Guide to Types of Health Insurance
There are several types of health insurance that you may have access to now or in the future. This guide will help you understand your options for getting health insurance for you and your family in Colorado, either through a job or on your own.
Click on the category below to find out more about each option:
Health Insurance Through an Employer or Other Group
Many people get their health insurance through work. These are group health insurance plans. Your employer often pays for some of the costs and you pay for some (usually taken out of your paycheck). Some people can also get group health insurance through a membership or professional organization. Group health insurance plans can be either fully insured or self-funded.
Fully insured means that your employer offers health insurance from one or more health insurance companies. With self-funded plans, the employer pays for employee health care directly instead of paying for health insurance. The “self” in a self-funded plan refers to your employer, not to you. Self-funded plans are also called ERISA plans because they are included in the Employee Retirement Income Security Act of 1974 (ERISA), a federal law that sets standards for employee benefits.
It’s important to know which type of plan your employer has because it can affect your benefits and your rights. Fully insured plans are regulated by the Colorado Division of Insurance and must follow Colorado law, but self-funded plans only have to follow federal law. For more information about self-funded (ERISA) plans, see ERISA-Employer-sponsored Self-funded Health Benefit Plans.
Health Insurance Options When You Lose or Leave a Job
For many people, leaving a job means losing health insurance. But you have a few options for staying covered. Any employer with 20 or more employees must let you keep your health insurance benefits for a limited time through COBRA (Consolidated Omnibus Budget Reconciliation Act). If you choose COBRA, you’ll have to pay the whole premium (including the part your employer used to pay) plus a 2% administrative fee. Coloradans who work for small businesses with fewer than 20 employees may have access to a similar option through Colorado Continuation and Conversion Coverage.
COBRA isn’t your only option. You could buy a health insurance plan through Connect for Health Colorado and you might qualify for help with the premiums and out-of-pocket costs. See the section, “Health Insurance You Buy on Your Own” for more information. You may also qualify for Health First Colorado (Colorado’s Medicaid program). Health First Colorado provides free or low-cost care for children, adults, pregnant women, and people with developmental, intellectual, and physical disabilities. Child Health Plan Plus (CHP+) is another free or low-cost insurance option for children and pregnant women.
Health Insurance You Buy on Your Own
Individual Health Insurance
Health insurance that you shop for and buy for yourself and your family is called individual health insurance. In Colorado, individual health plans are subject to Colorado law and regulated by the Colorado Division of Insurance. They are compliant with the Affordable Care Act, which means that they cover the ten essential benefits with no lifetime or annual benefit maximums.
You can buy an individual plan either on-Exchange or off-Exchange. Buying a plan off-Exchange means that you buy a plan through an insurance agent or directly from an insurance company. Buying on-Exchange in Colorado means buying through Connect for Health Colorado. This website lets you to search for plans and compare them. Insurers may sell similar plans on-Exchange and off-Exchange. The important difference is that if you buy on-Exchange through Connect for Health Colorado, you may qualify for an Advanced Premium Tax Credit (APTC) to help with monthly premium costs or Cost-Sharing Reductions to help with out-of-pocket costs.
You can buy individual plans only during open enrollment (between November 1 and January 15) unless you have a qualifying life event like getting married, having a baby or adopting a child, losing your employer coverage, or losing Medicaid eligibility. For the complete list and more information, see When Can I Buy Insurance? on the Connect for Health Colorado website.
Short-Term Health Plans
Short-term health plans cover you for a short time while you are waiting to enroll in a better health insurance plan. They are only available off-Exchange. Having one of these plans may be better than having no coverage at all, but they have disadvantages. They don’t have to cover everything that individual health plans have to cover. They often have high deductibles and caps on how much they will pay every year and in your lifetime – with no limit on how much you can pay. These plans can also decide not to cover you if you have a pre-existing condition.
Insurers are not offering short-term insurance plans in Colorado right now because of laws Colorado passed to strengthen consumer protections. If you had a short-term plan and lost your coverage since April 2019 as a result, Connect for Health Colorado is offering a special enrollment period for you beginning September 1, 2019.
