While this may be the time of year when your home decorations change from turkeys to Santas, it’s open enrollment season on the health care calendar. And that means it’s time again for many people in the state to find out how to buy a health insurance plan.
But do not worry. We at The Colorado Sun have compiled a massive catalog of tips and resources you can use to find the health care coverage that’s right for you. Feel free to browse this guide to find the answers you’re looking for or bookmark them for later.
Have a question we didn’t cover? Email me at email@example.com, and I’ll try to help you get an answer.
Happy shopping and good luck.
What is the deadline for making a decision?
In the individual market, open enrollment lasts until January 15. But if you want a plan with benefits that kick in on January 1st, you have to make a choice by December 15th.
What is open enrollment?
Open enrollment is the time of year when you can change health insurance plans. For most people it only happens once a year.
If you are covered by an insurance plan through your job, your company sets the open enrollment period. (For government employees, for example, open enrollment is tied to the end of the fiscal year in June.) For people who buy insurance on their own, open enrollment always lands at the end of the year, as it does for people looking for to Medicare Advantage plans.
Where can I go with questions about Medicare?
The State Health Insurance Assistance Program is a federally funded nationwide network of organizations that can help people with questions about accessing and using Medicare. In Colorado, there are SHIP programs in every county. You can find your country’s program, along with a phone number, in this list here.
The state Department of Insurance also provides some links and tips about Medicare on its website.
I know nothing about health insurance. Where should I start?
First, you need to know what market you are shopping in.
Are you covered by your employers health care plan? Find information from human resources or your benefits provider about your options.
Are you shopping on your own? Then you are in what is called the “individual market”. This means you will either shop at Connect for Health Colorado or use a broker. Connect for Health is the state’s insurance exchange — think of it like an online shopping platform, Amazon for health insurance plans.
A few years ago, we created a guide to buying a health insurance plan in Colorado. It is most applicable to people shopping in the individual market and includes tips for navigating Connect for Health. But it also offers advice from an actuary and a broker on how to determine what kind of coverage you need, regardless of what market you’re shopping in.
You can read that guide here.
If the language of the insurance world—deductible, deductible, subsidy—is foreign to you, Connect for Health has a handy glossary that provides some definitions. (The glossary is also available in Spanish.)
Is there anything new this year?
If you’re in the individual market, this is the first year you’ll be able to choose a Colorado Option health plan. Colorado option plans are sold by every insurance company – so Kaiser Permanente has Colorado option plans, Anthem has Colorado option plans and so on. But those plans are built on a standard benefit design created by the state government.
The hope is that the Colorado option will make it easier for people to compare plans. You know what benefits you’re getting, so it’s a matter of choosing a plan at the right price and with the right network of doctors and other medical providers.
“There are more services that are covered up front at no cost,” said Adam Fox, the deputy director of the Colorado Consumer Health Initiative, which supported the creation of the Colorado option. “So especially routine primary care, behavioral health care, pre- and post-pregnancy care, those services are covered with no additional co-pay, no cost sharing.”
But there is a catch with the Colorado option plans. Although they are also supposed to be priced lower than typical plans, they are usually not the cheapest in terms of premium price. So they may not be the best or most affordable option depending on your specific needs.
I heard about OmniSalud. What is it?
OmniSalud is the other thing that is new this year. It is a health insurance program designed specifically for people who cannot access insurance subsidies because of their immigration status.
Under OmniSalud, it is the state that provides the funding for the subsidies. The money comes from a fee on health insurance premiums, which in turn funds the Colorado Health Insurance Affordability Enterprise, which provides the subsidies.
OmniSalud plans are not sold on the regular Connect for Health Colorado insurance exchange. Instead, they are being sold on a new exchange called Colorado Connect, although the sign-up process begins on Connect for Health. The separation means that no information entered on Colorado Connect is shared with the federal government.
For Connect for Health’s Spanish language website, click here.
What are some tips for choosing the right plan?
The Colorado Sun hosted a virtual panel discussion on this topic with Fox, of CCHI, Connect for Health CEO Kevin Patterson and state Insurance Commissioner Michael Conway.
If you want to watch the whole thing, you can watch it here:
But here are some quick tips:
Fox recommended not just shopping around for the plan with the lowest price premium. Those plans often have high deductibles, and if you have more than minimal health care needs, buying the lowest-cost plan could mean paying more in the long run.
“What you’re really talking about when comparing health insurance options is comparing your current medical needs to what you can expect in the coming year, and your comfort with financial risk,” Fox said during the panel. “We’re really trying to encourage consumers to think, yes, it might be a little bit more in premium (price) to buy a silver level plan or a gold level plan. But it really provides such better protection for people’s finances. If something significant does happen, it’s very easy to rack up thousands of dollars in medical costs very quickly.”
Conway encouraged people to check Connect for Health to see if they are eligible for federal subsidies that help pay the cost of premiums. The federal American Bailout Act extended those subsidies to people who earn more money and the Inflation Reduction Act extended those extended subsidies.
“If you haven’t shopped on Connect for Health Colorado in the past two years, it’s imperative that you continue now because of the increased subsidies that were originally part of the American Rescue Plan,” he said.
Patterson said people shouldn’t hesitate to reach out for help when they get stuck.
“It’s a daunting task if you’re not sure what you’re looking for,” Patterson said. “And that’s why we always encourage people that they can look for a broker, look for an assistant.”
How do I know when to buy on Connect for Health versus using an assistant?
Assistants are people who can help guide you through enrollment via Connect for Health. Brokers can do this too, but they can also help you buy an off-exchange plan if that’s the best option.
Both are generally free for consumers to use – but be sure to ask a broker about any possible fees.
Connect for Health has lookup tools for both brokers and assistants on its website under the menu heading on the far right of the page that says “We Can Help.”
If you are eligible for premium subsidies, Connect for Health is the only place you can get them. Brokers, meanwhile, act like agents to find people the best deal based on their needs — whether that plan is on exchange or off.
“Our job is always to advocate for our clients,” said Meagan Fearing, the president of the Colorado State Association of Health Underwriters, which is a trade group for brokers. “For those who don’t use a broker, for heaven’s sake find a broker and make sure you make an educated and informed choice.”
The National Association of Health Underwriters also maintains a search tool to find member brokers. Just be sure to make an appointment quickly. Like accountants at tax time, brokers get booked up pretty quickly during open enrollment.