Rocky Mountain Health Plans vs. Anthem Blue Cross Blue Shield of Colorado

Rating the best health insurance in Colorado. Comparing Rocky Mountain Health Plans vs. Anthem Blue Cross Blue Shield or Colorado.

The Best Health Insurance in Colorado

Anthem BCBS and Rocky Mountain Health Plans RCHP are two of the leading health insurance options available to Colorado residents.

Each of these carriers has advantages and disadvantages. Health insurance is not a one-size-fits-all solution.

If you’re a Colorado resident looking for an Affordable Care Act-Qualified health insurance solution for yourself, your family, or for the employees of your small business, this article is for you.

Note: Anthem, Inc., the parent company, rebranded to the name Elevance in 2022. However, the company still markets health insurance under the name Anthem Blue Cross Blue Shield in Colorado.

Overview

About Rocky Mountain Health Plans

Founded in 1974, Rocky Mountain Health Plans (RMHP), has been helping individuals, families, and businesses in Colorado access health care services for the last 50 years.

It’s a non-profit organization headquartered in Grand Junction, Colorado, and provides a variety of health plans to Colorado residents.

In 2016, Rocky Mountain Health Plans became part of UnitedHealthcare. But they still retain their Colorado focus, putting particular emphasis in serving underserved, poor, and minority communities throughout Colorado.

They also offer innovative programs for maternal health and wellness, and for a variety of chronic conditions, such as diabetes, heart disease, and COPD.

The plan supports telehealth services and is recognized for quality care by the National Committee for Quality Assurance (NCQA).

About Anthem Health in Colorado

Anthem Health in Colorado, part of the larger Anthem, Inc., and a subsidiary of Elevance, provides a wide range of health insurance options to residents across the state.

The carrier is also known for its vast nationwide network of doctors, hospitals, and other healthcare providers – including approximately 9,700 providers and over 70 hospitals throughout Colorado.

Plan Offerings

Anthem offers individual and family plans, and employer group plans, Medicare, and Medicaid services. In the individual/family market they only offer HMO plans that are eligible for ACA subsidies and cost sharing reductions.

Additionally, Anthem offers a number of off-Marketplace plans. These aren’t eligible for ACA subsidies.

But if you don’t qualify for a significant subsidy under the Affordable Care Act anyway, these plans can be a great solution if you want a plan more precisely tailored for your specific needs.

Technology

Anthem has also invested heavily in technology to enhance access to care. These tools make it easier for you  to access and manage your  benefits.

Some of these online tools include: 

• A mobile app that allows you to  view their coverage details, find doctors and hospitals in their network, and file claims.
• An online portal that provides you with the same access to your benefits as the mobile app
  
• Access telehealth services right from your laptop or mobile device
• The ability to print out your insurance cards and make changes to your account.

Anthem Blue Cross Blue Shield also provides a 24/7 customer service line.

We discuss Engage – Anthem’s proprietary suite of technology tools and features – below.

Anthem and Rocky Health Plan Commonalities

The Ten Minimum Essential Coverages

First, let’s look at what these plans have in common:

Both Anthem and Rocky Mountain Health Plans are qualified plans under the Affordable Care Act (ACA).

That means that they both cover the ten “minimum essential coverages” required under the ACA.

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Hospitalization costs (overnight stays, surgery, etc.)
• Emergency medical treatment
• Prescription drugs
• Pregnancy, maternity, and newborn care
• Pediatric services including oral care and vision
• Mental health and substance abuse treatment, including therapy and counseling services
• Preventive services and chronic disease management
• Lab services 
• Rehab services

Because both carriers’ policies include all ten of these minimum essential coverages (MECs), they qualify for subsidies under the Affordable Care Act.

However, to qualify for the subsidy, you and your family must meet these additional criteria.

Subsidy Eligibility

To be eligible for income-based Advance Premium Tax Credits (APTC), federal cost-sharing reductions (CSR), or Colorado’s state-funded cost-sharing subsidies, you must meet the following criteria:

• You must not qualify for Health First Colorado (Colorado Medicaid) or Child Health Plan Plus (CHP+), nor should you be eligible for premium-free Medicare Part A.
• Married couples must file a joint income tax return.
• You cannot be claimed as a dependent on someone else’s tax return.
• You should not have access to affordable health coverage through an employer. If you’re uncertain about the affordability of an employer’s plan, make an appointment with a ColoHealth Personal Benefits Manager. We can walk you through your options, and see what course of action is best for you. 