Catastrophic plans are meant to cover you in a worst-case health scenario. They are offered off-Exchange and on-Exchange (Connect for Health Colorado). But you can only get one if you are age 30 or younger, or you qualify for a hardship exemption because you can’t afford other coverage. These plans have a low monthly premium but a very high deductible. They offer the same essential health benefits as other individual plans but you’ll pay out-of-pocket for everything except three primary care visits until you meet your yearly deductible. You can’t get Advanced Premium Tax Credits or Cost Sharing Reductions with catastrophic health plans.
Limited Benefit Plans
Limited benefit plans (“mini-med” or “bare bones” plans) cover only basic lower-cost medical treatments like doctor visits, prescription drugs, and some hospitalization. You can’t get these plans through Connect for Health Colorado and they’re not really insurance: they don’t protect you in expensive worst-case health scenarios. They have low monthly premiums but they don’t cover many things. They also have a yearly limit to what they will pay (sometimes very low) and you have to pay for any care beyond this amount. These plans will not protect you from the high costs of care for serious illness or injury.
Health Insurance for Young Adults/College/University Students
If you are a young adult or student at a college or university, you have several options for health coverage:
- Student health plans. Your school may offer a student health plan. These may be a good, affordable option for basic care through the health clinic on campus. It’s easy to enroll in this plan when you are enrolling in school. You may even be able to use financial aid to pay for it, but this cost will get added to your overall student loans. Some other options may be more affordable depending on your situation.
- Parent health insurance plan. The Affordable Care Act made it possible for students to be covered by a parent’s insurance until age 26. But if you’re going to school out-of-state, be sure to find out if you can get care in your insurance network and how your insurance plan handles out-of-network care.
- Individual health plan. You can purchase an individual health plan either outside or on the health insurance marketplace (Connect for Health Colorado). If you buy a qualifying plan through the marketplace, you might be able to get financial help with paying for your premiums and out-of-pocket expenses. (Young adults age 18-30 can also purchase CYA plans – Colorado Young Adult plans – through the marketplace, but these plans cannot qualify for financial help and carry very high out-of-pocket costs)
- Employer-based insurance. This is typically an option only if you work full time.
- State coverage (Medicaid and CHP+). If you’re in Colorado, you may qualify for Health First Colorado (Colorado’s Medicaid Program), which provides free or low-cost care for children, adults, pregnant women, and people with disabilities. Other states also have Medicaid programs, but each state has its own rules for qualifying. In Colorado, people who don’t qualify for Medicaid may qualify for Child Health Plan Plus (CHP+), but it is limited to pregnant women and children ages 19 and younger.
Buyer Beware: Health Sharing Ministries
Health Sharing Ministries are not insurance plans. They’re faith-based nonprofits that pool their members’ money to share medical expenses. These plans are not compliant with the Affordable Care Act and do not have the ACA’s consumer protections (like essential health benefits and out-of-pocket maximums). Health sharing ministries can exclude people with pre-existing conditions or require members to make a faith promise or participate in worship and prayers. They may not cover illnesses resulting from tobacco, alcohol or drug addiction, and may not cover mental health services, contraceptives, and out-of-wedlock pregnancies.
Health Sharing Ministries can be misleading and market themselves as health insurance. For this reason, the Colorado Division of Insurance told Trinity Healthshare and Aliera Healthcare they had to stop doing business in Colorado in August 2019. Consumers who were enrolled in Trinity Healthshare are eligible for a special 60-day enrollment period to enroll in new health coverage, starting August 28, 2019. If you were affected by this, contact Connect for Health Coloradoor contact insurance carriers directly to enroll in ACA-compliant health coverage.
VIVOR: We Can Help You Manage Prescription Drug Costs
Drug costs are disproportionately higher in the U.S. than in other countries, and they are continuing to rise. These high costs are a substantial barrier for many. Fortunately, CCHI has a new tool, VIVOR, that can help you get more affordable prescriptions.
If you are struggling with the high cost of prescription drugs, we encourage you to reach out to us and set up a VIVOR profile. After we build your unique profile, VIVOR matches you with underused, money-saving resources.
Finding Coverage and Care in Colorado During COVID19
The public health and economic crises that have been created by the COVID-19 pandemic have created a great deal of uncertainty and highlighted the need for a robust and responsive safety net. In Colorado and across the country, government, business, the nonprofit sector and, of course, the health care system are rapidly responding with ways to assist. The following is a list of resources for accessing health coverage and health care.
