Colorado is a western U.S. state nicknamed as the Centennial State and is known for a diverse landscape of arid desert, snow-covered Rocky Mountains, and river canyons. The Centennial State has been a leader in health reform and its residents are in luck as far as healthcare is concerned. As per the U.S. News study, Colorado has the ninth-best health care in the U.S., and the ranking was based on healthcare access, quality, and good public health. Before the implementation of the ACA reform on a federal level, maternity coverage was made mandatory by the state in the individual market and had banned gender-based premiums. It is the second state in the U.S. to actively pursue single-payer healthcare, though voters rejected the single-payer concept by a wide margin.
A reinsurance program was implemented in Colorado in 2020 to obtain federal pass-through funding for reinsurance that reduce unsubsidized health plans premiums in the state and stabilize the state individual market. In 2020, due to the reinsurance program the individual health insurance premiums in Colorado dropped by an average of 20%. The lawmakers and regulators of the state were working on a public option program that was expected to debut in the 2021 fall for the coverage to be effective from 2022. However, the legislation was abandoned amid the COVID-19 pandemic and the lawmakers expect to revive it during the 2021 session.
Highlights and Updates on Colorado Health Insurance Market
- Colorado uses a state-run health insurance marketplace, Connect for Health Colorado, through which residents of the state can enroll in the health plans.
- Colorado has permanently extended its open enrollment period and the open enrollment for 2021 health insurance plans will run from November 1, 2020, through January 15, 2021.
- In 2020 eight health insurers are offering health plans through the Colorado health insurance marketplace.
- In 2020, the average premiums decreased by 20% but the net premiums increased for people receiving subsidies.
- For the 2020 coverage, nearly 167,000 Colorado residents enrolled in plans through the Colorado health insurance marketplace. Around 14,263 residents enrolled during Colorado’s COVID-19 SEP.
- All Grandmothered health plans were terminated by the end of 2015 in Colorado.
- The ACA’s Medicaid expansion was adopted in Colorado and hence the growth in the Medicaid coverage is fourth highest in the nation.
- Colorado being a leader in health reform pre-ACA has been extremely supportive of the ACA and coverage expansion.
- Currently, the state does not allow the sale of any short-term health insurance plans.
- Around 926,000 people enrolled in Medicare in Colorado as of early 2020.
Individual and Family Health Plans in Colorado
Colorado utilizes a state-run health insurance marketplace called Connect for Health Colorado, so residents of the state can enroll in health plans through the Colorado exchange. Colorado residents have access to many health insurance options and irrespective of their situation there are plenty of individual and family health insurance options available and these plans certainly cater to the specific healthcare needs and budget of every resident. Right from the Affordable Care Act that is more affordable for everyone, to employer-sponsored health plans, to government programs like Medicare, CHIP, and Medicaid, to health plans offered through a private health insurance carrier. Residents of the state should compare plans and benefits to obtain better health insurance at the lowest cost. Some of the individual and family health insurance plans available in Colorado include:
Preferred Provider Organization or PPO plans are the most popular types of plan in the Individual and Family health insurance market. PPO plans are extremely popular among individuals mainly due to freedom and flexibility. Enrollees of the PPO plans are free to visit any in- or out-of-network doctor or specialist without requiring any referral from their Primary Care Provider. Members of the PPO plan do not require to have a Primary Care Physician. PPO plans have higher premiums and there is also a deductible and copay in these plans due to the freedom and flexibility of these plans. PPO plans to create a healthcare network by having contracts with hospitals, pharmacies, and other healthcare providers. Enrollees of the PPO plans while receiving in-network healthcare services will be covered at a higher benefit level compared to the out-of-network services. A PPO plan is best suited for individuals who prefer to have freedom in choosing a healthcare provider or medical facilities, and individuals who want a part of their out-of-network claims to be covered by their health insurance carriers.
HMO or Health Maintenance Organization plans to provide different healthcare services through a network of providers who agree to render medical services to members at pre-approved prices. Members of the HMO plans are likely to have coverage for a broader range of preventive healthcare services compared to other types of plans. Members of the HMP plans need to choose a primary care physician, who generally take care of most of their healthcare needs and also provide a referral for seeing a specialist. Members of the HMO plans usually have lower out-of-pocket healthcare expenses, as they are not supposed to pay a deductible before the start of the coverage and these plans also have minimal co-payments. Generally, members of the HMO plans do not have to submit their claims to the insurance company. Members of the HMP plans should always remember that they will not get coverage for the medical services received by out-of-network providers or for services received without a proper referral from their PCP. An HMO plan is ideal for individuals who want to have health plans with lower premiums and without a deductible and who don’t mind having an out-of-pocket limit.
A POS or Point of Service is a managed care plan having a few qualities of both the HMO and PPO plans. Benefit levels of the POS plans depend on whether the members of the plan receive healthcare from in or out-of-network providers. POS plan members just like the HMO plans are required to have a primary care provider to take care of most of their healthcare needs and to provide referrals to network specialists when required. Medical services received by the primary care provider usually include preventive care benefits and services are not subject to a deductible. Members of this plan have freedom and flexibility just like a PPO plan, as they are also free to receive healthcare from non-network providers by paying greater out-of-pocket costs, as they will be responsible for paying coinsurance, copayments, and an annual deductible.