How much subsidy can you qualify for?

The amount of the subsidy you qualify for depends on your income, the size of your household, and the cost of your plan.

Both Anthem and RMHP plans may qualify for a subsidy, especially if your income falls below about 400% of the federal poverty line. If your income is very low, you could potentially qualify for a zero premium plan.

Understanding Connect For Health Colorado “Metallic” Plan Tiers

Like all ACA Marketplace health insurance plans, both Anthem and Rocky Mountain Health Plans policies are generally offered in four basic “metal” tiers: Bronze, Silver, Gold, and Platinum.

The different tiers are defined by what percentage of covered costs you must pay out of pocket after you reach your deductible, but before you hit the plan’s maximum out-of-pocket limit for the year.

Once you reach the plan’s out-of-pocket limit, the plan will cover 100% of approved costs as defined by the plan. 

Plan Tier	Cost Sharing Structure	Premium Tax Credits Eligibility	Other Subsidies Eligibility
Bronze	Generally features lowest monthly premiums with highest out-of-pocket costs. Typically covers 60% of healthcare costs up to the maximum out-of-pocket limit, then 100% thereafter.	Yes	No
Silver	Moderate monthly premiums and moderate out-of-pocket costs. Typically covers 70% of healthcare costs up to the maximum out-of-pocket limit, then 100% thereafter.	Yes	Yes, Cost-Sharing Reductions (CSR) are available for eligible individuals.
Gold	Higher monthly premiums with lower out-of-pocket costs. Typically covers 80% of healthcare costs up to the maximum out-of-pocket limit, then 100% thereafter.	Yes	No
Platinum	Highest monthly premiums with lowest out-of-pocket costs. Typically covers 90% of healthcare costs up to the maximum out-of-pocket limit, then 100% thereafter.	Yes	No

Note: All tiers qualify for premium tax credits based on income eligibility, but only Silver plans offer additional cost-sharing reductions for those who qualify.

You can select and enroll in any Anthem or Rocky Mountain Health Plan health insurance plan offered in Colorado simply by scheduling an appointment with a ColoHealth Personal Benefits Manager.

Anthem Health in Colorado vs. Rocky Mountain Health Plans at a Glance

Feature	Rocky Mountain Health Plans	Anthem Health in Colorado
Cost/Premiums	Varies based on plan selection, age, location, and other factors.	Varies based on plan selection, age, location, and other factors.
Deductibles	Customers can choose plans with a range of deductibles.	Customers can choose plans with a range of deductibles.
Benefits	Offers a mix of HMO plans with integrated care models. Strong focus on community health initiatives.	Wide range of individual, family, employer group plans. Emphasis on preventive care and wellness programs.
Out-of-Pocket Costs	Customers can choose plans with different maximum out-of-pocket costs.	Customers can choose plans with different maximum out-of-pocket costs.
Network Size	Extensive network within Colorado, but limited outside of Colorado. Emphasis on historically underserved/minority communities.	Very large network with a broad selection of healthcare providers, hospitals, and specialists both in and outside of Colorado.
Technology and Access	Offers telehealth services and online resources for members.	Provides digital tools, telehealth services, and online healthcare management options.
Consumer Focus	Known for community involvement, outreach, and integrated healthcare services within Colorado.	Known for quality care, preventive services, and innovative healthcare solutions.

Key Differences Between Anthem and Rocky Mountain

• Network Size: Anthem, with its national presence, has a network of authorized providers all across the country. RMHP focuses exclusively on Colorado, and does not have network doctors outside the state. Even within Colorado, Anthem has a more extensive network, especially in more rural areas.
• Community Involvement: RMHP is particularly noted for its community health and outreach initiatives within Colorado.
• Plan Types: RMHP offers a variety of individual and family HMOs. Anthem also offers HMOs in the individual/family market, and has HMO and PPO plans available in the group market.

Accreditation and Ratings

Both Rocky Mountain Health Maintenance Organization of Colorado, the parent company of Rocky Mountain Plans, and Anthem have been rated by the National Committee for Quality Assurance.

By their criteria, these plans are running neck and neck: Both plans are sporting an overall rating of 3.5 out of 5 stars from the NCQA.

View the Anthem commercial HMO report card form NCQA.

View the Rocky Mountain Health Plan report card from NCQA.