Surprise Medical Bills
Sometimes, people get care from a health care provider such as a doctor, anesthesiologist, or radiologist, who is not in their health insurance plan’s network even though the care they received was at an in-network facility. This can happen if you have surgery at an in-network facility and it turns out that someone on the surgical team, like the anesthesiologist or surgical assistant, is not. It can also happen if you go to an emergency room that is in your network and the doctor who takes care of you does not accept your insurance. After the services are received, you might get a surprise bill in the mail saying you owe the out-of-network provider money. This is called a “balance bill”.
Hospital Financial Assistance
In Colorado, hospitals are required to offer financial assistance programs for qualifying people. Every hospital is supposed to have an established discount program for uninsured patients that earn less than 250% of the Federal Poverty Level (click here to see if your income qualifies). If you qualify, you shouldn’t have to pay more than the lowest negotiated rate paid by an insurance company. This is a minimum standard, though, and some hospitals have financial assistance programs that provide more generous relief for more people. So be sure to ask about your financial assistance options. To learn more about hospital-specific financial assistance and charity care programs go here.
Health Coverage Resources
Are you uninsured, looking for health coverage and wondering about your options? There are many programs that can help you with health care costs. Find the programs that best meet your needs.
Colorado Consumer Health Initiative
303 E 17th Ave, Suite 400
Denver, CO 80203
Sara Kraeski, Board Chair | Chief Financial Officer
Sara is the Chief Financial Officer for Davis Graham & Stubbs LLP, a Rocky Mountain regional law firm located in Denver, Colorado. She works with the firm’s Executive Committee to oversee the firm's financial management, risk management, and client relations programs, including practice economics, legal matter management, and client satisfaction initiatives. Sara joined Davis Graham & Stubbs in 1992 and was a partner in the firm prior to assuming an administrative management position. As a practicing lawyer, she specialized in corporate transactions, representing clients in public and private securities offerings, merger and acquisition transactions and corporate financings. Sara received her J.D. from the University of Pennsylvania Law School and her M.B.A. in Health Care Management from the Wharton School at the University of Pennsylvania in 1992.
Barry Danielson, Board Treasurer | Real Estate Investor
Barry Danielsen is currently a real estate investor and developer along with his wife of over 30 years. For the 20 years prior to these endeavors, he ran a consulting practice where he advised investors, owners and brokers regarding financial considerations of acquisition, disposition and development opportunities in commercial real estate. Barry served on the boards of St. Anne’s Episcopal School (PK-8) in Denver; the High Mountain Institute in Leadville which is primarily an academic and wilderness semester school for motivated college-bound juniors; and Big City Mountaineers, a non-profit out of Golden that offers transformative wilderness mentoring expeditions for under-resourced urban youth. Barry earned a B.S. of Business Administration from the University of Colorado and an M.B.A. in Finance from the University of Denver. He is a licensed real estate broker in the state of Colorado. A native of Denver, Barry enjoys all forms of skiing, backpacking, hiking, climbing 14ers, and yoga.
Phillip Chung, Board Vice Chair Elect | Evaluation and Research Consultant
Phillip is an evaluation and research consultant with 20 years of experience working at or with nonprofit organizations, foundations, and academic institutions. His research interests centers on patient and consumer representation in health organizational governance and the implementation of community-based approaches to improving health systems. He has experience developing single and multi-site evaluation initiatives, as well as translating complex research findings to diverse audiences. Formerly, Phillip was the Assistant Director for Research, Evaluation and Strategic Learning at The Colorado Trust where he managed the development and implementation of multi-year evaluation initiatives, designed approaches to assess the progress and results of grant strategies, and oversaw internal and external strategies to foster systematic opportunities for learning. He has served on the board of directors for Colorado African Organization and as an advisory member for The Denver Foundation’s Basic Human Needs committee and the National League of Cities’ Expanding Healthcare Access for Children and Families. Phillip has a Master of Science in Social Work from Columbia University and a PhD in Health and Behavioral Sciences from the University of Colorado Denver.
