During this Special Enrollment Period, take the time to find out what assistance is available.
The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), is reminding Coloradans about the Special Enrollment Period for individual health insurance. This enrollment period lasts until May 15, and is an opportunity for people to enroll in insurance outside of the annual open enrollment period that takes place in the fall.
The particular aim of this period is to help people who don’t have insurance due to the COVID-19 global pandemic, although anyone without health coverage can enroll. If you weren’t able to enroll last year, but still need health insurance, now is the time.
Making Insurance Affordable
Income-based financial assistance is available to many - assistance that can significantly reduce monthly premiums. In fact, 70% of people who apply for financial help through the state’s exchange, Connect for Health Colorado, receive it. But financial assistance for health insurance costs is only available when enrolling through Connect for Health Colorado.
In addition, many people also qualify for assistance that goes beyond the monthly premiums. Such help lowers the amount paid when receiving care, reducing out-of-pocket costs such as copays, deductibles and coinsurance and even the out-of-pocket maximums for plans. This assistance is called Cost Sharing Reductions, or CSRs.
“We’ve found that it’s still a well-kept secret that most people who buy coverage through Connect for Health, the state exchange, don’t pay the sticker price,” said Bethany Pray, Legal Director of the Colorado Center on Law and Policy. “Many pay under $50 a month in premiums. For middle-class households, like the family of four that makes under $66,000, the purchase of a mid-range silver plan comes with both lower premiums and smaller deductibles and copays. That’s what makes it so worthwhile to find out what you qualify for. But regardless of price, these plans come with great perks, including free preventive services like well visits and mammograms, and even some medications with $0 copays.”
“Bethany is absolutely right,” said Colorado Insurance Commissioner Michael Conway. “And what’s even better, Connect for Health Colorado has an easy to use tool to help you find those plans. If you’re without health insurance right now, I encourage you to not only shop for plans available on Connect for Health Colorado, but to use their Quick Cost & Plan Finder to determine what kind of financial help you could qualify for. It’s a free tool that takes into account your age, region and income to give you an estimate. You can then look at the available insurance plans armed with more information to help you choose."
In the same way that assistance with premiums is only available when enrolling through Connect for Health Colorado, CSRs are only available when choosing silver plans when enrolling through Connect. Silver plans are the middle range of Affordable Care Act (ACA) plans, which are divided into “metal” rankings - bronze, silver and gold. The ranking depends on how much the plan, on average, will pay for medical costs. A silver plan pays 70% of the medical care costs.
What income levels qualify for lower monthly premiums and CSRs?
Household size Qualify for CSRs with income up to:
How does this translate into savings?
- A single 30-year-old living in Arvada with an annual income of $30,000, would be eligible for a reduction in premiums of $102 per month, meaning this person could find silver plans starting at $191 per month. This person would also qualify for CSRs that would bring down the annual deductible by hundreds of dollars and in some cases, well over $1,000.
- A couple living in Pueblo, one 42 and the other 45, with an annual household income of $50,000, would qualify for a premium reduction of $562 per month, allowing this couple to find silver plans starting at $227 per month. They would also be eligible for CSRs that would, in most cases, bring their deductible down over $1,000 and for some plans, reduce the deductible over $2,000.
- A family of four, ages 55, 55, 22 and 19, living in Grand Junction with an annual household income of $60,000 would be eligible for premium savings of $1,449 per month, and the family could get silver plans starting at $314 per month. The family would qualify for CSRs that could bring down their deductible by as much as $2,600.
These are real examples of the financial assistance available, but everyone’s particular situation will be different. The amount of financial help you can receive is based on your specific situation, including age, family size, where you live and your estimated annual income.
It is important to know that not everyone who meets the income requirements can get this assistance. People eligible for health insurance from an employer or a spouse’s employer, or are eligible for a government program like Medicare, Medicaid (Health First Colorado), Tricare or the Children’s Health Insurance Program (CHIP), cannot receive this financial assistance.
Importance of Health Insurance
Even though considerable assistance is available to many that can make health insurance more affordable, many people will still go without. But that’s a big risk because we never know when an accident or unexpected illness will strike. On top of that, COVID-19 is still a very real health threat.
How To Enroll
People can enroll using Connect for Health Colorado or by contacting the insurance company directly. However, Connect for Health Colorado is still the only place where Coloradans can receive financial assistance to make insurance more affordable. To verify eligibility for this Special Enrollment Period, individuals have to verbally attest that they are currently not enrolled in ACA-compliant health insurance. Insurance companies cannot require additional verification or written documentation.
Colorado individual health insurance consumers who wish to use Connect for Health Colorado can enroll online at ConnectforHealthCO.com, can get help and/or enroll over the phone at 855-752-6749, or they can get free, virtual enrollment assistance from certified brokers and assisters.
About the Division of Insurance:
The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), regulates the insurance industry and assists consumers and other stakeholders with insurance issues. Visit doi.colorado.gov for more information or call 303-894-7499 / toll free 800-930-3745.
DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado. Consumer protection is our mission. Visit dora.colorado.gov for more information or call 303-894-7855 / toll free 800-886-7675.