Size

Anthem is by far the bigger carrier of the two in Colorado. According to the NCQA, Anthem plans cover 81,702 ACA-qualified plan enrollees, while Rocky Mountain Health Plan’s commercial HMOs cover just 3,447.

Anthem Blue Cross Blue Shield Features and Benefits

Anthem Blue Cross Blue Shield is the trade name of Blue Cross/Blue Shield in Colorado.

Blue Cross/Blue Shield affiliate companies operate across all 50 states. The company is known for their vast network of physicians, clinics and hospitals.

It’s a very large organization, with good network coverage in the states where it operates. In some areas, over 90% of doctors, clinics, and hospitals take Anthem patients, depending on the specific plan you choose.

Anthem Colorado plans also feature: 

• $0 preventive care services
• No additional cost for hundreds of commonly prescribed medications**
• $0 telehealth visits
• Extensive library of wellness tools and mental health resources via their website
• Blue View Vision plan with over 40,000 eye doctors and 30,000 locations in network.

Anthem’s “Engage” Program

Anthem Blue Cross Blue Shield customers in Colorado also have access to the Engage suite of digital tools. This innovative suite of apps and online interfaces includes these features: 

• A Personalized Health and Wellness Dashboard. By integrating health plan information with wellness data, Engage offers a personalized dashboard that helps you understand your health benefits better and track your wellness journey. This integration allows you to have a consolidated view of  health and wellness activities, making it easier to stay on top of your health goals and manage your benefits efficiently.
• Improved Decision Making. Engage provides tools that can help you make better decisions about your healthcare based on cost and quality. By having access to a wide range of data, including clinical and claims data, you should be able to make more informed choices about the care you need, considering both cost-effectiveness and quality of care.
• Access to Clinical and Wellness Programs. With this tool you can find programs tailored to your specific health goals, whether you’re looking to manage a chronic condition or improve your fitness, or seeking mental health support.
• Instant Telehealth Services Access. You have instant access to telehealth services, making it easier to consult with healthcare professionals without the need for in-person visits. This is great when you need fast medical advice and care, and you don’t have time to go visit a doctor in person.
• Support for Chronic Conditions and Maternity Care. Engage offers targeted support for managing chronic conditions and maternity care. They can help you monitor and manage specific health conditions, or provide guidance and assistance throughout your pregnancy.

Rocky Mountain Health Plans Features and Benefits

RMHP sets itself apart with a strong emphasis on health equity and community impact.

Their goal is to ensure that every Coloradan, regardless of their background, has access to necessary healthcare resources and services.

Premiums and deductibles are structured to accommodate a wide range of financial situations.

Plan costs depend on which plan you select, as well as your zip code or county. However, Rocky Mountain Health Plans are overall most competitive in and near major metropolitan areas like Denver and Colorado Springs.

Additionally, RMHP has invested millions with healthcare initiatives throughout the Rocky Mountain State.

In 2023 alone, Rocky Mountain Health Plans committed $9.5 million in recurring investments around Colorado, including a health information exchange, housing initiatives, and food programs for Coloradans in need.

Third-Party Ratings

Overall, Anthem’s patients rated their satisfaction rating at 2 stars out of 5, according to NCQA data.

Part of the reason for that low rating is on the network’s primary care doctors: Anthem patients rated their PCPs with two stars out of five.

However, that’s better than the one-star rating Rocky Mountain Health Plans members rated their primary doctors.

That said, Anthem scores very high marks from the NCQA in objective performance-based areas: Children and adolescent well care services rated 4.5 stars out of five, cancer screening services rated 3.5 stars out of five, 4.5 stars for following up after mental health treatment, and 5 stars for following up after substance abuse treatment.

Connect For Health Colorado Quality Rankings (2022). 

Category	Anthem	Rocky Mountain Health Plans
Medical Care Measures How well the plans’ doctors, hospitals, and others in the plan’s network improve or maintain member health through appropriate screenings, vaccines, and other basic services, and how informed and up-to-date your doctors are about your health care status, blood tests and x-ray results	★★★☆☆	★★★☆☆
Patient Experience Measures ease of access to care and how other plan members rate their doctors and the care they receive.	★★★★★	★★★★★
Plan Administration If the plan coordinates the care members get from different providers and how well the plan provides access to needed information	★★★★☆	★★★★★

Data courtesy of Connect For Health Colorado.