Christy Blakely, Board Member | Health Consultant
Christy is a health consultant and serves on several nonprofit boards including NICHQ Early Childhood Education CoIIN Project, Family Engagement Lead. She was Executive Director of Family Voices Colorado from 2000-2012, an organization that advocates for children and youth with special health care needs. She has a masters degree in Special Education from Purdue University. Her and her husband Todd, parented a daughter with significant disabilities. Lauren, now 35 years of age, was born prematurely and was oxygen deprived at birth. Having degrees in the field of special education gave Christy insights into the world of special needs, and over the years she teamed with insurance companies, doctors, families, schools, advocates, professionals, therapists, hospital staff, policy makers and state agencies to provide for her daughter and advocate for many other children with special needs. She has learned and shared her learning in assistive technology, systems navigation, service delivery systems, public and private health insurance, policy, law and most importantly resources and funding with people around the State of Colorado and nationally. Parenting Lauren and her other daughter, Allison, brought Christy's professional experiences an added personal dimension. Christy defines herself as a positive, strategic thinker, a life long learner, a relationship builder and a change agent. She has a passion to work with families to navigate today’s complex healthcare systems.
Beth Dembroski, Board Member | Lawyer
Beth is an attorney who practices consumer-based healthcare law, elder law, criminal defense, and VA disability law at Triple L Law, P.C.. Beth is a former Navy Judge Advocate, having joined the Navy JAG Corps upon completing her J.D. from U. of Denver, Sturm College of Law. During her time in the JAG Corps she served as a legal assistance attorney, military criminal defense attorney, and as the Deputy JAG at the Naval Medical Center in San Diego. After leaving the Navy, Beth earned a Master of Science in HealthCare Leadership focusing in HealthCare Policy and Law, and has been very active in the healthcare policy community in Denver. Before joining the Board in 2022, Beth had been a very active member of CCHI’s policy committee. Beth is currently a member of the Legal Advisory Council for Triage Cancer, and her legal associations include Secretary of the Colorado Bar Association Elder Law Section and member of the Military and Veteran’s Affairs Section, member of the American Health Lawyers Association, and member of the American Bar Association. Beth proudly holds a B.A. in Anthropology from Penn State University, is a returned Peace Corps Mongolia member, and is a former AmeriCorps VISTA Leader (Fairbanks, AK). Beth has two young boys who are wildlife enthusiasts, students of Tae Kwon Do, and the oldest of the two is a budding professional golfer.
Elizabet Garcia, Board Member | Entreprenuer
Elizabet Garcia Hernandez was born and raised in Greeley, Colorado to Mexican parents. She spent her childhood moving around town as work appeared for her parents ranging from farmwork to construction. She understands the complexity of the healthcare system and advocates for the community she grew up in. Elizabet graduated from the University of Denver with degrees in International Studies, Spanish, and a minor in Business Administration. She has
had the opportunity to create partnerships with various organizations over the last couple of years including Colorado Peoples Alliance, The Denver Foundation, CLLARO, and The Colorado Democratic Party. Most recently she opened up her own political consulting business called Verbo LLC where she worked with clients around the state passing legislation for directly impacted communities. During the 2021 legislative session, she supported legislation to create
a Colorado Public Option. Having had the opportunity to see firsthand the impact that healthcare can have on an individual and hear testimonies throughout the legislative session she knew that getting involved on a deeper level was the next step and has since then become one of our new board members. She is excited to continue to flourish the partnerships she has created and of course continue to make new ones along the way.
Sharon O’Hara, Board Member | Director
Sharon rejoins the CCHI board after a 2 ½ year break. Sharon has a proven track record in state level advocacy, legislative and regulatory initiatives as well as educational programs to address health and social issues. She currently directs the work of the Chronic Care Collaborative, a Colorado-based collaborative of 34 voluntary health organizations. In representing the 1 in 4 Coloradans with a chronic disease the Collaborative joined with other groups to pass the bi-partisan legislation that established the state based exchange, called Connect for Health Colorado, and more recently to pass network adequacy regulations that closely mirror model regulations from the National Association of Insurance Commissioners. Sharon recently retired after ten years as Executive Vice President at the MS Society Colorado-Wyoming Chapter and an accomplished career in executive leadership and management of nonprofit and health care organizations. Sharon was appointed five years ago to that Board by the Governor to represent consumers. She has demonstrated success and expertise in development of networks and community partnerships, working with state and local policy makers to address accessible and affordable health care.
