Health plans aren’t a “one size fits all.” Every individual and family is different. It’s important to take these differences into account when choosing a health plan for yourself, your family, or for your employees, if you are a business owner.
Understanding the different factors that make you and your family unique will help you identify the Colorado health plan that best fits your needs.
We’ll look at the individual and family-specific factors first, and then go on to analyze the parameters of the various different health plans available in Colorado.
At first, the details may seem overwhelming. The good news is, you don’t have to go through the process by yourself.
If you want free, personalized assistance at any time, all you need to do is click here, and pick an appointment time with a ColoHealth Personal Benefits Manager.
1. Conduct a Detailed Self-Assessment
To choose the best available health plan for you and your family, you should answer a few questions about yourself.
These answers will do more than anything else to drive your decision making process as you get into the details of the various health plans available in Colorado.
What is your income?
If your income is below a certain threshold depending on the size of your family, you may qualify for premium tax credits under the Affordable Care Act.
The exact amount you can qualify for will vary based on your household income and family size, as well as the health plan you choose.
Your income and family size together determine the amount the government figures you can afford for a health care plan.
This effectively means you will be expected to pay a certain amount for health insurance each month. The government will pick up the rest.
About 80% of Colorado households will qualify for a subsidy.
If you don’t qualify for a subsidy
If you don’t qualify for a subsidy, you can still buy a health insurance plan. However, in most cases, it is more cost-effective to choose a lower-cost health sharing plan, which we will discuss later in this article.
Is it during Open Enrollment?
Open enrollment for ACA-qualified Colorado Health Insurance plans runs from November 1st through January 15th.
However, if you want your new plan to become effective on the 1st of the year, you must complete your enrollment by December 15th.
If you wait until after December 15th to complete your enrollment, your new plan won’t be effective until February 1st.
Outside of these dates, you can’t enroll in an ACA-qualified health plan unless you qualify for a Special Enrollment Period. These are 60-day “mini open enrollments” which are triggered by qualifying life events.
Examples of qualifying life events include:
- Job loss
- Birth or adoption of a child
- Death of a family member or breadwinner
- Aging out of your parent’s policy
- Becoming a U.S. citizen or permanent resident
- Cancellation of your current health care plan.
- Significant reduction of your current income.
If you qualify for a Special Enrollment Period, you have up to 60 days to enroll in a new ACA-qualified plan.
During this time, you have guaranteed enrollment privileges. You can join any Colorado ACA-qualified health plan you choose. You cannot be turned down due to your medical history.
Do you tend to consume a lot of health care?
Do you or a member of your household need a lot of medical attention or take expensive prescription drugs on a regular basis?
This is an important factor in selecting a good health plan.
Are you 30 or younger?
If you are 30 or younger, you may qualify for a catastrophic health plan, described below.
These plans are very high-deductible plans designed to keep premiums very low. As such, they only provide coverage for low-frequency, high-cost medical events.
Catastrophic plans do not qualify for a subsidy under the Affordable Care Act. If you want a catastrophic plan, you need to pay full price.
They can be a great idea for younger, healthier individuals who don’t qualify for a premium subsidy, anyway
Are you younger than age 26 and a full-time student?
If you answered “yes,” you may qualify to stay on a parent’s health care plan.
You should look carefully at available ACA subsidies and compare your after-subsidy costs if you stay on your parents’ plan against your after-subsidy costs if you purchase your own plan.
Open enrollment season is a crucial period that can significantly impact your healthcare choices and financial well-being for the year to come. The options are vast, but here at ColoHealth, we’re dedicated to helping you make an informed decision that best suits your unique needs. The ideal starting point? Schedule a consultation with a ColoHealth Personal Benefits Manager. Below is an in-depth guide to aid you in navigating your choices.
Are you pregnant or do you anticipate becoming pregnant in the near future?
If this applies to you or someone else in your household, you should pay particular attention to the maternity benefits available in your plan.
All ACA-qualified health insurance plans and all major health sharing plans provide maternity care.
Do you want the freedom to choose your own doctor?
At ColoHealth, we are big believers in healthcare freedom.
Most ACA-qualified traditional health insurance plans are managed care plans – HMOs, PPOs, and EPOs – that restrict your ability to seek care outside of their own narrow provider networks.
