Navigating the health insurance landscape in Colorado can be daunting, especially with the array of options available through the Connect for Health Colorado Marketplace. This guide will provide you with an overview of the best affordable health insurance plans available in Colorado, including details about the Colorado public option, Marketplace plans, and even alternative options like health sharing plans.
We’ll also discuss how you can maximize your savings through subsidies and provide insights into which insurance carriers are operating in Colorado.
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Understanding the Colorado Health Insurance Marketplace
The Connect for Health Colorado Marketplace is the state’s official health insurance marketplace where residents can shop for and enroll in health insurance plans. To qualify for subsidies that can significantly lower your monthly premium and out-of-pocket costs, you must purchase one of the plans listed on the Colorado Connect For Health marketplace website.
The good news: You don’t have to deal with the website at all. You can use an agent, a ColoHealth Personal Benefits Manager, or navigator to walk you through the process, step by step. In fact, it’s much easier and less time consuming to go through an agent.
ACA Metal Tiers, Explained
Marketplace plans are categorized into four “metal” tiers: Bronze, Silver, Gold, and Platinum. Each tier represents a different level of cost-sharing between you and the insurance company:
- Bronze Plans: These have the lowest monthly premiums but the highest deductibles and out-of-pocket costs. They are ideal for individuals who are generally healthy and want to save on monthly premiums.
- Silver Plans: Silver plans offer a balance between premiums and out-of-pocket costs. Importantly, they are the only plans that qualify for cost-sharing reductions (CSRs) if you meet certain income criteria. CSRs can significantly lower your deductibles, co-pays, and other out-of-pocket expenses. If your income is at or below 200% of the federal poverty line, you should strongly consider a Silver plan to maximize these savings.
- Gold Plans: These have higher monthly premiums but lower deductibles and out-of-pocket costs. They are suitable for individuals who expect to use medical services frequently.
- Platinum Plans: These offer the highest premiums but the lowest out-of-pocket costs. They are ideal for those who require extensive medical care.
TIP: Choose a Silver Plan to qualify for cost sharing reductions.
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Health Insurance Carriers in Colorado
Several health insurance carriers operate in Colorado, each with its own strengths and weaknesses:
- Anthem Blue Cross Blue Shield. Known for its extensive network of doctors and hospitals, Anthem offers a wide choice variety of plans, including a Colorado Option, described below. Because of its broad care networks, Anthem is a good choice for those in rural communities and the Western Slope.
- Kaiser Permanente. Offers a well-integrated healthcare system with strong preventive care programs. It’s an HMO, and has relatively low premiums, in most cases. The tradeoff is Kaiser’s relatively restricted provider network: Patients must get non-emergency care at Kaiser facilities and local providers. Kaiser is a good option if you are price sensitive and you like having everything under one roof, and you’re comfortable with a more limited network of providers.
- Cigna. Provides a range of plans with competitive premiums and a broad network. Cigna has a reputation for being a relatively low-cost provider in Colorado, particularly in big cities like Fort Collins and Denver.
- Elevate. Working with Peak Healthcare, Elevate brings affordable health plans to nine historically underserved counties in Colorado: Archuleta, Park, Dolores, Grand, Lake, La Plata, Montezuma, San Juan, and Summit.
In these counties, Elevate may be the most affordable health insurance plan, especially for those who don’t get an ACA subsidy.
As of 2024 Elevate plans include:
- $0 preventative care services
- $0 to low-cost primary care visits
- $0 to low-cost mental health outpatient visits.
- Local in-network providers, including specialists, primary care doctors, and mental health providers.
Rocky Mountain Health Plans. Focuses on providing affordable plans with local network providers. However, the plan selection might be limited in certain areas of Colorado.
Price-sensitive Colorado residents should look at the Value Plan, which features affordable, low-copay primary care visits, along with robust access to money-saving virtual care and telemedicine using the cutting edge Galileo app.
The Colorado Public Option
Colorado has introduced a public option, known as the “Colorado Option,” to provide a more affordable choice for residents.
The Colorado Option is a standardized plan designed to offer lower premiums and more predictable costs, with a focus on reducing out-of-pocket expenses and providing a robust network of providers.
The main advantage of the Colorado Option is that it is designed to be more affordable for consumers and offer lower out-of-pocket costs compared to other plans. However, availability and specific benefits may vary by county, so it’s important to check if the Colorado Option is available in your area and compare it against other Marketplace plans.
However, like any plan the Colorado Option plans have some significant disadvantages:
- Limited Availability. The Colorado Public Option is not available in all counties. Depending on where you live in Colorado, you might have limited or no access to these plans, restricting your choices.
- Perceived as a Lower Reimbursement Option by Providers. Colorado Option plans are widely believed to have set reimbursement rates too low. As a result, hospitals and other providers have refused to take Colorado Option patients. State officials have threatened to coerce these providers in order to force them to treat patients they don’t want to accept. With fewer providers, however, there may be provider shortages in certain areas––leading to longer wait times and potentially impacting care.
