TABLE OF CONTENTS
In Colorado, there are a variety of affordable health insurance choices whether you’re seeking coverage as an individual or for your family. You can enroll in your employer’s plan or sign up for Medicare or Medicaid (if you qualify). There are government-funded health plans for children, direct plans from insurance companies, or you could use the Health Insurance Marketplace for Affordable Care Act options.
This guide explains what you need to know about getting health insurance in Colorado.
Colorado is one of a handful of states that has its own health insurance marketplace, so you’ll enroll on the state’s website instead of HealthCare.gov. New enrollees can get started by creating an account on the Connect for Health Colorado website. You’ll fill in your name, email address, and phone number, then choose a password and preferred language (either English or Spanish). Once you confirm your account through an automated email message, you can continue working on your profile and fill out an application for insurance coverage.
You need several pieces of information to complete your enrollment application, which are used to determine if you require an individual or family plan as well as to calculate whether you qualify for financial help with your premiums. These include:
Once your account is set up, you can shop online and compare available plans from multiple health insurance companies. You can also apply for financial assistance to lower your health insurance costs and request help from certified enrollment experts.
These insurance carriers offer plans on the Colorado Marketplace exchange in 2021:
Health insurance enrollment in Colorado works the same for both individuals and families. What the state calls individual health insurance plans are used for both individuals and families looking for coverage, but enrolling a family can be more time consuming, depending on the complexities of your household.
There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:
Whether your plan is for an individual or a family, Connect for Health Colorado only sells health maintenance organization (HMO) and exclusive provider organization (EPO) plans, which are very similar.
Signing up for an individual insurance plan as a single person is relatively uncomplicated. Ask yourself what types of medical services you need, prescription drugs you take, and doctors and other health care providers you already see that you want to continue seeing. Compare all your plan options, including each plan’s preferred drug list, provider network, and total costs to see which works best for your health care needs and budget.
Before comparing your plan options, see if you qualify for financial help or health care discounts. Many Coloradans don’t pay full price for the health plans sold through Connect for Health Colorado. You may qualify for advanced premium tax credits that lower your monthly premium and/or cost-sharing reductions that lower out-of-pocket costs, such as deductibles, copays, and coinsurance. You can use Colorado’s quick cost and plan finder tool to compare plans based on total costs and savings, then complete your financial assistance application.
Every Connect for Health Colorado plan must cover essential health benefits, such as hospitalizations, outpatient care, emergency services, prescriptions, pregnancy, and services for children, among others. Individual plans often include more services than a single person needs, but be sure you choose one with everything that matters to you by looking at the Summary of Benefits and Coverage.
Because family plans are identical to individual plans (except that the plans cover multiple people instead of a single person), families have access to the same insurance providers as single adults do. Some important inclusions for families in all Connect for Health Colorado plans are free preventive services, including certain services specifically for women and children. These services are covered without a copayment or coinsurance, even if your family hasn’t met your annual deductible.
Compare your plan options carefully to find one that meets the needs of everyone in your household. Depending on the number of people involved, this could become complicated, and family members may be covered under different plans within the same policy. Don’t forget to consider any special needs, doctor preferences, and prescription requirements of all family members before signing up for a plan.
Another consideration for family plans is that many plans have an individual deductible and a family deductible. An individual deductible applies to each person covered by the plan, while the family deductible applies to the entire family. If one of your family members is hospitalized or undergoes an expensive surgery, it’s possible to meet the family deductible before every person on the plan has met their individual deductible.
Health insurance plans in Colorado are organized into three coverage levels called health insurance metal tiers. These tiers help you decide which plan level is a good fit for you or your family based on how often you expect to need health care services.
The average lowest costs of insurance premiums have decreased for all three levels since 2018. While bronze and gold plans decreased each year between 2018 and 2021, the average cost for the silver plans went up in 2019 but dropped in 2020 and 2021. This is good news for Colorado residents who don’t qualify for financial help with their premiums, since this downward trend saves them money on their monthly premiums.
|Average premiums in Colorado||2018||2019||2020||2021|
|Most affordable bronze plan||$389||$363||$280||$273|
|Most affordable silver plan||$446||$475||$353||$346|
|Most affordable gold plan||$540||$495||$385||$383|
Low-income coverage options through Colorado’s Medicaid program help residents who can’t afford to purchase individual health insurance plans in Colorado, aren’t covered through their employer, or don’t qualify for Medicare. Colorado offers Medicaid to qualifying pregnant women and eligible adults. It also offers the Child Health Plan Plus for children whose families don’t qualify for Medicaid.
