Message from Wiley Long
President - ColoHealth
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Health Care Reform in Colorado:
What You Need to Know

ColoHealth is Connect for Health Colorado Certified

The Patient Protection and Affordable Care Act, also known as Obamacare, was signed into law March 23, 2010, bringing with it sweeping changes to how health insurance works.  The biggest changes concern who has to carry health insurance, the penalties for not having health insurance, when you can sign up for health insurance, and the specifics regarding how coverage is structured in every policy marketed.

Who Is Required to Have Health Insurance?

The Affordable Care Act requires that most Americans carry health care coverage. If you don’t have ACA-compliant coverage for at least 9 months of the year, you will have to pay a penalty when you pay your taxes. This is known as the “individual mandate.” As part of the ACA, insurance companies must file tax documents for all of their insureds, which are these are sent to you at the beginning of the year. These documents must be filed with your taxes in order to prove that you have coverage.

The federal government calculates the penalty for not having coverage in two different ways, and you are required to pay the amount that’s higher of the two. The first method calculates the penalty as 2.5% of your total household income. Only the amount of your income that is above the minimum tax-filing threshold is used to calculate the penalty. The maximum penalty using this method is the national average premium for a bronze level plan.

The second method involves multiplying the number of family members in your household by a fixed amount per person. The amount is $695 per adult and half of that ($347.50) per child under 18. If this method is used, the maximum penalty per family is $2,085.

Who Is Exempt?

You may be exempt from tax penalty if:

  • The lowest-priced plan in your area would cost more than 8.05% percent of your household income.
  • You don’t earn enough to have to file taxes.
  • You live in a state that did not expand its Medicaid services, but you would have qualified for Medicaid if it had.
  • You are a member of a federally recognized tribe, or you qualify to get health services from an Indian health services provider.
  • You belong to a recognized health care sharing ministry. (We recommend Altrua Healthshare.) 
  • You belong to a recognized religious sect with religious objections to insurance, including Social Security and Medicare.
  • You are incarcerated.
  • You are not a legal U.S. citizen, or you are a U.S. citizen living abroad.

Hardship Exemptions

Hardship exemptions are available to those who qualify, and you can qualify based on a variety of reasons including loss of an immediate family member, you are a domestic violence victim, you are homeless, and many more.

Download the hardship exemption application and see the full list of exemptions, and don’t forget to include your supporting documentation.

When Do I Need to Sign Up?

Perhaps the biggest change to health insurance under the ACA is that plans are all guaranteed-issue. This means that you cannot be turned down for coverage due to any health problems that you have. The consequences of this are that there is only one time during the year that most people can sign up for a new plan is during the Open Enrollment Period, which starts on November 1 and ends on January 31.

If you currently have coverage, the OEP is the only time you can switch to a different plan. And if you want your new coverage to start at the beginning of the year, you’ll need to have your application submitted no later than December 15.

If you have a grandfathered plan that is still in effect, you may want to keep it.  Keep in mind that once you drop your grandfathered plan, you won’t be able to get it back.  So, compare benefits and premiums carefully. If you qualify for premium assistance, you can probably save money by switching to a new health plan for 2017.

Some carriers in Colorado are cancelling grandmothered plans. If your plan was one of these you will have to get new coverage for 2017 during the OEP.

If you are joining a healthshare plan, you can do that any time of the year.


What About the Colorado Health Insurance Exchange?

Colorado operates its own health insurance exchange called the Connect for Health Colorado marketplace. If you expect to qualify for a premium tax credit to help pay for your premium, you must apply for a qualified health plan on the marketplace. You can only get a premium tax credit for plans sold on the exchange – either as an advance tax credit based on your estimated income, or as a later reimbursement at the end of the year when you file your tax return.

ColoHealth Personal Benefits Consultants (PBCs) are certified agents on the marketplace, and can help you choose the best plan option and guide you through the process of subsidy application.

The “navigators” who work for the marketplace have about 30 hours of required training and incur no criminal background check prior to handling your personal and financial information. It is essential that you enlist the help of a licensed, experienced independent Personal Benefits Consultant like those at ColoHealth to complete the application process and service your policy moving forward. There is never a charge for this service.

Starting November 1, 2017, you can enroll for ACA-qualified health plans on Connect for Health Colorado. Individual insurance carriers also sell ACA-qualified health plans off the exchange, and may offer you different deadlines.

Keep in mind, ColoHealth can help you with a wide array of health plan options—both on and off the marketplace. Visit our Connect for Health Colorado How-To page for more.

