In Colorado and elsewhere, traditional health insurance policies typically restrict your ability to choose your own doctor through network restrictions. Most insurance policies have a network of preferred providers who have contracted with the insurance company to provide services at a discounted rate.
These providers are often referred to as “in-network” providers, and seeing them usually results in lower out-of-pocket costs for the policyholder.
In contrast, healthsharing plans typically allow members to choose their own doctor or healthcare provider. If your medical need is shareable under your membership agreement, you can generally use your healthsharing benefits with any doctor, hospital, clinic, or other healthcare provider.
Some healthsharing plans have, however, negotiated more favorable pricing with some providers, and those discounts are passed on to the healthsharing members. This is especially important for those who have not satisfied their annual member responsibility amounts or household sharing portions, and who don’t expect to.
Each healthsharing plan is different. Here are the specifics for the most popular healthsharing plans in Colorado.
Altrua Healthshare Plans in Colorado
Altrua members are free to choose their own healthcare providers, including doctors, hospitals, and other medical professionals.
Altrua uses the Established Provider Reimbursement Solution (ERS). This allows members to go to any provider or facility they choose regardless of the provider’s “network” affiliation.
However, they do require pre-authorization for certain services such as hospitalization, surgery, or imaging tests that are expected to cost more than $2,500.
DPC Direct
The DPC Direct plan, offered through MPB Health, is designed especially to work with a direct primary care (DPC) plan. Generally, plan members can use their sharing benefits with any provider.
netWell
netWell members are free to choose any licensed healthcare provider or facility, without any network restrictions.
netWell does not require preauthorization for routine care. However, preauthorization is required for certain services and procedures, including hospitalization, surgeries, and diagnostic imaging. Check your Member Guidelines for specific preauthorization requirements.
OneShare Health
OneShare Health recently dropped their network restrictions. They now allow members to choose their own doctors and do not require preauthorization for medical services.
Learn more about OneShare Health
Medi-Share
Medi-Share members are able to choose their own healthcare providers, including doctors, without being restricted to a network of healthcare providers.
However, Medi-Share does also lets you use PCHS, a large preferred provider organization (PPO) network of providers that has pre-negotiated discounted pricing.
You can use your benefit with any provider. But you will only be eligible for Medi-Share-negotiated discounts from providers within the network.
This is true for all Medi-Share plans, including Medi-Share 65+, an alternative to Medigap insurance for Medicare beneficiaries.
Non-emergency procedures may require pre-authorization.
Sedera Health
Sedera Health allows members to choose their own healthcare providers, including doctors and hospitals, with no network restrictions.
Sedera requires preauthorization for certain medical procedures, but this is determined on a case-by-case basis.
Learn more about Sedera Health
Universal Healthshare Plans in Colorado
There are no network restrictions or requirements for Universal Healthshare members to choose from a specific list of providers.
Members are free to seek medical care from any licensed healthcare provider they choose, without needing a referral or preauthorization.
Learn more about Universal Healthshare
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Healthshare Plans in Colorado are Not Insurance
It’s important to note that healthsharing plans are not health insurance policies under the law.
Instead, healthsharing plans are an affordable and flexible alternative to the traditional health insurance model.
Healthsharing plans are not-for-profit associations that facilitate the sharing of medical bills among like-minded people who share similar values.
Unlike traditional insurance plans, healthsharing plans may impose a waiting period before costs related to pre-existing conditions. So they may not always be suitable for those with existing health conditions.
Additionally, healthsharing plans don’t qualify for premium subsidies under the Affordable Care Act. However, they are a proven money saver for many people and families with higher incomes that don’t qualify for an Obamacare subsidy under the ACA, or who only qualify for a small one.
Colorado Health Insurance Companies and Care Networks
If the freedom to choose your own doctor is important to you, but healthsharing isn’t the right fit for you, then you should look for a health insurance plan that includes your preferred physicians and providers in their network before signing up.
