Under the Affordable Care Act (ACA), hospitals must publish a list of standard charges for all common services. These “menus” must reflect the unnegotiated, undiscounted rates for services of at least 300 common medical procedures – 70 of them specified by the Department of Health, and the remainder to be selected by the hospital. So why should you shop for health insurance in Colorado?
Your 2023 Guide to Health Insurance in Colorado
Before you go in for a procedure, it’s a good idea to shop around for health insurance plans in Colorado. Because even for identical routine procedures, costs can vary extremely widely between providers, plans, towns, cities, and states.
Why Shop For Health Insurance in Colorado?
Even with health insurance in Colorado, most people still face significant out-of-pocket costs for common medical procedures. Deductibles can be significant. And depending on your plan, you may have coinsurance amounts that you would also have to pay out-of-pocket.
That’s why Coloradans should be smart consumers of healthcare. Where possible, you should know ahead of time how much your hospital, clinic, physicians, and other care providers will be charging you for your medical care.
Even if you’ve already met your deductible for the year, comparing pricing helps reward competitive providers, and reduces systemic healthcare costs. That benefits everyone, and helps insurers keep premiums more affordable across the state.
How To Compare Pricing on Health Insurance in Colorado
In Colorado, you can easily compare the cost of most common medical services at most providers by visiting the “Shop For Care” website, sponsored by the Center for Improving Value in Healthcare (CIVHC).
The Shop For Care tool allows you to compare procedure costs and quality ratings for dozens of common health care services at over 100 hospitals and facilities across the state.
Remember, these resources don’t necessarily tell you what your actual “out-of-pocket” costs will be after your insurance company or healthsharing plan picks up their share of the expense.
Yes, you can usually get cost information from the facility directly, as well. And this may be a great idea if the procedure you’re interested in isn’t included on Shop For Care.
But keep in mind that the information you receive may reflect that facility’s charges only.
You may also need to do additional research to find some additional fees and costs that may be charged by a hospital’s outside vendors and contractors. For example, these may include physician’s charges, anesthesiology charges, imagery, and lab fees.
CIVIHC’s website anticipates this need. When you visit Shop For Care, you can click between two types of search results:
The “Imaging” tab will show the facility’s charges only, excluding physician’s fees and other ancillary costs. This can be useful if you want to shop around for doctors or have your own existing doctor do the procedure.
However, on the Shop For Care site, by clicking on the “Other Procedures” tab, CIVIHC will include a menu of charges for all the additional services that typically come along with that medical procedure.
For example, a knee replacement may include all of the following chargeable services:
- Initial surgical consultation and assessment
- Imagery evaluation
- Pre-op health screening
- Lab tests to detect diabetes, high blood pressure, or other comorbidities that may lead to surgical complications
- Hospital fees
- Device costs
- Operating room charges
- Surgeon’s fee
- Anesthesiologist’s fees
- Cost of medications received during the procedure
Post procedure services
- Pain meds, anti-inflammatories, and antibiotic medications
- Physical therapy
- Follow-up visit with surgeon
- Additional images or lab tests
So just going to an individual hospitals’ website may not give you anything close to complete pricing information.
COLORADO HEALTH INSURANCE
Consider cost-saving alternatives like HSAs and Healthsharing
You can also help reduce your overall medical costs by exploring consumer-directed health insurance options like Health Savings Accounts, and alternatives like healthsharing. Both approaches help put more buying power in your pocket, and help you access better pricing and better access to care, regardless of HMO or PPO networks and health insurance plan restrictions.
When you use your Health Savings Account, or HSA, to pay for healthcare, you are in the catbird’s seat when it comes to negotiating prices for medical procedures. You can use your HSA with any provider – not just ones that happen to be in network.
Providers know you’re a cash payer. And they need to compete for your business. They’d rather give you a fair price than let you and your money go to another provider.
Health Savings Accounts provide a powerful triple tax benefit:
First, they let you set aside money pre-tax to pay for possible future medical expenses.
Second, your contributions accumulate tax-deferred as long as they remain in the account.
Third, any withdrawals you make to pay for qualified medical care are tax free, and penalty free!
If you don’t need your HSA money for medical costs, then you can just let it accumulate until you reach age 65. Then you can use that money to supplement your retirement income. Distributions after age 65 are tax-free and penalty-free.
Healthsharing plans are a much more affordable alternative to traditional health insurance approaches. They don’t provide as much coverage for pre-existing conditions in the first two or three years. But they do provide very significant protection against unexpected high medical costs – at a fraction of the cost of a health insurance plan without a subsidy.
Another bonus – most health sharing programs will pre-negotiate pricing for you, and may even be able to guide you to the providers that offer the best value.
To learn more about healthsharing and how it works, click here.
ColoHealth is Colorado’s leading independent insurance broker when it comes to expertise in healthsharing and HSAs.
To sign up, or to speak with one of our highly-qualified, experienced Personal Benefits Managers, click here, select your state, and make an appointment.
What You Can Do
If you have health insurance, you should contact your insurance company to determine what your out-of-pocket costs will be if you decide to have this procedure done.
If you don’t have health insurance, you can still contact the care provider(s) and work out a payment plan in advance.
If you have a healthsharing plan, you should contact your plan and ask if they have any recommended providers in your area. Many healthsharing plans have very effective bill negotiation services that can help you and other plan members keep costs low.
They also have access to loads of pricing data, and they have a very good idea of what prices are reasonable and competitive for common medical procedures and services.
If you’re a ColoHealth customer, you also have access to a very good medical bill negotiation service. Don’t hesitate to reach out and engage us!
Tip: Be willing to travel.
Often, you will find medical pricing to be much lower near major cities and universities than it is in rural and sparsely-populated areas. Depending on your location and the medical procedure, it might make much more sense to travel out of town.
If you’re willing to travel, you may find that the savings more than offsets the cost of traveling, many times over.
Take Advantage of Discounts
All these prices can normally be negotiated. And many organizations have already negotiated favorable pricing. For example, if you’re a ColoHealth client, you are already qualified to have access to our innovative health care pricing discount program.
Just show your membership card and you can receive discounts on a wide variety of medical services, medications, supplies, and other out-of-pocket medical costs.
Our clients save up to 50% on medical bills by taking advantage of this service!
If you’re already an ColoHealth customer, your Personal Benefits Manager can help you take full advantage of these programs.
If you’re not yet an ColoHealth customer, contact us to see how much you can save on your family health insurance and health care expenses in Colorado!
Just click here, select your state, and pick an appointment day and time that works for you. We’re confident you’ll be amazed at how much you can save!
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.