who will actually see an increase in their premiums for 2020.

Tri-County Health Network Executive Director Lynn Borup explained that the discounts resulting from the reinsurance program apply only to those who pay for their individual plans in full and that consumers who are receiving subsidies may not receive a discount.

“If you are on subsidies, you may be seeing an increase,” Borup said. “That’s the big message. People have been a little panicked when they come in to see us because they were expecting a decrease.”

To help locals navigate these and other complexities, TCHNetwork is currently holding a series of open enrollment fairs. The next sessions are scheduled for Saturday from 9 a.m. to 3 p.m. at the Ridgway Public Library; Wednesday from 10 a.m. to 2 p.m. at the Lone Cone Library in Norwood; and the final fair on Dec. 14 from 10 a.m. to 4 p.m. at the Wilkinson Public Library.

Borup encouraged locals to visit one of the health fairs, and avail of TCHNetwork navigators, expertise and resources.

“We don’t just serve a particular sub-set of the population or a specific income level,” she said. “I think it’s important for people to check in, it doesn’t hurt to talk to us before they renew.”

Borup added that buying health insurance coverage now for next year remains important, regardless of eye-catching headlines such as the possible introduction in Colorado of a so-called public option, or the potential rollout of a cooperative health insurance plan in San Miguel County, like the successful cooperative operated in Summit County that officials here are currently looking at.

“People hear about the public option or the Summit Plan and think these will be available in 2020,” Borup said. “So they may decide to wait and not sign up for health insurance during open enrollment. Sadly, what will happen is that people will be uninsured for next year. When they tell us that they are waiting for the public option, we explain that that might be another two to five years.”

She continued, “If they are wanting full, comprehensive health insurance, they need to enrol by Jan. 15 to have coverage in 2020.”

In the meantime, local consumers express frustration with the current system and perceptions of other systems.

“I know that I am paying for sick people through my premiums, that it is not there just for me,” Zeller remarked. “When people complain that universal health care is a socialist program, well guess what? So is your private insurance. But I get it. Whether it's private insurance or universal health care, it is all socialistic. My premiums help the people in the insurance system that need more health care.”

Said O’Dell, “The cost is prohibitive and essentially most of our care will be paid for out of pocket. The whole thing is ridiculous.”