Consumer Advisory: Division of Insurance Asks Coloradans to be Careful When Shopping for Health Insurance


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With Open Enrollment for 2026 now open, the Division shares tips on how to identify  plans that may not cover the care you need.
 

DENVER - With federal Enhanced Premium Tax Credits (ePTCs) set to expire at the end of the year, Coloradans across the state on the individual healthcare market are facing huge insurance premium increases and will likely shop around for the best available plan. The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), wants you to be informed about the differences between Affordable Care Act (ACA) compliant plans and limited benefit plans while you make decisions about what coverage is best for you and your family.

Plans offered through Colorado’s official marketplace, Connect for Health Colorado, offer comprehensive coverage that meets ACA standards, such as $0 preventative care visits. Limited benefit plans do not meet the requirements of the ACA. These can include short-term plans, limited benefit plans, trade association plans, and discount plans. These types of plans and products are not sold through Connect for Health Colorado and are often sold through unsolicited calls and text messages from brokers who are not affiliated with Connect for Health Colorado.

These plans typically provide low monthly costs but likely do not offer comprehensive coverage and may include exclusions for services covered by ACA plans. An example of an exclusion could be no coverage for pregnancy or delivery services, or no coverage for pre-existing conditions.

“Coloradans and Americans across the country are making difficult decisions about what kind of health insurance they can afford since Congress thus far has refused to extend the tax credits that keep costs down,” said Colorado Insurance Commissioner Michael Conway. “Colorado intervened to save consumers $220 million with the passage of special session bill 1006, and it’s beyond time for Congress to act to extend enhanced premium tax credits so Coloradans don’t have to make these impossible choices.”

Consumers who are deciding between ACA plans and limited benefit plans can review the following chart for some differences.

 

ACA Compliant Plans

Limited Benefit Plans

No restrictions for pre-existing conditions

May limit or exclude coverage regarding treatment for pre-existing conditions 

Prescription drugs included, may be charged based on drug tier

May limit or exclude prescription drug coverage

Hospitalizations covered after deductible

May limit or exclude hospitalization or emergency room coverage

Mental health must be covered at the same level and in the same way as physical health

May limit or exclude mental and behavioral health treatment

Prenatal care coverage included. Delivery coverage may require deductible to be met

May limit or exclude pregnancy related care and delivery

Outpatient and same-day surgery covered after deductible

May limit or exclude outpatient or same-day surgery 

Portion of all in-network medical bills covered after deductible is met

Coverage may be limited to a flat “per occurrence" amount, rather than covering a portion of each medical bill

 

When purchasing any plan, consumers should be sure to work with a trusted broker. Avoid brokers or sales tactics with red flags, including:

  • Aggressive and high-pressure sales tactics from an insurance broker or the company.
  • Reluctance from a broker to tell you their name or what company they represent. 
  • Unclear language around if a plan is ACA compliant or if it is a limited benefit that only meets the “minimum essential coverage requirements of the ACA,” referring to the repealed federal requirement for consumers to have health insurance.
  • The plan directly pays you a set amount for your care, rather than paying a doctor, hospital or other health care provider.

For consumers intending to purchase comprehensive ACA Plans, ask questions to be sure that you get what you’re looking for.  Before buying or signing up, ask for plan details in writing, such as how coverage works when visiting a doctor for tests and follow-up care, how claims are submitted to the plan, how the plan covers pre-existing conditions, how it would cover emergency care, or how the plan might cover a hospital stay that would include labs, surgery and specialists. Know that you have the right to ask questions and get details in writing, and you shouldn’t be pressured into a decision. Never provide banking information or a Social Security number or enroll in a plan before you’ve had a chance to review the materials and get all of your questions answered.

If you purchase a limited benefit plan, it’s important to plan for additional or unexpected costs that may pop up if you need major medical care. Limited benefit plans often exclude certain medical expenses or place a cap on reimbursements, so consumers need to be aware of what is and isn’t included in their policy. Saving what you can for a rainy day can help be sure your health care needs are met.

Congress still has the ability to extend the enhanced premium tax credits to prevent an average doubling of premium costs for 225,000 Coloradans.

If you or a family member need help determining what kind of questions to ask when considering health insurance, or you just want some assistance decoding the language of a health plan, contact the Division of Insurance Consumer Services Team: 303-894-7490 / DORA_Insurance@state.co.us / doi.colorado.gov  (click on “File a Complaint”).

 

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