Here are some examples from among the biggest health insurance companies in Colorado:
- Anthem Blue Cross Blue Shield
Anthem offers PPO plans in Colorado that allow you to see any provider you choose, although you may pay more for out-of-network care. Learn more about Anthem Blue Cross Blue Shield. - Cigna
Cigna offers PPO plans in Colorado that allow you to choose any provider you want, although you may pay more for out-of-network care. Learn more about Cigna. - UnitedHealthcare
UnitedHealthcare offers PPO plans in Colorado that allow you to see any provider you want, although you may pay more for out-of-network care. - Rocky Mountain Health Plans
Rocky Mountain Health Plans offers PPO plans in Colorado that allow you to choose any provider you want, although you may pay more for out-of-network care. Learn more about Rocky Mountain Health Plans.
Ready to Enroll in a Healthshare Plan in Colorado?
Enrolling in any of these great health plans is very easy, and normally just takes few minutes.
Furthermore, while traditional health insurance policies impose a limited enrollment period, you can enroll in a health sharing plan at any time.
To self-enroll, just follow the link to the plan you want. Read more about the plan and make sure it suits your needs and budget.
If you need help, make an appointment with one of our experienced Personal Benefits Managers. We’ll be happy to help you go over your options, and select the very best plan that suits your needs and those of your family or business.
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FAQs About Healthshare Plans in Colorado
I missed open enrollment for a Covered Colorado Plan. Can I still get a healthsharing plan?
The open enrollment period for individual health insurance plans in Colorado typically runs from November 1st to January 15th each year.
If you miss this window, and you don’t qualify for a special enrollment period due to a qualifying life event, you will have to wait until November 1st to enroll in an ACA-qualified health insurance plan. And it won’t become effective until January.
Fortunately, healthsharing plans have no such open enrollment requirements. You can enroll in a healhsharing plan at any time during the year.
Are pre-existing conditions covered under healthsharing plans in Colorado?
It depends on the specific healthsharing plan in question, and on the medical condition.
Healthshare plans generally do cover pre-existing conditions. But there’s usually a waiting period before costs related to the pre-existing condition become fully shareable. This waiting period can last from about two to five years. There may also be a lookback period.
This in contrast with traditional ACA-qualified insurance policies, which must by law cover pre-existing conditions right away.
For this reason, traditional health insurance may be a more suitable fit for people with pre-existing conditions, despite the generally higher costs of unsubsidized health insurance plans.
It’s important to carefully review the details of the healthsharing plan you’re considering to determine whether pre-existing conditions are covered, and if so, to what extent.
Are there any tax penalties for choosing healthsharing instead of traditional individual health insurance coverage in Colorado?
No, the federal tax penalty for not having health insurance was eliminated in 2019.
Members of qualified healthsharing organizations were exempt from that requirement, however, even before 2019.
How do I enroll in a Colorado healthsharing plan or health insurance plan?
Enrolling in either a healthsharing plan or an ACA-qualified health insurance plan is very easy: Contact a ColoHealth.com Personal Benefits Manager.
Whatever your medical situation and budget, your Personal Benefits Manager can help you analyze your needs and help you choose the approach and plan that works best for your individual situation.
Can I get financial assistance to help pay for my healthsharing plan in Colorado?
No, healthsharing plans are not eligible for financial assistance through the Colorado Health Insurance Marketplace.
However, even without an Obamacare subsidy, healthsharing is routinely a much more cost-effective and affordable option.
Here are some additional articles on healthsharing programs: Why Colorado Doctors Are Switching to Direct Primary Care | Colorado Healthshare Plans: F.A.Q. & Overview | Best Health Plans in Colorado for Families
Christine Corsini is a health insurance and medical cost sharing expert, and a Personal Benefits Manager at ColoHealth. Her goal is to help people embrace life’s amazing possibilities by staying healthy, saving money, and making the best decisions when it comes to healthcare.
