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Colorado Health Insurance

Colorado Medical Insurance Overview

There are a multitude of options in health insurance benefits of which residents of the state of Colorado can enjoy. These options range from individual plans, to group plans offered at work and state-funded health insurance plans. These benefits are made available to residents based on their employment status and how much they earn. Many residents of Colorado do not have health insurance coverage, but the number of uninsured people in the state was expected to decrease with the new health reform bill that has been enacted. For an overview on what plagues those in Colorado with regard to health issues and the many programs available, see the information provided below.

Colorado’s Health Problems

According to statistics provided by the United Health Foundation, the state of Colorado ranks in eleventh place in terms of the health of the state’s residents. This ranking is compared to the rest of the country, but it leaves some areas of which can be improved.

Understanding The Uninsured Population Of Colorado

As of 2011, there were 14 percent of residents of the state of Colorado who have gone without some form of insurance coverage, according to information provided by the Henry J. Kaiser Family Foundation. More information on the uninsured parties in Colorado was provided by the Colorado Health Institute, which has a lot of information on its website. According to the available statistics, Colorado’s uninsured population has not seen a decrease since 2008 and has slightly gone up. Despite the lack of insurance coverage among the problems for Colorado’s residents, the percentage of those who are without insurance is still lower than the percentage in the nation.

The following information represents more statistics centered on the residents in Colorado who are currently without insurance coverage:

  • A fourth of the residents in the state receive insurance coverage through Medicaid and Medicare.
  • Those who work in the state are likelier to have employer-sponsored health coverage as opposed to those working in the entire United States.
  • The percentage of companies that offer health coverage in Colorado is lower than those companies that offer group plans in the U.S., overall.
  • Children who are not covered under any type of insurance plan in Colorado make up twenty percent of the total population of the state.

Group Health Plans

Many people living in Colorado receive health insurance through their workplace or a union using group health plans for workers. In Colorado, employers often share the costs associated with health insurance policies, so this has proven to be more beneficial as opposed to individual health plans offered in the state. With regard to group insurance plans, employees cannot be denied insurance coverage because of a pre-existing condition. The Division of Insurance regulates the private insurance providers in the state of Colorado.

Signing Up

If you have a job, you should contact the Human Resources Manager at your place of employment for more information on how to enroll in the company’s plan. The HR Manager will have a good knowledge of the type of plans offered at the company, and with that in mind, you should consider the following information when deciding on your employer’s plan:

  • Do you have any pre-existing conditions? If you do, will your needs be covered under the terms of your insurance contract?
  • Is there more than one option for insurance coverage through your workplace? Many companies offer two options: one that is more expensive and more comprehensive and another that is less expensive with lower amounts of coverage.
  • When is the enrollment period? Many companies have a time in which you can enroll and enrollment is not available otherwise.
  • Do you have to find coverage for your spouse or dependents? If so, is coverage available through your group plan?

Pre-Existing Condition Exclusion Periods

Although your insurance company cannot reject your application due to a pre-existing condition, you may be required to wait out an exclusion period after beginning the enrollment process. In Colorado, you can be required to wait six months prior to the commencement of your benefits.

With regard to exclusion periods, you should keep the following information in mind:

  • Exclusion periods cannot be enforced on children who are under age 19 and are new to the health plan.
  • The private insurance providers in Colorado have a look back period of up to six months when considering the application of a new enrollee.
  • If an individual looking for insurance coverage has a predisposition to a certain condition, it doesn’t mean that it is necessarily a pre-existing condition until the person has received a diagnosis from his or her doctor.

Affiliation Or Waiting Periods

A waiting period is the length of time that a new enrollee must wait in order to receive benefits under the new insurance policy. With the exception of late enrollees (who have to wait longer), this period of time cannot extend longer than two months time. Someone who enrolls late can be subject to a waiting period of three months. A waiting period may not be required in addition to an exclusion period, as these two periods can occur at the same time.

Individual Health Plans

People who cannot obtain insurance coverage through their employer or a state-funded program can look for an individual plan for their healthcare needs. Of the entire population of the state of Colorado, only 8 percent are covered under individual health insurance plans. Because insurance companies cannot spread the risk over a select group of people, they do not extend many individual plans to consumers.

Insurance companies offering individual health insurance plans reserve the right to deny coverage to people who exhibit pre-existing conditions. These plans can also prove to be quite expensive and are subject to a lot of underwriting and restrictions as set forth by the insurer. According to estimates, a young person who is healthy can obtain individual health insurance in Colorado for $72 each month. For more detailed data on individual health insurance policies, you can look at the website belonging to the Foundation For Health Coverage Education.

Continuation Coverage

Individuals changing jobs or going through a divorce can find themselves without the benefit of health insurance coverage. However, there is hope in the form of COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage. COBRA insurance coverage acts to fill in the gaps in time of which you do not have insurance coverage. Through this plan, you can be insured for a period of up to 18 months or the length of time it takes to find another policy through other means, whichever comes first).