What Is an ACA-Qualified Plan?

ACA-qualified plans consist of four basic “metal” plans along with a catastrophic health plan for those 30 years old and younger. ACA-qualified plans must include defined Essential Benefits, including a lengthy list of preventive services. Plans will vary in actuarial value. This means that the insurance company must structure the plans at each level to pay a specific percentage of the insured’s total healthcare costs. Bronze level plans pay 60%, silver plans pay 70%, gold plans pay 80%, and platinum plans pay 90%.

Insurance carriers must have their health insurance plans approved by the exchange board as a "qualified health plan." A qualified health plan must include the 10 Essential Benefits as mandated by the ACA.

These plans are more comprehensive than virtually all existing plans, since they must accept anyone with pre-existing conditions and offer an expansive list of preventive services. This is good for those who have been unable to obtain health insurance or preventive services, but will drive the cost up for everyone.

Which Insurance Carriers Offer Plans in Colorado?

In Colorado, the following carriers offer plans:

  • Anthem BCBS
  • Bright Health Plans
  • Cigna
  • Colorado Choice
  • Denver Health
  • Freedom Life Insurance
  • Kaiser Foundation
  • National Foundation Life
  • Rocky Mountain HMO

Many of our clients are also considering faith-based sharing plans as an alternative to signing up for a health insurance plan. More information is available here:

In Colorado, 15 carriers will be offering plans that qualify for tax credits. Additional plans will be available to people who do not qualify for a tax credit. Across these 15 companies are approximately 176 individual and family plans,plus 120 small group employer plans.  These are  the plans that qualify for tax credits:

  • All Savers Insurance Company (UnitedHealthcare)
  • Anthem Blue Cross and Blue Shield (HMO Colorado, Inc.)
  • Bestlife
  • Cigna Health and Life Insurance Company
  • Colorado Choice Health Plans
  • Denver Health
  • Humana
  • Kaiser Foundation Health Plan of Colorado/Kaiser Permanente
  • New Health Ventures
  • Rocky Mountain Health Plans

What is a Qualified Health Plan?

Insurance carriers must have their health insurance plans approved by the exchange board as a "qualified health plan." A qualified health plan must include the 10 Essential Benefits as mandated by the ACA.

These plans are more comprehensive than virtually all existing plans, since they must accept anyone with pre-existing conditions and offer an expansive list of preventive services. This is good for those who have been unable to obtain health insurance or preventive services, but will drive the cost up for everyone.

Do I Have to Buy My Insurance on the Exchange?

No, you don’t.  ColoHealth offers you options both on and off the exchange, including short-term plans that are a great alternative if your health plan has been canceled and you cannot find an affordable ACA-qualified plan to replace it.

Your ColoHealth Personal Benefits Consultant can help you determine your eligibility for tax credits, and even show you how to lower your taxable income with a health savings account.  We can walk you through the application process to find the best combination of plans and savings for you, from plans available both on and off the exchange.

How to Lower Costs, Get Tax Credits, and Save for Retirement

We believe that our role is to help you keep more of your money in your pocket, and to make the process of choosing a new health care plan easy. You should be able to take every tax deduction and tax credit for which you qualify, and you should be able to shop and choose the plan with the best value for you.

For many people, we recommend combining a high-deductible HSA-eligible bronze plan with a health savings account to lower taxable income and possibly qualify for tax credits on your insurance premiums. The HSA funds can be used for expenses such as copayments and unexpected health issues. You can also roll over any unused savings from year to year to build a retirement fund.

You may also want to consider a healthshare plan, especially if you don't qualify for tax credits to help you pay your health insurance premium. These plans are only available to those in good health and they do have other requirements, but the costs are typically less than half that of the health insurance plans now available in Colorado. 

Once you establish coverage with us, you will receive our Annual Comprehensive Policy Review every year so we can be sure you are staying with the plan that offers the best value for your needs.

What if I Miss Open Enrollment?

There are accessible options for coverage outside of open enrollment. You can read here about who qualifies for Special Enrollment Periods. If you don’t qualify for a Special Enrollment Period, you can get short term health insurance coverage, which will make sure that you’re protected if you have a major illness or accident.

You can join a healthshare plan any time of the year, as long as you qualify.

Call your ColoHealth Personal Benefits Consultant today at (800) 913-6381 or send an email to info@ColoHealth.com. There is never a charge for our services or advice.