Colorado Health Insurance
Need help getting covered? Let us help you navigate the health insurance maze.
Do You Need Health Insurance?
Everyone needs health insurance because it is required unless you have a hardship exemption. However, health insurance can also be cheaper than the fee, and unexpected healthcare costs are certainly more expensive. Take a look for your specific situation:
- You have a family: Your plan may have a family deductible on top of individual deductibles for family members.
- You’re married without kids: You don’t need to buy health insurance as a family if you don’t have children. Separate plans may make more sense for you and your spouse, or one may be covered by the other’s employer coverage.
- You’re a student: A parent’s health insurance can cover you until you turn 26 and your university may also have health insurance plans. Check if your parent’s insurance will cover you if you go to university in another state.
- You’re a veteran: You may qualify for coverage through the U.S. Department of Veterans Affairs.
- You’re currently in the military: You and your family’s healthcare will be covered by TRICARE if you’re an active duty service member.
- You’re elderly: You probably qualify for Medicare if you’re over 65, and you can additionally buy Medigap, a supplemental insurance which helps pay for copayments, coinsurance, and deductibles.
- You’re pregnant: Every qualifying health insurance plan covers pregnancy and birth-related services, even if you became pregnant before your coverage began. They are also covered by CHIP and Medicaid.
- You’re self-employed: After leaving a full-time W2 job, COBRA can help you continue under your old employer’s coverage.
- Your income is low: You may qualify for Medicaid and your health insurance can be subsidized depending on your income.
The Right Health Insurance for You
There are two types of health insurance: public, like Medicaid, and private. Private insurance can be purchased through the marketplace or an employer. Public and private health insurance can be offered by state exchanges and the federal exchange. The different types are as follows:
- On-exchange private health insurance: Sold on government-run exchanges.
- Off-exchange private health insurance: Sold by health insurance companies or brokers.
- Employer-provided health insurance: Private plans managed by an employer.
- Short-term health insurance: Provide limited coverage for short-term coverage gaps.
- Medicare: Federal health insurance for people over 65.
- Medicaid: Federal and state health insurance program.
- Children’s Health Insurance Program (CHIP): Similar to Medicaid, but for people under 18.
The Different Forms of Private Health Insurance in Colorado
Private plans partner with healthcare provider networks. The way they work with these networks isn’t always the same, and you should understand the differences.
- Health Maintenance Organization (HMO): The most restrictive type of plan where you choose a primary care physician within the network who coordinates all your healthcare.
- Preferred Provider Organization (PPO): The least restrictive type of plan where you can choose between in- and out-of-network physicians.
- Exclusive Provider Organization (EPO): A mix between HMO and PPO where you can see specialists without referrals.
- Point of Service (POS): A mix between HMO and PPO where your primary care physician from a network coordinates your care while you still have access to out-of-network options.
What Are Metal Tiers?
So, we know that all health insurance plans split costs between the customer and the insurer. Well, metal tiers categorize plans based on the proportion of that split. The splits are as follows:
- Bronze: 60% insurer, 40% consumer
- Silver: 70% insurer, 30% consumer
- Gold: 80% insurer, 20% consumer
- Platinum: 90% insurer, 10% consumer
The numbers shown here take into account the coinsurance, co-payments, and deductible. They don’t take into account premiums. Bronze plans usually have the lowest premiums, with platinum having the highest. The pricing is different because on a bronze plan, for example, the customer spends more out-of-pocket for their healthcare.
There are also “catastrophic plans” which have extremely high deductibles and are only really helpful to stop you going into serious debt after a major accident or illness. They are only for young people and those with hardship exemptions.
Factors That Determine the Price You Pay
- Maximum out-of-pocket amount
Personal Factors that Affect the Price of Your Premium
- Whether you are a smoker or non-smoker
- Whether you require an individual or family plan
- Your plan category (“metal tier”)
10 Mandatory Benefits of Every Health Insurance Plan
- Emergency services
- Ambulatory patient services
- Hospitalization for overnight stays, surgery, and other reasons
- Maternity, pregnancy, and newborn care
- Prescription drugs
- Mental health and substance use disorder services
- Laboratory services
- Rehabilitative services and devices
- Preventative and wellness services
- Pediatric services
Insurance providers cannot take your gender or past and present health status into account when determining the price you’ll pay.
When You Should Buy Health Insurance in Colorado
You can buy health insurance on a government-run or private marketplace during the open enrollment period. In Colorado, for 2020, this begins on November 1st and ends January 15th, however to get a January 1st coverage date, you must enroll by December 15th. There is also a special enrollment period which extends this period, for example if you have a baby or turn 26. You can fill out a form on your state, federal, or private marketplace to see if you can qualify for this special enrollment period.
Finding an Affordable Health Insurance Plan
After you figure out the style of plan which makes sense for you, depending on how often you use healthcare services, you can search on the state and federal marketplaces. This can be tricky, but we are here to assist you in finding a plan that fits your budget and your needs. You can also visit connectforhealthco.com to see what savings you qualify for.