While it may be the time of year when your home decorations change from turkeys to Santa Clauses, on the health care calendar it is open enrollment season. And that means it is time, once again, for many people in the state to figure out how to buy a health insurance plan.
But don’t fret. We at The Colorado Sun have assembled a massive catalog of tips and resources you can use to find the health care coverage that is right for you. Feel free to scroll through this guide to find the answers you’re looking for or bookmark it for later.
Have a question that we didn’t cover? Email me at firstname.lastname@example.org, and I will try to help you find an answer.
Happy shopping and best of luck.
What’s the deadline for making a decision?
In the individual market, open enrollment lasts until Jan. 15. But, if you want a plan with benefits that kick in on Jan. 1, you must make a choice by Dec. 15.
What is open enrollment?
Open enrollment is the period of the year when you can change health insurance plans. For most people, it comes around only once per year.
If you are covered by an insurance plan through your work, your company sets the open enrollment period. (For state employees, for instance, open enrollment is tied to the end of the fiscal year in June.) For people who buy insurance on their own, open enrollment always lands at the end of the year, as it does for people looking for Medicare Advantage plans.
Where can I go with questions on Medicare?
The State Health Insurance Assistance Program is a federally funded nationwide network of organizations that can help people with questions on accessing and using Medicare. In Colorado, there are SHIP programs in each county. You can find your county’s program, along with a phone number, in this list right here.
The state Division of Insurance also provides some links and tips about Medicare on its website.
I know nothing about health insurance. Where should I start?
First, you need to know what market you’re shopping in.
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Are you covered by your employers’ health care plan? Look for info from human resources or your benefits provider about your options.
Are you shopping on your own? Then you’re in what’s called the “individual market.” That means you will either be shopping on Connect for Health Colorado or using a broker. Connect for Health is the state’s insurance exchange — think of it like an online shopping platform, Amazon for health insurance plans.
A few years ago, we created a guide for buying a health insurance plan in Colorado. It applies most to people shopping in the individual market and contains tips for navigating Connect for Health. But it also offers some advice from an actuary and a broker on how to gauge what kind of coverage you need, regardless of what market you’re shopping in.
If the language of the insurance world — deductible, copayment, subsidy — is foreign to you, Connect for Health has a handy glossary that provides some definitions. (The glossary is also available in Spanish.)
Is there anything new this year?
If you’re in the individual market, this is the first year you will be able to select a Colorado Option health plan. Colorado Option plans are sold by each insurance company — so Kaiser Permanente has Colorado Option plans, Anthem has Colorado Option plans and so on. But those plans are built on a standard benefit design created by the state government.
The hope is that the Colorado Option will make it easier for people to compare plans. You know what benefits you’re getting, so it’s a matter of choosing a plan at the right price and with the right network of doctors and other medical providers.
“There are more services that are covered with no cost upfront,” said Adam Fox, the deputy director of the Colorado Consumer Health Initiative, which supported the creation of the Colorado Option. “So particularly routine primary care, behavioral health care, pre- and post-pregnancy care, those services are covered with no additional copay, no cost share.”
But there’s a catch with the Colorado Option plans. While they are supposed to also be priced lower than typical plans, they are most often not the cheapest in terms of premium price. So they may not be the best or most affordable option depending on your particular needs.
I heard about OmniSalud. What is that?
OmniSalud is the other thing that’s new this year. It’s a health insurance program designed specifically for people who are unable to access insurance subsidies because of their immigration status.
Under OmniSalud, it’s the state providing the funding for the subsidies. The money comes from a fee on health insurance premiums, which in turn funds the Colorado Health Insurance Affordability Enterprise, which provides the subsidies.
OmniSalud plans aren’t sold on the usual Connect for Health Colorado insurance exchange. Instead, they are sold on a new exchange called Colorado Connect, though the signup process starts on Connect for Health. The separation means that no information entered on Colorado Connect is shared with the federal government.
What are some tips for picking the right plan?
The Colorado Sun hosted a virtual panel discussion on this topic featuring Fox, from CCHI, Connect for Health CEO Kevin Patterson and state Insurance Commissioner Michael Conway.
If you want to watch the whole thing, you can watch that here:
But here are some quick tips:
Fox recommended not just shopping for the plan with the lowest-price premium. Those plans often have high deductibles, and if you have more than minimal health care needs, buying the lowest-cost plan could mean paying more in the long run.
“What you’re really talking about when you’re comparing health insurance options is comparing your current medical needs versus what you might anticipate in the coming year, and your comfort with risk financially,” Fox said during the panel. “We really try to encourage consumers to think about, yes, it might be a little bit more in premium (price) to purchase a silver level plan or a gold level plan. But those really provide such better protection for people’s finances. If you do have something happen that is significant, it’s really easy to rack up thousands of dollars in medical costs very quickly.”
Conway encouraged people to check on Connect for Health to see whether they are eligible for federal subsidies that help pay the cost of premiums. The federal American Rescue Plan Act expanded those subsidies to people making more money and the Inflation Reduction Act extended those expanded subsidies.
“If you haven’t shopped on Connect for Health Colorado in the last two years, it’s vital that you go on now because of the increased subsidies that were originally part of the American Rescue Plan,” he said.
Patterson said people shouldn’t hesitate to reach out for help when they get stuck.
“It’s a daunting task if you’re not sure what you’re looking for,” Patterson said. “And so we always encourage people that they can seek out a broker, seek out an assister.”
How do I know when to buy on Connect for Health versus using a helper?
Assisters are people who can help guide you through enrollment via Connect for Health. Brokers can do that, too, but they can also help you buy a plan off-exchange if that’s the best option.
Both are generally free for consumers to use — though be sure to ask a broker about any potential fees.
Connect for Health has look-up tools for both brokers and assisters on its website under the menu heading on the far right of the page that says “We Can Help.”
If you are eligible for premium subsidies, Connect for Health is the only place where you can obtain them. Brokers, meanwhile, act like agents to find people the best deal based on their needs — whether that plan is on-exchange or off.
“Our job is always to advocate for our clients,” said Meagan Fearing, the president of the Colorado State Association of Health Underwriters, which is a trade group for brokers. “For those who aren’t using a broker, for heaven sakes find a broker and make sure you are making an educated and informed selection.”
The National Association of Health Underwriters also maintains a search tool for finding member brokers. Just be sure to make an appointment quickly. Like accountants at tax time, brokers get booked up pretty fast during open enrollment.