- Potentially Higher Costs in the Future. While the Public Option aims to reduce premiums and out-of-pocket costs, there is a concern that if reimbursement rates to providers are too low, some healthcare providers might choose not to participate. This could lead to reduced competition and, paradoxically, potentially higher costs or reduced care quality in the future.
Medicaid for Colorado Residents
The Medicaid program for Colorado is called Health First Colorado.
It’s a state and federally funded program providing free or low-cost health coverage to low-income, indigent, and disabled Colorado residents.
If your income falls below a certain threshold, and you have very limited assets, you should consider applying to Health First Colorado.
Who Qualifies for Health First Colorado?
Eligibility for Health First Colorado is based on income, household size, and certain other criteria.
Generally, individuals and families with low income, children, pregnant women, elderly adults, and people with disabilities may qualify.
As of 2024, adults aged 19-64 with incomes up to 138% of the federal poverty level may qualify. Pregnant women and children under 18 may qualify at higher income levels.
Here’s a breakdown of the income levels needed to qualify for Health First Colorado, as of 2024:
| Family Size | Adults 19-65 | Children 0-18 | Pregnant Women |
|---|---|---|---|
| Family of 1 | up to $1,670 | up to $1,783 | up to $2,448 |
| Family of 2 | up to $2,266 | up to $2,419 | up to $3,322 |
| Family of 3 | up to $2,862 | up to $3,056 | up to $4,196 |
| Family of 4 | up to $3,458 | up to $3,692 | up to $5,070 |
You may still qualify if you make more. Apply for more details.
What Does Health First Colorado Cover?
Health First Colorado covers a wide range of medical services, including but not limited to:
- Doctor visits
- Hospital care
- Prescription drugs
- Mental health services
- Preventive care (like vaccines and screenings)
- Long-term care for seniors and people with disabilities
- Prenatal and maternity care
Additional services may be covered depending on the individual’s specific health needs and Medicaid program requirements.
How to Apply for Health First Colorado
You can apply for Medicaid online, by phone, in person, or by mail:
- Online: Visit the Colorado PEAK website, which you can access here.
- Phone: Call Colorado’s Medicaid Customer Contact Center at 1-800-221-3943 (TDD: 1-800-659-2656).
- In Person: Visit your local county human services office. You can find the nearest office using the Colorado PEAK website.
- By Mail: Download a paper application from the Colorado PEAK website and mail it to your county human services office.
For more information or assistance with your application, you can also contact Health First Colorado at the same phone number.
The Colorado Health Insurance Buy-In Program (HIBI)
The Colorado Health Insurance Buy-In (HIBI) program helps Medicaid-eligible individuals pay for employer-sponsored health insurance premiums.
Instead of enrolling in Health First Colorado directly, individuals in the HIBI program receive assistance to pay their portion of the employer-sponsored health insurance premiums. This would allow you to access broader provider networks and the benefits offered through private insurance, while still receiving Medicaid-covered services if needed.
HIBI can save money for both the participant and Medicaid by utilizing existing employer coverage.
Don’t Get a Subsidy? Consider a Health Sharing Plan!
Health sharing plans are an affordable alternative to traditional health insurance, and they’re very popular in Colorado.
These plans are typically more affordable but are not insurance. Instead, members share each other’s medical expenses. While health sharing plans can offer significant savings, it’s important to note they do not qualify for ACA subsidies.
Therefore, if your income is below 300% to 400% of the federal poverty line, the subsidy you would receive for a Marketplace-qualified plan may make traditional health insurance a more attractive option. However, if your income is high enough that you don’t qualify for an ACA subsidy, a health sharing plan could be the way to go.
This is because health sharing plans are typically available for around half the cost of an unsubsidized Connect for Health Colorado plan.
Learn More: The Best Health Sharing Plans in Colorado in 2024
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Conclusion
Choosing the right health insurance plan in Colorado depends on various factors, including your income, health needs, and preferences. Remember:
- To qualify for subsidies, you must purchase a Marketplace plan, but you can do so through an agent.
- Only Silver plans qualify for cost-sharing reductions, making them a smart choice if you are below 200% of the federal poverty line.
- Evaluate the strengths and weaknesses of the carriers available in Colorado to find the best fit for your needs.
- Health sharing plans might be a good alternative if you do not qualify for ACA subsidies but require a lower-cost option.
For personalized guidance and to ensure you’re getting the best plan for your situation, make an appointment with a ColoHealth Personal Benefits Manager. It’s free, and you’ll have a live agent on your team who can help you pick the best plan and keep it up-to-date over time.
For Further Reading: Coloradans, Concierge Medicine, and Health Sharing Plans: A Winning Combination!|PPOs, HMOs, and EPOs in Colorado|How Health Sharing Saves Money for Colorado Residents
