Colorado health insurance: Your options, costs and how to buy a plan

Types of Colorado health insurance

In 2021, 326 different individual health care plans are offered in Colorado. Connect for Health Colorado offers four different health insurance tiers that differ by costs.

• Bronze -- Lowest premiums, but highest out-of-pocket costs; Bronze plans pay approximately 60% of medical expenses, while the member pays the rest.
• Silver -- Lower premiums than any tier except Bronze, but higher out-of-pocket costs than Gold and Platinum; Silver plans pay approximately 70% of medical expenses.
• Gold -- Higher premiums than Bronze and Silver, but also lower out-of-pocket costs than those plans; Gold plans pay about 80% of medical expenses.
• Platinum -- Highest premiums but lowest out-of-pocket costs; Platinum plans pay approximately 90% of medical expenses.

Determining the metal tier that's right for you depends on several factors, including your financial status, health status and what you want from a health plan.

The best candidates for a Bronze plan include:

• Healthy and young individuals who don't anticipate requiring many health care services.
• Coloradans who desire to pay the cheapest premiums possible.

The best candidates for a Silver plan include:

• Those who yearn for lower premiums but wish to avoid high out-of-pocket expenses.
• Households eligible for additional subsidies that are found in Silver plans.

The best candidates for a Gold plan include:

• Those who don't want to spend as much when they need health care services in exchange for higher premiums.
• Coloradans who believe they may need many health care services over the next plan year.

The best candidates for a Platinum plan include:

• People who don't mind spending money on high premiums while paying the lowest out-of-pocket expenses when they need health care services.
• Those who anticipate visiting the doctor often, use many health care services and have multiple prescriptions.

Best health insurance in Colorado

Health care plans available via Connect for Health Colorado are offered by nine different insurers:

• Anthem Blue Cross Blue Shield
• Bright Health
• Cigna
• Denver Health
• Friday Health Plans
• Kaiser Permanente
• Oscar
• Rocky Mountain Health Plans
• UnitedHealthcare

Determining which health insurer and plan are best for you depends on your needs and health care coverage goals. To help narrow down your choices, ask yourself:

• Are your preferred physicians and providers within the plan's network?
• Does the plan cover your prescription drugs?
• Do you prefer paying lower premiums but higher out-of-pocket expenses when it's time to see a provider?
• Or is paying higher premiums but lower out-of-pocket costs when health care is needed more desirable?

"There is no such thing as the 'best health insurance plan.' Everyone has different needs, so the best plan for you or your family may be unsuitable for another," says John Bartleson, owner of Health Benefits Connect in Englewood, Colorado.

Two different health plan types are offered by Connect for Health Colorado (PPOs are not an option):

1. Health maintenance organization (HMO) plans: These are commonly less expensive than EPOs; however, they are more restrictive. You will likely be required to choose a primary care physician and obtain referrals from that provider if you want to see a specialist in the network. Additionally, HMOs usually don't cover costs for out-of-network care unless it's an emergency.
2. Exclusive provider organization (EPO) plans: EPOs combine some of HMOs’ and PPOs’ best elements. Like an HMO, you’re required to remain within your plan's network. But you don't have to select a primary care physician or obtain referrals to visit a specialist.

Learn more about each of these health plans and what makes each different.

You can also shop for a dental benefits plan through Connect for Health Colorado at any time of the year, even after the health care plan open enrollment period ends, by phoning 855-752-6749. Families and individuals can select from 11 different dental plans provided by three insurers:

• Anthem Dental Coverage
• Cigna Dental
• Delta Dental

Connect for Health Colorado offers two dental plan designs: HMOs and PPOs.

Colorado has no individual mandate or penalty

The Affordable Care Act previously required most Americans to obtain health care insurance (called the "individual mandate") or pay a penalty fee. But in recent years, Congress removed the individual mandate penalty on the federal level. The same is true in Colorado.

However, just because health insurance isn't a requirement and there is no fee for going without it doesn't mean you shouldn't acquire health care coverage. In fact, going without health insurance can lead to devastating financial and health consequences. Consider that you’re twice as likely to file for bankruptcy if your health insurance is interrupted, per an American Bankruptcy Institute study.