We understand people have budget constraints. And there are many truly outstanding providers who work in plans with limited care networks. But overall, we recommend getting a plan that provides as broad a network of physicians as possible that you can afford.
Or, even better, plans that don’t have limited preferred providers at all, but instead allow you to select your own doctor, clinics, and hospitals.
We believe that unfettered, free competition and open access to a full and free market of healthcare providers ultimately provides the best value for consumers. We also believe that in the long run, a free market ensures better quality health care is available to everyone.
“Walled gardens” that keep people in are counterproductive, and ultimately harm the health care market for people both inside and outside the walls.
How to Qualify for Subsidies During Colorado Health Insurance Open Enrollment
To qualify for a subsidy, you must select an ACA-approved plan.
Subsidies are only available if your household income falls below certain thresholds, and if you select a “silver,” “gold,” or “platinum” tier plan, discussed below.
Health sharing plans do not qualify for a subsidy under the Affordable Care Act.
However, because they are so cost-efficient (up to 50% less than the pre-subsidy cost of an ACA-qualified plan), they can still make a lot of sense for people who don’t qualify for a subsidy, or who only qualify for a partial one.
Where to Buy an ACA-Qualified Colorado Health Insurance Plan With a Subsidy
You don’t have to buy it over the Connect For Health Colorado online exchange. You also can buy an ACA-approved plan through a ColoHealth Personal Benefits Manager.
These are highly experienced and trained agents who provide free help in analyzing, selecting, and enrolling in the health plan that best suits your needs and budget.
Working with a Personal Benefits Manager costs you nothing. But it can save you hours of effort, research, and stress. More importantly, your Personal Benefits Manager can minimize the chance and cost of signing up for the wrong plan.
Understanding the “Metal” Tiers
Health insurance plans sold on the Connect for Health Colorado exchange come in one of five tiers, which refer to the percentage of your medical costs the plan will pay after you meet your deductible.
The plan tiers are bronze, silver, gold, and platinum. The fifth tier is the catastrophic-only plan, only available to those under age 30, mentioned above.
Here’s a look at each of the metal tiers:
The Bronze tier offers the lowest monthly premiums.
But a bronze plan only pays 60% of your health care costs in a given year after you pay your deductible. You are responsible for the remaining 40%—up to a maximum out of pocket limit that Congress sets each year.
After you hit your max out-of-pocket limit, Bronze plans will pick up 100% of your medical costs after that for the rest of the plan year.
Bronze plans are best for younger and healthier people who do not expect to need health care during the year, and who do not qualify for an Obamacare subsidy.
They aren’t a good match if you expect to need healthcare during the year, because your 40% coinsurance requirement will offset any premium savings you thought you would get when you opted for a Bronze plan.
They also aren’t a good match if you qualify for a subsidy under the Affordable Care Act. They don’t qualify for certain cost sharing reductions (you need to enroll in a silver-tier plan or higher for those!).
And if you qualify for a subsidy, you will likely get a better value and have less exposure to high medical costs for the same out-of-pocket premium by selecting a higher tier plan.
Silver plans balance moderate premiums with reasonable out-of-pocket costs.
They are the least expensive tier you can buy that still qualifies for an Affordable Care Act Subsidy.
Silver plans pay up to 70 percent of your medical expenses in a given year after you meet your deductible for the year. You must pay the remaining 30%, up to the out-of-pocket maximum for the year.
Silver plans represent a balance of cost and value for many people. However, they may not be appropriate if you believe the 30% coinsurance would force you to delay or skip needed medical care.
Gold plans carry higher premiums but offer greater coverage and lower out-of-pocket costs for most people.
Gold plans are essentially “80-20” plans. That is, the insurance company pays up to 80% of your medical costs in a given year after you meet your deductible.
You must pay the remaining 20%.
If you need regular medical services, prescriptions, or have chronic or pre-existing conditions, the Gold tier may be a good option.
These are the highest tier and come with the steepest premiums.
However, they offer the most comprehensive coverage, boasting low out-of-pocket costs for those who need care.
Platinum plans pay 90% of your medical costs in any given year, up to the plan’s out-of-pocket limit. You are responsible for the remaining 10% of costs.
This is a good option if you expect to have high medical expenses and can afford the premium after accounting for subsidies.
People under 30 or those experiencing specific hardships (detailed below) might qualify for a catastrophic plan.
