Jakob Rogers, The Gazette

For the first time since 2013, health insurance markets will open this week without a federal tax penalty for people without coverage.

But that doesn’t mean it’s OK to be uninsured, consumer advocates say.

Open enrollment, which kicks off Thursday, is the only time people who don’t already have coverage through their employer or the government can purchase health insurance. And, for the first time since the Affordable Care Act took effect, no tax penalty will be waiting for people who don’t purchase plans because of Congress’ decision to end the individual mandate in last year’s tax overhaul.


It’s among the biggest changes facing shoppers as markets under the Affordable Care Act, also known as Obamacare, amble along for their sixth year. But advocates and the leaders of Colorado’s health insurance exchange, Connect for Health Colorado, say people should still purchase coverage.

“It protects against the big catastrophes in life,” said Vincent Plymell, a Colorado Division of Insurance spokesman. “That’s the advantage it brings. It can be costly, yes, up front, but so can an unexpected accident or injury or illness. So that’s the protection you buy.”

“Spending more than $2,000 happens very fast in a health care setting, so the real cost is not being covered,” added Luke Clarke, an exchange spokesman. “You can get bankrupted by an accident or a diagnosis of a serious illness.”

Unlike last year, when insurance rates spiked and the health law’s future appeared in question, this year’s open enrollment has arrived quietly. Few other changes to the law have been made, and insurance markets appear to have stabilized.

Exchange leaders are planning for the same number of people to enroll for 2019 coverage as during the previous open enrollment period, when more than 165,000 people signed up. In the process, they have introduced a new enrollment system they say is easier to use.

“When they come to our site, it will be new, and it is a lot simpler,” said Luke Clarke, the exchange’s spokesman.

The first — and most important — deadline to purchase coverage is in only a month and a half. Here’s a rundown of what to expect:

What’s new this year?

First off, no more double-digit rate increases.

Across the state, rates for insurance premiums went up an average of 5.6 percent in 2019 — a distinct change from the 20- and 30-percent rate increases of the past couple years.

Still, actual rates vary widely by insurance company. While most carriers saw single-digit rate increases, monthly rates for plans sold by Anthem will decrease an average of 2.6 percent, while Denver Health’s plans will increase an average of 21.6 percent.

And it’s important for people to shop around, experts say.

People who stick with their current plans and who receive financial assistance are expected to see their monthly rates decrease by 24 percent in 2019, according to the state’s insurance division. But those same people can find rate decreases of 30 percent to 50 percent if they shop around.

People who aren’t eligible for financial assistance, however, may see price increases in some cases if they don’t shop around — especially if they currently have silver plans.

Who is eligible for that financial help?

In general, the less that Coloradans earn, the more help that’s available.

Tax credits are available that cut down the cost of premiums — the monthly cost of having an insurance plan. They’re available to anyone earning 138 percent to 400 percent of the federal poverty level. In general, that means a single person earning about $16,800 to $48,600 a year, and a family or four earning $34,600 to $100,400 a year.

Also, subsidies exist that can cut down on out-of-pocket costs charged to people seeking medical care, such as deductibles, co-payments and co-insurance.

Those subsidies are only available to people earning up two and a half times the federal poverty level — meaning a single person earning about $30,400, or a family of four earning up to $62,800 a year. And importantly, they are only available to people purchasing mid-level, silver-tiered plans.

Both forms of financial assistance are only available on Colorado’s exchange, Connect for Health Colorado.

And there’s a lot more of it to go around than last year.

Wait: Why are tax credits more generous this year?

The reason is complicated. In short: When the cost of a certain silver-level plan rises, so do tax credits across the board. And this year, the cost of that type of plan for most of the state went up.

It’s all due to a decision by state insurance regulators called “silver loading.” Essentially, those regulators allowed insurers to make up for the loss of certain federal subsidy payments by jacking up rates solely on those silver-level plans, rather than across the board.

That means only silver plans sold on the exchange are going to be substantially more expensive than usual this year — in general, far more than any other type of plan.

And it also means that the tax credits also will be far more generous for most of the state this year.

So what’s the upshot?

Shop around, says Adam Fox, of the Colorado Consumer Health Initiative.

First, if you had a silver plan in the past, research other options, he said. Silver-level plans sold off the exchange were not affected by “silver loading,” meaning their prices weren’t raised as much. That option may be most appealing to people not eligible for financial assistance, he said.

But for people eligible for financial help, the decision to “silver load” means there are far more deals available on the exchange than in previous years.


Many bronze-level plans can be had for free, after accounting for tax credits that cut the monthly cost of having that coverage (though out-of-pocket expenses may still arise during doctor’s visits). Two-thirds of current policyholders on the state’s exchange could qualify for such a plan, Clarke said.

And there are even some gold-level plans that could be cheaper than a silver-level plan, thanks to those same tax credits. In other words, shoppers could get more robust coverage with fewer out-of-pocket expenses at a cheaper price.

Is there any fine print?

With health insurance? Always.

Most importantly, consumer advocates suggest considering more than just a plan’s monthly premium cost while purchasing a plan. That’s because, in general, plans with cheaper premiums have skimpier benefits. As a result, someone with that plan could end up paying far more for their care, after accounting for copays and their deductible.

That’s why a bronze plan may not be the best deal for someone who has several health ailments, experts say, even if a policyholder ends up not having to pay any monthly premiums for that coverage.

Also: Different plans cover different sets of doctors. And, to cheapen rates, insurance companies have steadily reduced the number of doctors included on many of their plans.

As a result, changing insurance plans could mean losing the ability to see your doctor.

How long do I have to shop?

Colorado differs from many other states across the country, in that shoppers here have a lot more time to shop. Open enrollment here ends Jan. 15.

But there’s a catch.

Anyone who wants their coverage to begin on Jan. 1 — avoiding a one-month gap in coverage — needs to sign up for a plan by Dec. 15. Otherwise, anyone who signs up after that will have to go without coverage until Feb. 1.

What if I do nothing?

For the most part, people who were already enrolled in coverage this year on the exchange, and whose plans are still available in 2019, will automatically be re-enrolled on Dec. 15 (though some exceptions exist, so Fox says it’s always best to check).

If you aren’t already covered, and you miss both deadlines, then you may be out of luck until 2020.

Most plans can only be purchased after Jan. 15 following a qualifying life event, which include losing a job with insurance coverage, having a baby and getting married.

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