There’s no upside to searching for a Colorado health insurance policy on your own. The price for health insurance is the same whether you use a broker or not. We can help you find the right plan, either through the exchange (Connect for Health Colorado), or you can choose from one of the carriers offering ACA-compliant plans outside the exchange. We’ve been working with health insurance in Colorado since 2002.
A lot has changed in Colorado’s individual health insurance market in the past few years. Most importantly, the ACA has reformed the market and added numerous consumer protections. That legislation changed everything about the way people shop for health insurance. All health insurance in Colorado covers in-network mandated preventive/wellness care before the deductible and pediatric dental insurance, even on high deductible HSA health insurance plans.
As a result, open enrollment is a big part of the equation now. Consequently, individual health insurance now mirrors group coverage in that it’s only available during an annual open enrollment window. After open enrollment, you’ll only be able to get an individual plan if you have a qualifying event. Examples include loss of coverage, birth, marriage, etc.
Most importantly, applications are limited to the open enrollment period because all major medical policies are now guaranteed issue. Your medical history doesn’t determine eligibility. As a result, pre-existing conditions are no longer a barrier to enrollment. That’s great news for anyone who has struggled to get a plan on their own. These changes are helping to encourage entrepreneurs to follow their dreams. Now they know they can obtain health insurance in the individual market regardless of their medical history.
Qualifying for Subsidies or Tax Credits
Based on your income, you may qualify for advanced premium tax credits (otherwise known as subsidies). The government pays tax credits directly to the insurance company. As a result, you’ll reduce the amount you have to pay in premiums each month. As a result of the American Rescue Plan and Inflation Reduction Act, there is no income cap for subsidy eligibility through the end of 2025.
If the benchmark plan (second-lowest-cost silver plan) would cost more than 8.5% of your household income, you can qualify for a subsidy, regardless of how high your income is. Medicaid is available to adults under age 65 in Colorado with household income up to 138% of the poverty level (in 2023, that amounts to $20,120 in annual income for a single adult). Above that income, subsidies are available to offset the cost of private coverage, until income reaches a level at which the full-price cost of the benchmark plan is no more than 8.5% of income.
Family Glitch has been fixed
To qualify for a premium tax credit, you can’t have access to affordable, comprehensive employer-sponsored coverage. Through 2022, the affordability determination for a whole family was based on just the employee’s cost for employer-sponsored coverage, regardless of the cost to add family members to the plan. This was known as the “family glitch.”
Fortunately, the IRS finalized a fix for the family glitch that took effect in 2023. Under the new rules, the exchange will conduct two separate affordability determinations if your family has access to an employer-sponsored plan: One for the employee, and one for the entire family. If the employee’s coverage is considered affordable but the family’s is not, the family members are potentially eligible for a subsidy through the exchange. We can help you understand how it works and how it might relate to your situation.
We focus on staying current on the evolving reform process. Our goal is to provide you with accurate information and up-to-date advice. Please let us know if we can help you find the best coverage for your needs.
Small business group health insurance offers wider network options like PPO, which is not available in the individual market. Employees will typically place more of a value on the benefits an employer provides versus how much they actually cost the employer. That’s because certain benefits (like PPO networks or dental coverage with no waiting period) will only be available on the group health insurance plan, but not through the individual market.
Reimburse Employees for Individual Health Insurance Coverage
Small group health insurance in Colorado can be pricier than purchasing coverage through the individual/family market. The solution is an Individual Coverage Health Reimbursement Arrangement (ICHRA). If you’re an employer who would like to learn more about reimbursing your employees for their private health insurance plans, contact us now.
Hedge Your High Deductible Health Insurance Plan with an Accident Supplement
If you’re healthy, it can be smart to save money with a high-deductible health insurance plan, especially an HSA-qualified plan. If that’s you, and you think you’re more likely to need your health insurance for an accident or injury, check out an accident supplement.
There’s no upside to searching for a Colorado health insurance policy on your own. The price for health insurance is the same whether you use a broker or not. We can help you find the right plan, either through the exchange (Connect for Health Colorado), or you can choose from one of the carriers offering ACA-compliant plans outside the exchange. We’ve been working with health insurance in Colorado since 2002.
