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.
The Colorado Division of Insurance (DOI) regulates Colorado’s insurance industry, which includes homeowners and renters insurance, auto insurance, life insurance and annuities, and health insurance. The DOI can investigate complaints, help you understand your insurance, and answer your questions. If you believe your rights have been violated, contact the DOI.
Open enrollment is under way, and many of you have enrolled in brand new health coverage plans. Now, you may be looking to your plan documents for information on the benefits, cost-sharing, and coverage limits of your plan.
Don’t give up hope if you find the world of health insurance confusing! You are not alone. Luckily, free professional advice is out there. And, you can always call CCHI with questions at 303-839-1261, or email us at [email protected]
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.
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.
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”.
Do you have any questions or issues with your current health care coverage?
CCHI has created a series of informative videos to provide consumers with the best contacts and resources to help them resolve their issue. You can watch the videos below or view/download our one page overview.
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.
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.