Colorado’s state-sponsored Medicaid program is called Health First Colorado, which offers free or low-cost health care for children and adults who qualify. Some benefits and services included in Health First Colorado are doctor visits, emergency room and urgent care, hospital stays, well-child visits, maternity care, prescription drugs, and dental services, among others.
To qualify, you must be:
Eligibility hinges on your monthly income. You can apply for Medicaid by submitting an application through Connect for Health Colorado or Colorado’s Program Eligibility and Application Kit (PEAK) eligibility system.
Colorado’s Child Health Plan Plus offers low-cost health insurance for certain children and pregnant women. If you earn too much to qualify for Health First Colorado, you or your child may still qualify for CHP+ because this program has different rules. CHP+ covers doctor visits, preventive care such as immunizations, emergency care, and other services.
Children aged 18 or younger and pregnant women aged 19 and older who don’t qualify for Medicaid, don’t have any other insurance, and have a household income under 260% of the Federal Poverty Level may qualify for CHP+. The cost for CHP+ depends on your household size and income. You may have to pay an annual enrollment fee and copays at the time of service. However, pregnant women, American Indians, and Alaskan Natives don’t pay premiums or copays.
Elderly Colorado residents and younger individuals with certain disabilities can receive health care coverage through Medicare, the federal government-administered insurance program.
You can also purchase a Medigap plan, which is Medicare Supplement insurance to help you cover your Original Medicare deductibles, copays, and coinsurance costs.
To qualify for Medicare, you must be a U.S. citizen or legal resident and aged 65 or older, or younger than 65 and receiving Social Security Disability Insurance for at least 24 months. You may also qualify if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
Older adults who receive Social Security or Railroad Retirement Board benefits should be automatically signed up the month before their 65th birthday. Adults receiving SSDI benefits should be automatically enrolled before their 25th month of disability.
If you aren’t automatically enrolled, you can sign up for Medicare at your local Social Security office, use the Medicare only application if you’re not ready to start collecting Social Security, or call 800-633-4227 for help. You can enroll in Medicare during the following periods:
If you need help signing up for Medicare, visit your local State Health Insurance Assistance Program (SHIP) office or call 888-696-7213 for free Medicare counseling and assistance choosing plans and filling out forms.
Due to Colorado’s strict laws regarding short-term health insurance plans, no insurance companies offer short-term plans in the state.
No, Colorado doesn’t require health insurance since the federal mandate for individuals to have a qualified health plan or pay a penalty ended in 2019.
No, you can also purchase health insurance from an insurance company, agent, or broker who provides policies in the area in which you live. However, you can only qualify for a premium subsidy through the marketplace.
Colorado has several health care sharing plans available. Members share medical expenses rather than paying monthly premiums to an insurance company. Health care sharing plans are less expensive than traditional health insurance, but aren’t required to cover pre-existing conditions, so these plans are usually best if you’re in good health.
While a health savings account can help you manage health care costs, it doesn’t replace insurance coverage. You’ll need health insurance to cover major health expenses. An HSA or FSA is good for covering out-of-pocket health costs.
If your employer doesn’t provide short-term disability insurance for you, then yes, you should consider getting short-term disability coverage on top of your health insurance plan. Short-term disability coverage pays for daily living expenses when you can’t work due to a non-job-related injury or illness. Some states have laws requiring employers to provide short-term disability insurance, but Colorado isn’t one of them, so you must purchase your own policy from an insurance plan provider.
Colorado doesn’t require you to have long-term disability coverage, but it’s an excellent supplement to your health insurance. LTD insurance may be purchased through individual insurance companies or provided by employers for the benefit of qualified employees. LTD benefits typically kick in when your short-term disability benefits run out, making LTD insurance ideal for long-term injuries and illnesses.
CHP+ covers an array of health care services, including primary care, hospital services, emergency care, urgent care, prescriptions, maternity care, dental care for children and pregnant women, and mental or behavioral health care.