An indemnity or Fee-for-Service Plans
An indemnity or Fee-for-service plans provide plan members complete control on their healthcare needs and they are free to visit any doctor, specialists, or hospital of their choice with no referral required. However, members are allowed to choose a healthcare provider for receiving the majority of the medical care, their insurance companies do not make mandatory to choose a primary care physician. Members of the indemnity plan need to pay upfront for the received medical services and then submit a claim to their insurance carrier for reimbursement. They will also require to pay an annual deductible before their carriers start paying on their claims and once they meet their deductible amount, their carriers will pay their claims at a set percentage of the usual, customary, and reasonable rate for the service. This indemnity plan is perfect for individuals who prefer a great amount of freedom in choosing doctors as well as hospitals and who don’t want to have a primary care physician for receiving most of the healthcare services or to obtain a referral for visiting a specialist.
Short-term health insurance in Colorado
Due to the powerful new state regulations that came into effect in 2019 in Colorado currently, there is not any short-term health insurance coverage available in Colorado. The state created a special enrollment period in Colorado for people who were enrolled in the short-term health plan and lost coverage because their plan was terminated and with no availability of other short-term plans they became uninsured.
Dental Insurance Plans in Colorado
Dental insurance plans in Colorado work exactly like the healthcare insurance, where members of the plan are required to pay a monthly premium to receive certain dental benefits like regular check-ups, x-rays, cleanings, and dental care services that promote general dental health. Some of the dental plans available in Colorado also provide coverage for oral surgery, dental implants, or orthodontia. Dental insurance plans in Colorado are categorized as
Indemnity or Managed Care plans.
Indemnity Dental Plans
In Indemnity dental plans members will have access to a broader choice of dental care providers. In this dental plan, the dental insurance carriers will pay for the covered dental services only after receiving a bill. This means that the insured will require to pay up-front for the received dental care and then, later on, obtain reimbursement from their dental carrier.
Managed-care Dental Plans
Managed care plans usually have a network of dental care providers who agree to provide dental care services to members of the plan at pre-negotiated rates. The claim for dental care services is submitted by the dental care providers to the insurance carriers.
Vision Insurance in Colorado
Vision insurance is a supplemental health insurance coverage designed to manage the routine eye-care expenses like annual eye exams, eyeglass lenses, frames, and contact lenses. Members of the vision insurance plan in Colorado are provided with a specified amount to purchase eyeglasses, contact lenses and to make payment for some eye exams and a few vision insurance plans even provide discounts on refractive surgery.
Insurance Carriers in Colorado
Right now eight insurers participate in the Colorado health insurance marketplace as of 2020 that provide policies through the state exchange in Colorado:
- Bright Health
- Denver Medical Plan
- Friday Health Plans
- Kaiser Permanente Colorado
- Anthem Blue Cross Blue Shield
- Rocky Mountain Health Plans
Frequently Asked Questions on Colorado Health Insurance
The federal mandate that required individuals to have a qualified health insurance plan has been lifted from the tax year 2019 in Colorado. Now individuals are no more required to have health insurance and even there is no penalty for not having health insurance. Though the federal mandate has been removed but still individuals should have health insurance, as it will protect them and their families from sudden medical expenses and allow them to make routine medical expenses more predictable. Individuals should understand the significance of health insurance and take the initiative to enroll in a suitable health plan.
Most of the health insurance plans available in Colorado provide the 10 essential health benefits that are mandatory with the ACA-compliant plans. Coverage includes ambulatory patient services, emergency services, hospitalization, pregnancy, maternity, and newborn care, mental health, prescription drugs, laboratory services, rehabilitative and habilitative services, preventive and wellness services, and pediatric services. Some of the health plans may even cover some additional benefits but may cost more than basic plans or may have higher out-of-pocket costs for some services. Individuals can obtain a custom health insurance quote to cover you and your family today.
The actual cost of the health insurance plan depends on several factors like the applicant’s age, gender, health conditions, and the area where they live. Therefore, while purchasing a health plan, individuals first need to identify the health plans available in their county and the plans they find affordable. The health insurance plans available in Colorado are categorized in the three metal-tiers namely Bronze, Silver, and Gold and so each category has its own cheapest plan. The cheapest Bronze plan available in Colorado is Anthem Bronze Pathway X HMO 8150 and the monthly premium for a 40-year old is $262, whereas the cheapest Silver plan is Anthem Silver Pathway X HMO 5500 and the monthly premium for a 40-year old is$329, and the cheapest Gold plan is KP Select CO Gold 1750/20 and a monthly premium for 40-year old is$378. Though, it is not necessary that these specific plans may be available in every county, so individuals need to check whether these plans are available in their area or not.
Colorado has implemented rules to permanently extend the annual open enrollment period in the state to 2.5 months. The open enrollment period starts from November 1 and ends on January 15. Thus, the open enrollment period for 2021 health insurance in Colorado will run from November 1, 2020, through January 15, 2021.
Health First Colorado
Rocky Mountain Health Plans
Denver Health Medical Plan
Bright Health Plan