Colorado Health Insurance

Health insurance covers your medical expenses if you get injured or become ill, as well as preventative care costs such as well checks and standard lab tests. Your health insurance shares the cost of these expenses with you up to a specific out-of-pocket plan limit. Beyond that limit, the insurance pays for all costs described in the coverage. There are strict consumer protections that ensure policyholders have basic care, including inpatient and outpatient hospital visits, prescription drug coverage, pregnancy and childbirth, mental health services, and more. While the Affordable Care Act, or “Obamacare,” no longer requires Americans to pay a fee without qualifying health coverage, not having a health plan can quickly lead to mounting bills or even bankruptcy.

Do You Need Health Insurance?

Everyone needs health insurance to avoid financial hardship and stress. Health insurance may be far cheaper than unexpected healthcare costs, loss of income, ongoing therapy, and a family’s emotional crisis. Take a look at your specific situation:

• Families: Check to see if you have a family deductible on top of individual deductibles for family members.
• Couples without kids: Separate plans may make more sense for you and your spouse, or one may be covered by the other’s employer coverage.
• Students: A parent’s health insurance can cover you until you turn 26, and if you are still a student, your school may also have health insurance plans. Check if your parent’s insurance will cover you at a college or university in another state.
• Veteran status: You may qualify for coverage through the U.S. Department of Veterans Affairs.
• Active military: TRICARE will cover you and your family’s healthcare if you’re an active duty service member.
• Seniors: You qualify for Medicare over the age of 65, and you can additionally buy Medigap/Medicare supplemental insurance, which helps pay for copayments, coinsurance, and deductibles.
• Pregnant women: Every qualifying health insurance plan covers pregnancy and birth-related services, even if you became pregnant before your coverage began. Coverage can also be found through CHIP and Medicaid.
• Self-employed: After leaving a full-time W2 job, COBRA can help you continue insurance coverage under your old employer’s coverage until you find a replacement.
• Low income: You may qualify for Medicaid and health insurance subsidies depending on your income.

The Right Health Insurance for You

There are two types of health insurance: public, like Medicare and Medicaid, and private insurance companies known locally or nationally. 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 located by using Healthcare.gov or your local insurance broker. 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, representatives, agents, or brokers.
• Employer-provided health insurance: Private plans managed by an employer with payroll deductions and contributions.
• Short-term health insurance: High deductible plans for catastrophic coverage (hospitalization) for short-term policy gaps.
• Medicare: Federal health insurance for people over 65 and those with qualifying disabilities.
• Medicaid: Federal and state health insurance program.
• Children’s Health Insurance Program (CHIP): Similar to Medicaid, this coverage is for people under age 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 blend of HMO and PPO where your primary care physician from a network coordinates your care and you still have access to out-of-network options.

What Are Metal Tiers?

Metal tiers categorize plans based on the proportion of costs split between the customer and the insurer involving coinsurance, copayments, and deductible amounts. The percentages 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 have nothing to do with account premiums. Bronze plans usually have the lowest premiums, with platinum having the highest. The pricing is different because the amount a customer spends out-of-pocket for their healthcare varies.
There are also “catastrophic plans” called Major Medical and Short-term plans which have extremely high deductibles and are used in preventing a serious debt after a significant accident or illness. They are primarily used for young people transitioning from their parent’s policies at age 26. You may also use them if income is temporarily limited and in between jobs. They guarantee insurability in between policy cancellations and new coverage start dates (avoiding any rate increases due to age), and they can be combined with other supplemental coverage.

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.

Plan Pricing Factors

• Premium
• Coinsurance
• Copayment
• Deductible
• Maximum out-of-pocket amount

Personal Pricing Factors

• Age
• Location
• 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. Special enrollment periods extend enrollment for life events such as having a baby, moving to a new state, or turning 26. You can fill out a form on your state, federal, or private marketplace to see if you can qualify for Special Enrollment.

Finding an Affordable Health Insurance Plan

After you figure out the plan that makes the most sense for you based on needs varying between general wellness or chronic healthcare services, you can search state and federal online marketplaces. This can be tricky due to the sheer volume of applicants and available online representatives, but a local broker can assist you in finding a plan that fits your budget and your needs right away. You’ll get personalized service and explanations or answers to questions. Ask your agent what subsidies or exemptions you qualify for, or visit connectforhealthco.com.