They have lower premiums but also high out-of-pocket costs. One downside is that they are not eligible for subsidies, so you’ll be shouldering the costs yourself.
Catastrophic plans have the most affordable monthly rates, even lower than the rates of Bronze plans, however, their out-of-pocket costs tend to be the highest. Also unlike the metal plans, preventive care benefits are limited.
You’ll pay up to $9,100 out of your own pocket. But every catastrophic plan currently available in Colorado as a maximum out of pocket cost of $9,100.
If you qualify, a Catastrophic-only plan may be a good option if you’re in very good health, don’t expect to see a doctor, don’t need ongoing medical treatment, you want to keep costs low, and you can afford the extremely high deductible.
To qualify for a Catastrophic plan, you must either be under the age of 30, or have a hardship exemption at any age. You may qualify for a hardship if you are experiencing:
- An eviction/foreclosure;
- A notice of shutoff from your utility company;
- Domestic violence or a death in the family;
- A natural or man-made disaster.
- Bankruptcy or substantial debt from medical expenses;
- An increase in expenses due to caring for an ill, disabled, or aging family member;
- Claiming a child as a tax dependent who was denied Medicaid or CHIP;
- If you won an appeal for previously being denied a qualified health plan, but were denied eligibility at the time;
- You lost coverage in the past, but found qualified health plans to be unaffordable;
- Some other hardship related to obtaining health insurance.
Note: Many people experiencing these hardships who also have self-employment income or who own a business would be better off with HSA SECURE, and contributing aggressively to a health savings account.
Joining the HSA SECURE plan reduces your tax bill substantially, and preserves your ability to choose your own doctor.
COLORADO HEALTH INSURANCE
2. Understand the Different Health Insurance Plan Types: HMO, PPO, or Fee-for-Service
ACA-qualified plans in Colorado come in three basic categories: HMOs, PPOs, and EPOs, which are managed care plans that require you to get non-emergency care from the plan’s network of preferred providers, and “fee-for-service” plans that allow you to choose your own providers.
The vast majority of ACA-qualified plans sold are HMOs and PPOs, due to their lower out-of-pocket premiums.
There may not be a fee-for-service plan available in your area.
Here is a brief overview of each plan type:
HMO (Health Maintenance Organization)
HMOs require you to select a Primary Care Physician (PCP) and get referrals from this doctor to see any specialists.
HMOs generally feature low monthly premiums, but offer limited freedom in choosing healthcare providers.
HMOs will pay less if you go outside of the network for non-emergency care, and will not pay for specialist visits unless you first get a referral from your PCP.
PPO (Preferred Provider Organization)
PPO plans offer somewhat more flexibility compared to HMOs.
You can visit any doctor without a referral, including specialists. But seeing providers within the plan’s network will cost you less. Conversely, if you go outside your plan’s network of approved providers, you’ll have to pay more out of pocket.
If you prefer having a broader choice of providers compared to HMOs and are willing to pay a bit more in premiums, PPOs are suitable.
EPO (Exclusive Provider Organization
These plans have very low premiums compared to other types of health insurance plans.
But they offer almost no flexibility when it comes to choosing your provider. You may only have very limited options in your area, and these may be discount clinics and hospitals.
These plans are usually only suitable for people who are in good health and don’t expect to need health care during the year.
These plans are increasingly rare. but allow much more freedom in selecting healthcare providers.
However, this comes at a higher cost and is generally less streamlined in terms of billing and paperwork.
In some cases, you’ll need to pay your provider up front, and then apply to be reimbursed. Every provider has different rules, however.
3. Do You Want to Use a Health Savings Account?
Health savings accounts, or HSAs, are special tax-advantaged savings vehicles designed to incentivize saving to pay for future medical expenses.
They are among the most powerful savings tools available to individual citizens in the tax code.
But to contribute, you must be covered under a high-deductible health plan, or HDHP.
Tax Benefits of HSAs
Why are HSAs so powerful? They offer a triple tax benefit:
- You (or an employer) can contribute money to your HSA tax free.
- The money grows tax-deferred for as long as it remains in the account.
- Withdrawals to pay for qualified medical expenses are tax-free.
Essentially, HSAs enable you to pay for healthcare using tax-free dollars.
