A healthy outlook
Southwest Health Alliance perseveres, announces new plan with 35% savings

A healthy outlook

Primary care visits, like checkups, would have a very low or $0 copay under a new health insurance plan through the locally based Southwest Health Alliance. The new plan, which is being done in conjunction with Bright Health, would also have premiums about 35% lower than last year./File photo

Missy Votel - 10/08/2020

by Missy Votel

 

After going on life support early last year, efforts to bring a community-based health insurance plan to Southwest Colorado are alive and well. Quite well, actually. According to the Southwest Health Alliance, a newly hammered out plan, which will debut on the state’s insurance marketplace Nov. 1, is expected to offer savings of about 35 percent compared to the average price of plans last year. 

“We’re really pleased to share the good news,” Monique DiGiorgio, director of the Local First Foundation, which spearheaded the effort, said Tuesday. “I think the community’s voice was heard loud and clear.”

But it’s not just the Southwest Health Alliance’s premiums that will be lower. DiGiorgio said across the board, premiums for Southwest Colorado residents are expected to drop by 35 percent over last year. “We’re not sure exactly what the savings will be because the Division of Insurance hasn’t finalized rates yet,” she said. “But, you will probably see that the SHA is one of the most competitively priced.”

The SHA plans will be offered in conjunction with Bright Health Plan, a Minneapolis-based company that offers plans throughout Colorado. In addition to likely being the least expensive option, the SHA plans will offer other local-centric perks, such as access to both Animas Surgical Hospital as well as Mercy Medical Center. “We were willing to work with any local provider that was interested,” DiGiorgio said.

In addition to offering more local choices, she said the SHA will have a $0 co-pay for mental health visits. “We worked really hard with mental health practitioners on that,” she said.

And for those wanting no deductible at all, there’s a plan for that (which likely will result in a higher premium.) “I had to wrap my head around that,” DiGiorgio said. “Overall, people will save money off the bat. It’s a trade-off, people will need to decide what’s most important to them.”

After about a year of community meetings and negotiations with local providers, including Mercy’s parent company Centura Health, the plan was almost dead in the water last February. That’s when Centura announced its own plan to reduce costs by 20 percent by bargaining directly with insurance companies and cutting out “third-party” packages, ostensibly referring to the SHA. The news caught many, including DiGiorgio, by surprise.   “We are extremely disappointed in this response because Centura’s plan cuts the community out of health care entirely,” she said at the time.

However, all hope was not lost – and the SHA and Centura continued meeting over the next several months to reach a deal. “We met once a week for six months, looking at what a plan would look like,” said DiGiorgio. “Everyone came to the table.”

The SHA is based on a similar model in Summit County, Peak Health Alliance, which partnered in crafting the local plan. Both models were borne out of frustration among Colorado’s rural residents, who found plans on the state exchange were prohibitively expensive (and much more expensive than elsewhere in the state) and often limited to only one option. When the SHA was launched, more than 5,000 local residents and business owners expressed support for the idea. 

DiGiorgio said the new plan won’t just offer relief to existing plan holders, but hopefully will bring in customers who left the marketplace in favor of cheaper, non-ACA compliant plans. Although premiums are lower on those plans, they often don’t cover basic services, like preventive visits, have higher out-of-pocket costs and can preclude existing conditions. “I hope it encourages people to look at an ACA-compliant plan and not take the risk,” she said. “People may want to take time this year to reconsider their options.”

The SHA will also offer something for business owners in the form of ICHRAs (pronounced “ick-rah,” also known as an individual coverage health reimbursement arrangement). Through the new option, businesses can give employees a monthly allowance, tax-free, for them to put toward the cost of a health plan of their choosing. “The days of employers being locked in are gone, it offers more flexibility,” DiGiorgio said.

The SHA/Bright plans will be available to all residents of La Plata, Montezuma, Dolores and San Juan counties starting Nov. 1 on the state exchange, www.connectforhealthco.com. Enrollment will be open through Jan. 15, 2021.

DiGiorgio urges local residents to log on and do some shopping (something we’ve all gotten good at during the pandemic). “If you don’t shop, you won’t know what’s out there,” she said.

And, of course, she encourages folks to “look local first,” even when it comes to health insurance. “It was the community’s voice that we brought to this process,” she said. “This will only be a success if people shop and use the plan. We stepped forward to create this, now we need the community to step up too.”