Colorado Health Benefit Exchange

The Colorado Health Benefit Exchange was established in June of 2011, and at that time, the decision was made that the state would be responsible for its own health benefit exchange following the passage of Senate Bill 11-200. This program has since launched its own website as well. This program essentially offers residents an online resource that allows them to compare and research various insurance options that are available for them to choose from. It is managed by a Board of Directors and will provide information that will allow both residents and businesses to make clear and informed decisions.

This Board of Directors, consisting of a total of 12 individuals and ranging from the Insurance Commissioner to the Executive Director of the Department of Health Care Policy and Financing, will work to both design and implement the overall operation of this program. Furthermore, the Board will also operate in conjunction with a Legislative Health Benefit Exchange Implementation Review Committee, which will consist of a total of ten legislators. This particular group will be responsible for reviewing all functions and finances related to the operation of the Colorado Health Benefit Exchange.

Colorado State Insurance Programs

The state’s Department of Health Care Policy and Financing is the entity responsible for the vast majority of health care programs throughout Colorado. In order to be eligible for these programs, you must meet certain requirements, such as age, income, pre-existing conditions, etc.

Here is a list of some of the programs that are available through the Colorado Health Benefit Exchange. There is a lot of information available about each of these plans on the matrix created by the Foundation for Health Coverage Education.

CoverColorado

Individuals who have either chronic medical conditions or pre-existing conditions will be able to apply for insurance coverage through this program. Services such as x-rays, hospital stays, and doctor visits will be completely covered. In order to be eligible for this program, you must be a resident of Colorado for at least six months and have a qualifying health condition. Additionally, monthly premiums may also be applicable.

GettingUSCovered

This is another program that helps individuals who suffer from pre-existing conditions obtain health insurance coverage. Many medical services are covered; however, monthly premiums between $184 and $876 are generally required to be paid. These premiums typically depend on aspects such as age, gender, area of residence, etc.

Medicaid

This program offers health insurance to children and lower-income families, as well as those who are more medically needy. Services including family planning, prenatal care, general checkups, and hospital services are completely covered under this program. If medical services are provided within three months of the date of the application being submitted, all charges for them may be retroactively covered. Income limits will determine whether or not you will be granted guaranteed coverage through Medicaid.

Child Health Plan Plus (CHP+)

This is a program that assists lower-income children obtain benefits for necessary medical services, such as general checkups, immunizations, prescriptions, hospital visits, eyeglasses, and more. This program also completely covers pre-existing medical conditions. Guaranteed coverage through this program is determined through income limits.

Women’s Wellness Connection

This program provides coverage for treatments such as breast cancer and cervical cancer screenings, pap smear tests, and other diagnostic examinations for women. Coverage is guaranteed if the participant has an income level at or below 250% of the federal poverty level or if they meet other certain requirements.

Adults Without Dependent Children (AWDC)

This is a program that assists adults who, as the name suggests, do not have any dependent children, but are at a lower income level, to obtain coverage for necessary medical services. These can include general checkups, prenatal services, newborn care, and more. This program also completely covers pre-existing medical conditions.

Indian Health Services (IHS)

This program is designed to cover individuals of Native American descent, as well as non-Native American women who are pregnant with the child of a Native American for eligible health coverage. There are many hospitals throughout Colorado that are IHS-funded are able to provide these types of services, as they are managed by Native American tribes. Individuals who are covered through this program will be required to pay little or no monthly cost.

VA Medical Benefits Package

This program is available exclusively to veterans throughout the state. It completely covers all pre-existing conditions, as well as offering primary and comprehensive preventive care.

Medicare/Medicare Prescription Drug Program

This program covers benefits such as prescription, dental, and vision services to individuals over 65 years of age or those who are suffering from any kind of a disability or end-stage renal disease. Medicare is something that consists of Parts A, B, C, and D and which offer a variety of different options depending on the individual’s specific needs and eligibility.

Partnership for Prescription Assistance

This is a program that is designed for individuals who do not have prescription drug coverage, as it allows for them to obtain these at little or no cost to them. You will be able to take advantage of a variety of different options, which includes a total of 475 different programs that are operated by public and private entities that will ensure you get your medications.

Womens-Infants-Children (WIC)

This is a program that serves lower-income women, children, and infants by providing nutritional assistance for children up to five years of age. Additionally, they also provide some immunization benefits as well.

Colorado Indigent Care Program (CICP)

This is a program that provides supplementary funds to both hospitals and clinics that offer services to residents that meet certain requirements.

National Association of Mental Illness Helpline (NAMI)

This is a mental health organization that offers various resources to help improve the lives of those who suffer from all types of mental illnesses. This is a helpline that is run entirely by volunteers, and it provides all kinds of information related to mental health treatments and services.

HIPAA/Conversion Health Plans

Also known as the Health Insurance Portability and Accountability Act of 1997, HIPAA implemented many different rules and regulations on health insurance providers regarding aspects such as pre-existing condition coverage, monthly premium costs, exclusion periods, and more. For more information on how this applies to the state of Colorado, click the following link.

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