This effectively potentially saves thousands of dollars per year: Especially if you are in a jurisdiction with high state income taxes, you’re in a high marginal income tax bracket, or both.
If you want to save thousands in tax dollars a year, and you can afford to contribute to a health savings account, you should look for an Colorado ACA-eligible plan that is designated as an HDHP.
Need help finding one? Click here to make an appointment for a FREE consultation with a ColoHealth Personal Benefits Advisor.
Advantages of High-Deductible Health Plans
Because high-deductible health plans require you to keep more “skin in the game” compared to conventional health plans with higher deductibles, they feature much lower monthly premiums.
Joining an HDHP allows you to contribute to a health savings account –– one of the most powerful tax savings tools available to individual taxpayers.
This means that your contributions are tax-deductible, the growth is tax-free, and withdrawals for qualified medical expenses are also tax-free.
You can contribute to an HSA if you’re enrolled in a high-deductible health plan, and not covered under a different health plan such as the VA.
Also, you can spend your HSA money with any provider. You do not need to limit yourself to any insurance plan’s narrow networks.
Click here to learn more about how the HDHP/HSA combination can help save money on premiums, income taxes, and health care.
Health Sharing Plans: An Alternative to Traditional Insurance
If you don’t qualify for a large subsidy, a health sharing plan might be an attractive alternative.
Note: Health sharing is not insurance.
Instead, health sharing is a cooperative model where members share each other’s eligible medical costs. While not insurance per se, these plans can offer considerable savings—up to 50% less in premiums compared to traditional health insurance.
Thanks to the immense cost savings compared to unsubsidized traditional health insurance plans, health sharing plans have become extremely popular in Colorado.
A recent Department of Insurance report found that as many as 1 in 4 Coloradans who don’t get insurance from their employers and who don’t qualify for an Obamacare subsidy choose a health sharing plan to help protect their family against high out-of-pocket health care costs.
Who Should Consider a Health Sharing Plan?
You should consider a health sharing plan instead of a traditional health insurance option if you meet some or all of these criteria:
- You earn too much money to qualify for an Affordable Care Act subsidy, or you only qualify for a small one.
- You are in generally good health with no significant pre-existing conditions.
- You want the freedom to choose your own doctors, clinics, and other healthcare providers.
- You may need surgery within the first few years of membership.
- You want to be part of a faith-based organization that shares your basic values. (Not all health sharing organizations are faith-based. Some are completely secular. Others, however, are very much centered on faith.)
- It’s outside of Open Enrollment and you need a plan right away. Unlike health insurance plans, healthshare plans don’t limit enrollment to a few months a year and special enrollment periods. You can sign up for a health sharing plan at any time during the year.
Who Should Stick to Traditional Health Insurance?
You should stick to traditional health insurance if you meet some or all of these criteria:
- You qualify for a significant subsidy under the Affordable Care Act.
- You have access to a quality group health insurance plan from your employer.
- You have pre-existing conditions that could require significant care in the future.
- You can’t afford the annual member responsibility amount of a health sharing plan, but you can afford the deductibles and premiums of a traditional health insurance plan.
- You qualify for Medicaid. If you believe you may qualify for Medicaid, visit www.HealthFirstColorado.com.
Which Insurance Carrier Should I Choose?
As of 2023, there are just five health insurance companies writing business in the individual health insurance market in Colorado:
- Anthem/Blue Cross Blue Shield
- Denver Health
- Kaiser Permanente
- Rocky Mountain Health Plans/UnitedHealthcare
Note: Friday Health, Bright Health, and Oscar Health have recently pulled out of the Colorado market, and are no longer taking on new customers in the state.
Each insurance carrier selling ACA-qualified plans in Colorado will have plans based on the metal tier levels. They all have the same basic structure in common.
Each of their ACA qualified plans will also offer, as a minimum, the ten Minimum Essential Coverages mandated under the Affordable Care Act.
You should definitely compare and contrast monthly premiums (after accounting for a subsidy), deductibles, co-pays, co-insurance costs, and the maximum out-of-pocket costs for each plan.
But that’s just a start. And the cheapest plan isn’t always the best plan. Don’t just shop based on the lowest monthly premium alone. Ask anyone who’s ever been seriously sick or hurt: Having an insurance or health sharing plan that will be there for you at claim time is much more important than saving a few dollars each month.
