With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Colorado, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Colorado
Colorado placed 8th in United Health Foundation’s 2014 America’s Health Rankings.1 The state’s strengths include low prevalences of obesity, physical inactivity and diabetes; low levels of air pollution; and a low rate of preventable hospitalizations. Colorado’s challenges include a high prevalence of binge drinking, a high rate of drug deaths, and a large disparity in health status by educational attainment.
Colorado Individual and family health insurance
Colorado elected to run its own state-based health insurance exchange starting Oct. 1, 2013. Individuals and families may shop Connect for Health Colorado or buy Obamacare qualified health insurance coverage in the private marketplace through websites such as HealthCare.com.
Those who buy health insurance through Colorado’s exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
The U.S. Department of Health and Human Services reported that 125,402 individuals in Colorado selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Colorado enrolled in a marketplace plan increased to 140,327 during the open enrollment period.3
|Colorado’s health insurance exchange:||connectforhealthco.com|
|Colorado’s department of insurance:||dora.colorado.gov/healthinsurance|
Colorado small group health insurance plans
Small businesses with 50 or fewer employees may purchase small group health insurance plans through the Connect for Health Colorado exchange and in the private marketplace through websites such as such as HealthCare.com. Small businesses that use Colorado’s state-based exchange and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from the state’s exchange.
Colorado state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Colorado’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||Employees of any group policy where COBRA does not apply|
|Maximum continuation period – standard||18 months|
|Maximum premium Increase||See additional notes|
|State legislation reference||Colo. Rev. Stat. Sec. 10-16-108|
|More Information||303-894-7490 or 800-930-3745 — Colorado Division of Insurance|
|Additional notes||Within 10 days of termination, employers must send written notice of right to continue and must inform the employee of the amount he or she must pay monthly to retain coverage; how, where and when payment is to be made; and the fact that loss of coverage will result if timely payment is not made to the employer.Employees must nutty the employer in writing of their intent to continue coverage and submit payment to the employer within 30 days of termination.|
Colorado high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated. 5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Colorado expanded its Medicaid program in 2014.7 Medicaid/CHIP open enrollment takes place year-round.
The information below is specific to Colorado’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Colorado Department of Health Care Policy & Financing|
|How to apply online||coloradopeak.secure.force.com|
|Phone number||800-221-3943/TTD 800-659-2656|
|Additional application options||colorado.gov/pacific/hcpf/colorado-medicaid|
|Open-enrollment period||Year-round in all states|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Colorado’s health insurance program for low-income children:
|Program name||Child Health Plan Plus — CHP+|
|How to apply||colorado.gov/hcpf/how-to-apply|
|Eligibility8||Based on family size and income
Available to children age 18 and pregnant women 19 and over who are: Colorado residents; permanent legal residents who have an Alien Registration number for at least five years, a refugee or asylee; not eligible for Medicaid; do not have other health insurance; able to provide minimal verification as required.
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 State of Colorado. Department of Regulatory Agencies. Division of Insurance. “COBRA Verses Colorado Continuation/Conversion.” N.D. http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheadername1=Content-Disposition&blobheadername2=Content-Type&blobheadervalue1=inline%3B+filename%3D%22COBRA+versus+Colorado+Continuation%2FConversion.pdf%22&blobheadervalue2=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251818800892&ssbinary=true.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Colorado.” Medicaid.gov. N.D. http://www.medicaid.gov/medicaid-chip-program-information/by-state/colorado.html.
8 Child Health Plan Plus. “About CHP+.” http://www.chpplus.org/index.cfm?action=aboutCHP&language=eng.