Comparing Consumer Complaint Index Scores

According to Connect for Health Colorado, Rocky Mountain Health Plans has a better than average Complaint Index Rating of 0.13

The Complaint Index is a ratio of the number of customer complaints for a given product divided by the total premium amount collected. A Complaint Index Ratio of 1 is average.

In contrast, the Anthem Consumer Complaint Ratio is much higher, at 4.31

The advantage here goes to Rocky Mountain Health Plans.

Medical Loss Ratios

The Medical Loss Ratio is the percentage of premium collected divided by the amount the carrier actually spends on providing patient care, as opposed to spending on overhead, executive salaries, administration, sales, and marketing.

If a health insurance carrier has a Medical Loss Ratio of 80%, it means that they spend 80 cents out of every dollar they take in on patient care.

A Medical Loss Ratio of 80% or higher is the standard generally required of Affordable Care Act-qualified health plans.

According to Connect for Health Colorado data, Rocky Mountain Health Plans had a Medical Loss Ratio of 81.3% in 2022.

Anthem plans had a Medical Loss Ratio of 77.4%.

Again, another slight advantage for Rocky Mountain Health plans.

Comparing the Two Carriers

Both plans deliver value to their members, but in very different ways.

• Anthem Blue Cross Blue Shield  provides clear, tiered plan options with detailed information on premiums and deductibles, catering to a wide range of needs and budgets. 
• RMHP focuses on community impact and health equity, with less emphasis on specific plan details. Their plans are designed to be inclusive and accessible to lower-income customers, offering a range of options to ensure broad access to healthcare.

Healthcare Access and Networks

• Anthem BCBS boasts an extensive network of providers and innovative virtual care options, 
• RMHP emphasizes health equity and access, particularly for underserved communities. Their care networks tend to be concentrated in larger cities and accessible to inner city residents, with fewer options in remote areas.

Community Involvement

• RMHP is deeply involved in community health initiatives, aiming to address broader health outcomes and social determinants of health.
• Anthem, while also offering comprehensive plans, focuses more on individual plan benefits and options.

Learn More: How To Choose the Best Health Insurance Plan In Colorado for 2024

Can I Sign Up Now?

Outside of Open Enrollment (November 1st through January 15th in Colorado), new enrollments are limited to those who have a qualifying life event that triggers a 60-day special enrollment period.

During this time, you are entitled to guaranteed enrollment privileges. That means you cannot be turned down or charged a higher premium for medical reasons.

Examples of qualifying life events include:

• Marriage or divorce
• Relocation
• Loss of access to an employer plan
• Birth or adoption of a child
• New permanent resident or citizenship status
• Aging out of your parents’ plans
• Release from incarceration

Any of these circumstances may result in you qualifying for a 60-day special enrollment period.

I Missed Open Enrollment. Now What?

If you find yourself outside of Open Enrollment and you don’t seem to qualify for a SEP, don’t worry: We still have options for you.

For example, many of our clients choose to drop health insurance altogether, and join a health sharing plan. These are innovative, cost-effective, non-insurance alternatives to traditional Obamacare insurance products.

These non-profit health plans can help you pay for even catastrophic healthcare events. There are no open enrollment periods to worry about; you can enroll in health sharing plans all year round.

However, they can and do impose waiting periods before they will share costs related to pre-existing conditions and surgeries.

They don’t qualify for subsidies under the Affordable Care Act. But these plans are designed to be very affordable. In most cases, health sharing plans save up to 50% compared to the unsubsidized cost of a traditional ACA Marketplace/Connect For Health Colorado type of plan.

Learn More: Colorado Residents: What To Do When You Miss Open Enrollment

Take the Next Step

Either way, if you’re looking for a great, affordable health plan for you and your family, the next step is quick, easy, and painless: make an appointment with a ColoHealth Personal Benefits Manager for a free consultation, needs analysis, and quotes.

We’re happy to guide you through the enrollment process, discuss alternative solutions, and ensure you find a plan that fits your needs and budget.

There’s never any charge for this service. Our fees are 100% paid by whatever plan you choose to sign up with.

For Further Reading: How To Shop for Health Insurance in Colorado | Anthem Blue Cross Blue Shield of Colorado | Colorado Introduces New “Public Option” for Health Insurance. We’re Skeptical.| The Comprehensive Colorado Small Business Health Insurance Guide