In addition to the factors above, you should also consider the following factors which will be specific and unique to the carrier and plan.
There’s no one-size-fits-all solution: Everyone has unique needs and circumstances.
Your ColoHealth Personal Benefits Manager can help you research the following:
- What plan networks include your preferred doctors and other providers?
- What prescription drugs do you take? Are they included in the plans’ formulary?
- Do you travel outside of your local area much? Which plans only cover your local area and provide little coverage outside it?
For example, Denver Health has a lot of providers in its network immediately in and around Denver.
But outside of Denver, you may find they have few or no providers.
You can also compare online reviews, and reports from the Better Business Bureau. This is true of both health sharing and traditional health insurance.
If you live far from major cities, or out on the Western Slope, you may have fewer options.
The HSA SECURE Plan: Combining the Best of Both Worlds
Interested in the savings of health sharing but don’t want to sacrifice the ability to contribute to a health savings account? If you qualify, the popular HSA SECURE plan could be a great match for you.
The HSA SECURE Plan includes the ten minimum essential benefits the law requires of a high-deductible health plan. As such, unlike other health sharing programs, the HSA SECURE plan enables members to make pre-tax contributions to a health savings account.
The HSA SECURE plan is currently the only major health sharing plan that allows members to contribute to an HSA.
To enroll in HSA SECURE, you must have verifiable income from self-employment or ownership of a small business.
Click here to learn more about the HSA SECURE plan, and get a free quote.
The Best Health Sharing Plans in Colorado
Here are the best health sharing plans currently available in Colorado:
There are several terrific health sharing organizations doing business in Colorado.
- HSA SECURE – Currently the only health share plan that maintains member eligibility to make contributions to health savings accounts. To enroll, you must have verifiable self-employment income, or evidence of business ownership.
- netWell Health Share – A tremendously popular health share plan featuring a good balance between affordability and benefits, as well as no network restrictions.
- DPC Direct – A health sharing plan specifically designed to work well with direct primary care.
- OneShare Health – Another popular health sharing plan. Features a catastrophic-only tier which works well with DPC memberships, and a relatively short “look-back” period of 24 months for pre-existing conditions compared to most other health sharing plans.
- A couple of other plans that you can explore are –
- Altrua Health Share
- Sedera Health
- Universal Health Plans
Is The Colorado “Public Option” a Good Deal?
Colorado is one of a handful of states that are experimenting with a so-called “public option” for those who are looking for a low-priced traditional health insurance plan.
They first became available and operational at the beginning of 2023.
These plans started out with the promise of saving Colorado consumers money on health insurance.
Meanwhile, the plans have had difficulty attracting participating hospitals and doctors because of their low reimbursement rates.
If you are currently in good health, you don’t qualify for a subsidy, or you qualify for only a small one, you may be better off in a health sharing plan.
If you have pre-existing conditions, expect to need surgery soon, or if you are pregnant already, or may become pregnant and you are unmarried, then you may want to use any available ACA subsidies you may have to purchase a traditional health insurance plan.
This is because health sharing plans keep costs down, in part, by putting a waiting period on certain pre-existing conditions, surgeries (except for surgeries to treat an injury that occurred after your membership effective date) and pregnancy/maternity care.
Your Next Step: Schedule a Consultation
We’ve covered a lot of ground, but health insurance is complex and varies greatly depending on individual circumstances.
Fortunately, you don’t have to go it alone: if you have trouble enrolling online, or you want more personalized expert analysis and attention, you can schedule an analysis and consultation session with a ColoHealth Personal Benefits Manager.
Consultations are always free – and we can save you hours of research, hassle, and stress.
Here are some additional articles on the topic: Which Healthshare Plans in Colorado Allow You to See Any Doctor? | Why Is Colorado Health Insurance So Expensive? | When is the Health Insurance Deadline for 2024 Plans in Colorado?
Colorado Health Insurance Open Enrollment FAQ
How Can I Determine Which Health Plan Meets My Needs in Colorado?
To choose the best health plan for your situation, consider factors like your expected medical needs, budget, preferred healthcare providers, and any pre-existing conditions.
Look at the scope of coverage, premium costs, copays, and deductibles. Use tools like the Colorado health exchange website to compare plans side-by-side.
