Colorado Healthcare: Public Vs Private Insurance Preferences

Colorado has a variety of public and private health insurance options for its residents. On the public side, there is Health First Colorado, the state's Medicaid program, which is funded by both the federal government and the state government. Colorado also offers Child Health Plan Plus (CHP+), a low-cost public health insurance program for certain children, pregnant women, and newborns. Additionally, the state has a separate platform for undocumented residents to enroll in state-subsidized health coverage. On the private side, residents can shop for health insurance plans through Connect for Health Colorado, the state's health insurance marketplace. They can also purchase insurance directly from private companies or brokers, with plans reviewed by the Colorado Division of Insurance to ensure they meet healthcare reform requirements.

Public vs. private healthcare insurance

In Colorado, there are a variety of public and private healthcare insurance options available to residents. On the public side, the state offers Health First Colorado, which is Colorado's Medicaid program. Health First Colorado is a public health insurance program for qualifying residents, jointly funded by the federal government and the state government. It provides coverage for a wide range of services, including doctor visits, hospital stays, emergency care, prescription drugs, dental services, mental health services, and more. Enrollment for Health First Colorado is open year-round.

Another public option is Child Health Plan Plus (CHP+), a low-cost health insurance program for uninsured Colorado children under the age of 18 whose families earn too much to qualify for Medicaid but cannot afford private insurance. CHP+ also offers benefits to pregnant women and newborns, with a prenatal care program that provides free health insurance to pregnant women who meet certain income requirements.

In addition to these public programs, Colorado has created its own state-run health insurance exchange called Connect for Health Colorado. This platform allows residents to shop for individual and family health plans offered by private insurance carriers. Connect for Health Colorado also helps residents determine their eligibility for financial assistance and enroll in coverage. During the open enrollment period, residents can explore different plans, compare prices, and make informed decisions about their healthcare options. It is important to note that Connect for Health Colorado is not limited to private plans, and individuals can also use it to enroll in public programs like Health First Colorado.

When it comes to private healthcare insurance in Colorado, individuals can purchase insurance directly from private companies or brokers. These plans can vary in terms of coverage and cost, and it is essential for individuals to carefully review the options available in their geographic region. Private insurance may be obtained through employer-based plans, where the employer often contributes to the premium, or through individual plans purchased directly by the resident.

In summary, Colorado offers a mix of public and private healthcare insurance options to meet the diverse needs of its residents. Public programs like Health First Colorado and CHP+ provide essential coverage for those who qualify, while Connect for Health Colorado offers a centralized platform for residents to explore both private and public insurance options and access financial assistance if needed. Additionally, private insurance plans offer an alternative for those who prefer or require coverage beyond what the public programs provide.

Colorado's Medicaid program

Health First Colorado covers a range of services, including doctor visits, hospital stays, emergency room and urgent care, prescription drugs, dental services, behavioral and mental health services, x-rays and blood work, well-child visits, maternity care, and newborn care.

The program has been designed to help more people access the insurance they need. For instance, more adults without children and parents may now qualify for free or low-cost coverage. Additionally, children who are adopted from foster care may qualify for Health First Colorado.

Health First Colorado also offers a mobile app that allows users to check their coverage status, find their renewal date, complete their renewal, learn about their benefits, update their information, and view their member ID card.

Connect for Health Colorado

Colorado residents can also use Connect for Health Colorado to enrol in Health First Colorado, the state's Medicaid program. Health First Colorado is a public health insurance program for qualifying Colorado residents, funded jointly by the federal and state governments. It covers a range of services, including doctor visits, hospital stays, emergency care, prescription drugs, dental services, and mental health services.

The platform also offers a state-wide network of certified experts who can provide help with completing the application process.

Employer-based insurance

Colorado residents can get health insurance through their employer, as part of a package of benefits that can include other insurance and services. The employer may pay part or all of the premiums. This type of insurance can be large-group insurance (100 or more employees) or small-group insurance (99 or fewer employees). Employees will typically choose from insurance plans selected by the employer.

If you are an employee, the spouse of an employee, or a dependent child of the employee (if the dependent is under the age of 26), you may be eligible for an employer's health insurance plan. In this case, contact the employer's human resources or personnel department as soon as possible. Be aware that employer plans can set time limits for joining after a person loses other coverage (such as Medicaid, CHP+, or another employer's coverage), so check with the employer for the specific time limits and rules.

If you lose your employer-based health insurance, you are eligible for a 60-day period in which you can enroll in an individual plan, even if it is outside of the annual open enrollment period of November 1 to January 15.

In Colorado, all employers with 50 or more full-time employees are required to offer some form of health insurance benefit. Once a company reaches 50 employees, it is considered a large employer and may face penalties if it does not offer health insurance. All Colorado businesses with fewer than 50 full-time employees are not required to provide health benefits to employees.

Small businesses in Colorado have various types of small business health insurance options, including SHOP Marketplace plans, traditional group health insurance plans, Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Exclusive Provider Organization (EPO) plans, High Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs), and Catastrophic Health Insurance Plans. These options offer a range of coverage levels, provider networks, and cost structures, allowing employers to tailor health benefits to their employees' needs and financial considerations. Consulting with a licensed insurance broker or agent can aid in navigating these options and selecting the most suitable plan for the business and its workforce.

Individual insurance

Individual health insurance is purchased by an individual for single-person coverage or family coverage. The individual pays the premium, unlike employer-based health insurance, where the employer often contributes. Individuals can shop for and purchase insurance from any plans available in their geographic region.

In Colorado, plans can be purchased through Connect for Health Colorado, the state's health insurance marketplace, through an insurance agent or broker, or directly from an insurance company. Connect for Health Colorado is the only place where individuals can apply for financial help to lower the cost of private health insurance. This financial help is called a Premium Tax Credit. The cost of individual insurance plans varies depending on the individual's age, location, and income. For example, a 25-year-old single person in Denver with an annual income of $35,000 could expect to pay a monthly premium of around $100-$126 in 2024. On the other hand, a 50-year-old single person in Alamosa County with an annual income of $50,000 could pay a monthly premium of around $261-$318.

Individuals and families may qualify for financial assistance to lower the cost of insurance premiums and out-of-pocket expenses, but only when enrolling through Connect for Health Colorado. This financial assistance can be especially helpful for those who do not have access to affordable employer-sponsored health coverage. To be eligible for this assistance, individuals must meet certain criteria, such as not having coverage through their employer, not being eligible for government plans like Medicaid, and filing a joint tax return if married.

Additionally, if an individual experiences certain life changes, such as losing their employer's health insurance, getting married, or having a baby, they are eligible for a 60-day period to enroll in an individual plan outside of the annual open enrollment period.

Frequently asked questions