Note: This story was originally written for the 2019-2020 regular open-enrollment period. But its tips work just as well for any time you are trying to buy health insurance without help from your employer.
We’re going to take a guess here and say that if you clicked on that headline, you’re probably scrambling a bit right now to find health coverage for next year.
And, frankly, you’ve got good reason to be a little panicked. If you’re in Colorado and buy insurance on your own — meaning, without help from your employer — you have until the end of the day on Sunday, Dec. 15, to buy a plan that will kick in on Jan. 1.
Miss that deadline and you can still buy coverage for next year, but that plan won’t start until Feb. 1, leaving you with a month-long gap. (And, if you just let your existing plan renew automatically, you could find yourself paying more in premiums.)
But, you’re also in good company. A lot of people are still shopping for plans. Brokers report being inundated with last-minute calls.
Nearly 42,000 people signed up for coverage in November through the state’s insurance exchange, Connect for Health Colorado. That’s fewer than the 46,000 who signed up during the first month of open enrollment last year. But here’s the real kicker: Last year, more than 156,000 people ended up buying a plan on the exchange that started Jan. 1 — meaning 70% of people bought their plan at least relatively last-minute.
So, pretty much everybody procrastinates. And this is the guide for you. (But, even if you get insurance through work, some of these expert tips will come in handy when picking your plan.)
Here’s The Colorado Sun’s definitive explanation of how to shop for a plan quickly and when to know you’re in over your head and need to seek help from an expert.
Learn the basics
First, let’s start with some definitions. There are five basic concepts that are important in shopping for a plan: premium, deductible, out-of-pocket maximum, metal tier and benefits.
Premium: This is the monthly payment that you make to have insurance.
Deductible: In addition to your premiums, this is the amount of your health bills you have to pay before your insurance really starts covering stuff. People sometimes say the deductible is what you have to pay to use your insurance, but that’s really not true. All real-deal insurance plans sold in Colorado pick up costs for some preventative services — like flu shots or annual physicals — before you hit your deductible.
Out-of-pocket maximum: This, plus the cost of your premiums, is the most you could possibly pay in a year under your plan — as long as you stay within all the coverage limitations and doctors’ networks.
Metal tier: Just like at the Olympics, there’s a hierarchy for insurance plans: gold, silver and bronze. Gold plans are often thought of as the most “expensive” plans and bronze plans are the “cheapest.” But, as you’ll see, those descriptions aren’t as significant as they seem.
Benefits: The good stuff. This is what your plan does for you.
If you need help understanding more complicated insurance terms — Aggregate family deductible? Cost-sharing reductions? — Connect for Health Colorado has useful a glossary.
Get to shopping
So how do you find a health insurance plan?
You could always talk directly to insurance companies and buy from one of them. But that’s expert-level shopping. For most people, the best options are either to go online to the Connect for Health Colorado exchange or to buy through a broker.
Brokers are exactly what they sound like — they’re people who help you to find the right plan. In most cases, they get paid commissions by the insurance companies, so there’s no cost to you, though be sure to ask them about their commission structures. (And Kaiser Permanente doesn’t pay commissions, so most brokers will probably charge you a fee if you want a Kaiser plan.)
If you’re thinking of using a broker, book an appointment now. Most are booked solid with clients this close to the deadline.
The other option is to go on Connect for Health Colorado, which is sort of like an online mall for insurance plans.
Most significantly here, Connect for Health has a plan-finder tool that will help you pick and compare plans. (More on that below.) And, just to note: Connect for Health says the tool is anonymous. Although it asks you for a name when you get started, Connect spokeswoman Monica Caballeros joked, “You can be Daffy Duck.”
Know your needs
Buying health insurance isn’t all about price. You need to know that your plan will cover what you need it to.
Do you want to keep the doctor you have now? Then that narrows down your choices; you need to make sure your doctor is included in the provider network of whatever insurance you pick. (And you should check with your doctor to make sure they don’t plan any changes for 2020.)
Do you regularly take medications for which you need a prescription? Better see which of your options covers it — and at what price.
This is pretty obvious stuff, but they’re also the first questions a broker or Connect for Health is going to ask you. So make a list of your doctors and medications first.
Check your income
Before you dive headlong into buying private health coverage, just double-check that you need it.
As one of the states that expanded Medicaid with the Affordable Care Act, Colorado’s Medicaid program covers some people who are above the federal poverty line. And Colorado’s Child Health Plan Plus covers kids in families with incomes more than double the federal poverty level. (See here for more on CHP+ eligibility.)
“If you’re eligible for those programs, that should be your first option,” said Richard Rush, a local health care consultant.Even if you don’t qualify for government coverage and, thus, you need to buy private insurance, you might still be eligible for government help in paying your premiums. Connect for Health has this handy graphic showing the income limits for subsidies:
Connect for Health makes it easy to check if you qualify for any financial assistance by asking you about it upfront. In the plan-finder tool, the question is a little vague and looks like this:
Just be sure to click “Yes” and answer the income questions honestly, since the Internal Revenue Service tracks the subsidies you receive and you could be on the hook for paying back subsidies you weren’t actually eligible for. One other note: Connect for Health is the only place where you can buy subsidized plans, so if you’re eligible for a subsidy, shop there.
Compare your options
OK, now we’re finally getting down to business.