What Is the Affordable Care Act (ACA) and How Does It Affect Colorado Residents?
The Affordable Care Act, also known as Obamacare, provides opportunities for Colorado residents to purchase subsidized health insurance through state or federal exchanges.
It also expanded Medicaid in Colorado, allowing more low-income residents to receive healthcare coverage. Make sure to explore these options to see if you qualify for financial assistance.
What Is the Open Enrollment Period?
Open Enrollment is the designated period during which you can sign up for or change your health insurance plan.
For most ACA plans in Colorado, Open Enrollment typically happens in the fall. If you miss this period, you’ll have to wait until the next Open Enrollment, unless you qualify for a Special Enrollment Period due to life changes like marriage, childbirth, or loss of other coverage.
Click here for more information on Open Enrollment as it pertains to Colorado residents.
How Do I Research Health Plans?
Start by assessing your healthcare needs and budget.
Utilize online resources such as the Colorado health exchange website, read customer reviews, and speak with healthcare advisors.
Make sure to compare premiums, out-of-pocket costs, and benefits. Don’t forget to check if your preferred doctors and hospitals are in-network.
What Are Health Sharing Plans and Are They Available in Colorado?
Health sharing plans are community-based, often faith-based, alternatives to traditional insurance.
They are available in Colorado and can be more affordable. However, they’re not insurance and aren’t regulated by the same laws, so it’s crucial to read the terms carefully and understand what’s covered.
Are Health Savings Accounts (HSAs) a Good Option?
Health Savings Accounts (HSAs) are available to those with high-deductible health plans.
They offer tax advantages for saving money specifically for medical expenses. If you’re a healthy individual expecting low medical costs, an HSA could provide financial benefits.
How Do I Know If My Preferred Doctors Are In-Network?
You can check by visiting the insurance plan’s website or by calling customer service. Many insurance companies also provide search tools to help you find in-network providers. Always double-check directly with your healthcare providers to ensure they accept your plan.
What Are Copays, Premiums, and Deductibles?
- Copays are fixed amounts you pay for certain services or prescriptions.
- Premiums are the monthly fees for your insurance plan.
- Deductibles are the amounts you have to pay out-of-pocket before insurance starts covering costs.
Can I Change Plans Mid-Year?
Generally, you can only change your health plan during Open Enrollment or a Special Enrollment Period.
Exceptions are typically life-changing events like marriage, childbirth, or loss of other healthcare coverage.
How Can I Save Money on Health Insurance in Colorado?
Research thoroughly to compare plans, consider higher deductible plans with HSAs for tax benefits, and see if you qualify for subsidies through the ACA. Health sharing plans can also be more affordable alternatives.
What Are Catastrophic Plans?
Catastrophic plans are high-deductible plans aimed at young adults under 30 or those who qualify for a hardship exemption.
They cover three primary care visits per year before meeting the deductible but are generally less comprehensive.
How Do I Check the Quality of a Health Plan?
You can consult online reviews, check ratings on the Colorado health exchange, or seek advice from healthcare advisors.
Look for plans accredited by organizations like the National Committee for Quality Assurance (NCQA).
What About Prescription Medication Coverage?
Check the plan’s drug formulary to see if your medications are covered and what the copay would be. Some plans offer better prescription coverage than others.
If your plan doesn’t share prescription drug costs, you can also use a discount plan, such as HSA Advantage Rx, GoodRx. And the Mark Cuban Cost Plus Drug Plan, which allows steep discounts of up to 80 percent on hundreds of commonly-prescribed generic drugs.
Can Pre-existing Conditions Affect My Coverage?
Due to the ACA, insurance companies can’t deny coverage or charge more due to pre-existing conditions.
Healthsharing plans, however, do typically impose a waiting period of 1 to 5 years before they will share costs related to pre-existing conditions. There may also be a short waiting period for surgeries.
Is Short-Term Health Insurance a Good Option?
Short-term plans can fill gaps in coverage but are generally not as comprehensive as standard health insurance.
They’re not ACA-compliant, meaning they don’t have to cover essential benefits or pre-existing conditions.
Wiley Long is the president of ColoHealth, and has been in the health insurance industry since 1987. He received his master’s degree in nutrition and exercise science at Colorado State University, and is passionate about individual healthcare freedom. Read more about Wiley on his Bio page.