Expanded health insurance subsidies in Colorado

Americans benefit from cost-saving subsidies in the Affordable Care Act exchanges if their household income qualifies. These subsidies cover premium costs and decrease out-of-pocket expenses.

If your household income is 400% or less of the Federal Poverty Level, you can qualify for subsidies in Colorado. Many Colorado residents don't pay full price for health care plans offered through Connect for Health Colorado.

Coloradoans within some income ranges may be eligible for:

• Advanced premium tax credits, which decrease your monthly premiums. The credit can be taken in full when you file your taxes for that tax year, or a portion of the credit can be applied monthly to your insurance plan to lower your premium.
• Cost-sharing reductions (CSRs) that lower your out-of-pocket expenses. CSR payments from the federal government are made to your insurance company to help reduce your costs. You can qualify for CSRs if you make 250% or less of the Federal Poverty Level and you select a Connect for Health Colorado Silver level plan.

Here are the subsidy eligibility by household size in Connect for Health Colorado:

Colorado households beneath subsidy eligibility may qualify for Health First Colorado, the state's Medicaid program. Health First Colorado provides low-cost, comprehensive health care plans based on household income.

Source: Kaiser Family Foundation

The Kaiser Family Foundation didn't provide estimates for Platinum plans, which only comprise a small portion of Affordable Care Act plans.

Note that these average costs don't consider subsidies that may apply. Remember that if you qualify for subsidies, you'll likely pay much less than these average premium costs.

"Health insurance premiums are set by the state commissioner, so the monthly premiums are the same whether you purchase the plan online, through a brokerage or directly through an insurance company," says Bartleson.

Colorado has not published median premium costs for its various counties. However, the Colorado Division of Insurance recently announced that health insurance premiums in the individual market will decrease, on average, 1.4% from 2020 premium costs.

Shop around for Colorado health insurance

It pays to shop around among various health insurance plans and insurers and compare and contrast what you find carefully.

"Understanding different plans and coverages can be difficult, so working with a professional is always a good idea," suggests Bartleson. "This reduces any surprises and small print issues further down the road."

COBRA insurance in Colorado

If you have recently lost your employer-sponsored group health care insurance coverage, you may be eligible to enroll in a COBRA plan. This option allows you to continue your plan previously provided by your former employer for a limited time -- typically between 18 and 36 months.

Keep in mind that, with COBRA, you pay all the expenses, including premiums, copays, deductibles and other out-of-pocket costs. Your previous employer will not contribute money to help offset your premiums.

The federal COBRA law only pertains to employers with 20 or more employees. States often have mini-COBRA laws that cover former employees of business with fewer employees. In Colorado, you can have a COBRA plan for up to 18 months if you were employed by a small business.

Other ways to get health insurance in Colorado

Aside from Connect for Health Colorado, an employer-sponsored group plan, Medicare and Health First Colorado (Medicaid). Coloradoans may also obtain health care coverage in other ways:

• An individual private plan outside of the Connect for Health Colorado exchange
• A catastrophic plan

Individual private plans not offered through Connect for Health Colorado may provide other plan options. The downside is that these plans don't qualify for subsidies. Consequently, it may be best to shop for and obtain a health care plan through Connect for Health Colorado if you’re eligible for subsidies.

As a last resort, consider a catastrophic plan. People under age 30 or who qualify for a hardship exemption are only eligible. While they come with much higher out-of-pocket costs, catastrophic health plans provide many benefits similar to what's offered in a traditional health care plan. You can enroll in a catastrophic plan directly with an insurer if you are eligible.

If you qualify for a catastrophic plan, compare the plan with a Bronze plan in the marketplace. You may find a Bronze plan with similar premiums and lower deductibles.

States also allow short-term health insurance. However, due to tightening restrictions, no insurer currently offers short-term health insurance in Colorado. Available in most states, these plans promise lower premiums in exchange for higher out-of-pocket costs. But short-term insurance plans usually do not provide coverage for services included in traditional health insurance plans, including maternity care, prescription drug coverage and mental health.

Still not sure about health insurance eligibility? Check out Insurance.com's Health Plan Finder tool to explore your health insurance eligibility.

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