If you’re talking with a broker, they will walk you through your choices at this point. That’s why you’re working with them.
“That broker is going to save them money and time,” said Brad Niederman, a broker who is on the board of the Colorado State Association of Health Underwriters. “This stuff is clear as mud.”
If you’re shopping on Connect for Health, though, let’s do a little tutorial on the plan finder.
Use the plan finder
So, the plan finder asks your gender, date of birth and where you live. Your sex can’t be used to charge you more, but your age and county of residence can. It will ask you the income questions. It will also ask you questions about which medications you take and which doctors you want to make sure are included in your new plan’s network. And it will ask you to estimate your annual health care usage — low, medium or high — which is important for coming up with an all-in number for your annual coverage cost.
Then it will spit out a list of options and prices that looks like this:
When people talk about health insurance prices, they’re often talking about premiums. But don’t get too focused on those numbers on the far left side. The numbers you really want to be looking at are the yearly cost estimates, which roll premium, deductible and other out-of-pocket costs into one.
The plan finder lets you sort based on that:
The tool also allows you to compare plans side-by-side. Click the check boxes on the far right side for the plans you want to compare, and then at the top of the page click the “Compare plans” button. In this view, you will be able to compare not only costs but also deeper details of the plans, such as what (or whether) they charge office visit copays:
Think like an actuary
As you can see, one of the most important things in picking a health insurance plan is knowing how — and how much — you’re going to use it. And, to determine that, it helps to think like an actuary.
Actuaries, the supersmart numbers people who help insurance companies figure out how much to charge, make predictions about future costs based on past experience. You can do the same thing by looking over your previous years’ health spending to come up with a good idea of what you’re going to spend in the coming year. (And, then, that informs whether you select low, medium or high for health care use in the Connect for Health plan finder.)
“If someone in the family has been to the ER every year for the past five or six years,” said Rush, who is himself an actuary, “you might want to think that the past predicts the future.”
There’s another consideration here, too. Rush said consumers need to understand where in their household finances they can most afford to pay for health costs.
If you have a robust savings account, you might be more inclined to choose a bronze plan — which typically features lower premiums but higher deductibles. If you have a healthy year, you might save money. And if you end up with an unexpected $5,000 medical bill, you can afford to pay it.
But, if your savings account is a little slim, a gold plan with higher premiums but lower deductibles might actually be better for you. You’ll have more taken out of your paycheck every month, but you’ll have less risk of getting hit with a big medical bill you can’t pay.
Be smart about silver
For some consumers, those mid-level silver plans can strike the perfect Goldilocks balance — not too pricey on premiums, not too steep on deductibles. But just a note of caution about them.
Last year, Colorado health insurance regulators pulled off something of a judo move on health coverage prices. The mechanics of it are fairly complicated, but the gist is that they heaped costs onto silver-level plans sold on Connect for Health in order to increase the subsidies that help some people pay for their premiums. It worked really well.
But there’s a side effect: Silver plans sold on Connect for Health are expensive for people who don’t get subsidies. The workaround, if you want a silver plan but don’t receive subsidies, is to buy a silver plan “off-exchange,” meaning through a broker or directly from a company. Those off-exchange plans are similar to the ones sold on Connect for Health but don’t cost as much.
Niederman said it’s important to be aware of this information because it might not be apparent when shopping just on Connect for Health.
“People aren’t going to know if there’s a lower cost plan off-exchange,” he said.
Dive in deep
All of these tips so far are probably enough if you have fairly run-of-the-mill health needs. But what if you need something really specific covered?
Then you need to dig into the plan documents. And that can be hard.
Niederman said people needing precise details should look for a plan’s official summary of benefits and coverage, or SBC. These are available directly from insurance companies or through Connect for Health’s website, with a little snooping.
To see a plan’s SBC via the Connect for Health plan finder, click on the “View plan” button:
Then, click on the link for “Summary of benefits and coverage.” This will download a multi-page PDF document with more details about the plan:
But, be warned: SBCs can be both wildly dense and maddeningly sparse. The level of detail can be hard to understand. But, on the flip side, they may not tell you all the information you are looking for.
Seek outside help
If you’ve gone so far as to look at the SBC and still can’t be sure if a plan will cover what you need it to — or if you’re having trouble navigating the Connect for Health website — it’s time to get help.
Connect for Health has a customer service center, and there are a number of events this week to help people get signed up for coverage. The exchange also has a network of certified “assisters” — people who are not brokers but are trained in helping consumers find coverage and other resources.
But, if your health needs are really complex, a broker might be your best bet. Brokers are used to talking directly with insurance companies, finding out what a plan covers and what it doesn’t, and then coming up with customized solutions for clients.
“There are a lot of intricacies that come into play on strategizing what is the best plan for them to keep money in their pocket,” said Niederman, who works with a number of clients with complex medical issues.
Don’t do this again
OK, yeah, this one is obvious. But shopping for health insurance last-minute is … not the best thing to do. The Connect for Health customer service center is slammed. Brokers are booking appointments late into the evening. The looming deadline makes everything stressful.
“My first piece of advice,” Niederman said, “is don’t put yourself in this situation next year.”
(But, just in case you forget and find yourself scrambling again in 2020, bookmark this guide to keep its tips handy.)