Tracey Stewart, Board Member | Senior Program Officer-Affordable Housing
Tracey, who joined The Colorado Health Foundation in November 2020 as a senior program officer, has amassed a breadth of experience in the philanthropic and nonprofit sectors, including public policy development and community investment projects. With a BA in English Literature from Dartmouth College and a MA in Education and Leadership at University of Denver, and backed by almost twenty years of expertise in family economic mobility, she searches for sustainable investments that create lasting solutions, and ultimately change the way philanthropy thinks about community-driven initiatives to emphasize self-sufficiency and self-determination. Previously, Tracey served as the director of family economic security at Gary Community Investments, where she led the expansion of community-based investments in workforce, affordable housing and financial inclusion. Other highpoints of her nonprofit career include working on policy at Colorado Center on Law and Policy and community data management at Colorado Coalition for the Homeless. Prior to her roles in the nonprofit sector, Tracey was a technologist specializing in data systems and organizational change management. Tracey remains committed to strengthening her community and serves as a board member for both Hope Communities and Uncharted. She is also a part of advisory committees for Warren Village, Grounded Solutions and NPX Advisors Group. Tracey loves immersing herself in written and filmed stories, and is a self-described bibliophile (a person who loves books) and science fiction fan. When she is unable to travel internationally, Tracey loves to visit Crestone, Colorado, or explore her neighborhood through lengthy walks that end with a treat from a local restaurant or market. A proud aunt, she is close with her siblings who also live in Denver.
Monserrath Vera, Board Member | Healthcare Consultant
Monserrath is a healthcare professional, and management consultant, who brings 14 years of experience in the healthcare arena. She holds a bachelor’s degree from Regis University in Human Resources Management with a Minor in Health Care Administration. As well, a Master’s degree from the University of Denver in Healthcare Management, Concentration in Global Health Program Management and Certification in Policy & Regulations. Also, she earned a Diploma in Medical Coding and an Associate degree in Project Management. Her experience in the public health area started, more than 20 years ago, as part of the MIDUVI (Ministry of Urban Development and Housing of Ecuador) team, providing training to the rural native communities in the Andean region of Ecuador. She found directly the lack of public services, the lack of health services in indigenous areas, the lack of personal hygiene, and the negligence in food preparation due to the lack of water for human consumption. Therefore, this experience deeply impacted her view, regarding the lack of effective and balanced work in the public health zone towards these communities. Her experience in the healthcare field within the US, started at Saint Joseph Hospital Foundation serving families in economic vulnerability through a program that helps families in needs, where she learned from mistakes in daily habits are due by lack of knowledge, lack of education, and neglect of the people. As well, she has been a high devoted for the volunteer job, as she served for more than three years at Saint Joseph Hospital in Denver at the optional cosmetic surgery department. After that, she has been participating as a volunteer in the cure for breast cancer with the Susan Komen Foundation since 2014. She worked for Colorado Access an organization that works directly with Medicaid patients, her role there was crucial to managing the education and training for medical providers to serve better the Medicaid consumers. She is foundress the community of Ecuadorian residents in Colorado and serves on the Board of directors of this association. As a Board member of the Colorado Consumers Health Initiatives (CCHI); across this entity, she is looking forward to serving the Coloradoan community through her inputs to improve the access to services of health consumers.
Marley Weaver-Gabel, Board Member | Campaign Coordinator
Marley recently graduated from Regis University with a B.S. in International Business and a B.A. in Interpersonal, Intercultural Communication. After graduating, she worked in the Colorado State Senate as a legislative aide. During the 2020 session, Marley supported legislation to create a Colorado Public Option, which was finally passed and signed into law in 2021. Working closely with non-profit organizations, like CCHI, on healthcare accessibility and affordability inspired Marley to seek opportunities to become more engaged with healthcare advocacy and policy. Marley is passionate about integrity driven representation, and creative, bipartisan legislation that ensures rural communities are not left behind, and delivers sustainable, accessible, and affordable healthcare solutions. She has previously worked for Governor Polis in the Office of Correspondence, and is currently a campaign coordinator for a congressional campaign, Coloradans for Kerry Donovan. Born and raised in Colorado, Marley is a frequent visitor to the mountains and a novice backyard gardener and innovative home chef.