How to choose a health insurance plan through the Colorado health exchange can be daunting. Here is advice to get you started. Source: Getty Images
By Rick Ansorge, for UCHealth
Mark your calendar if you’re among the thousands of Coloradans who rely on a health plan supplied by Connect for Health Colorado, the state’s health insurance exchange.
Nov. 1 is the start of the exchange’s open enrollment period. If you want an exchange health plan for 2022, you must complete your paperwork by Jan. 15.
This applies even if you’ve previously signed up for coverage. Even if you’re happy with your plan, you must re-enroll in it by the Jan. 15 deadline. It’s an opportune time to make any necessary updates, such as adding or removing dependents.
If you’re new to the exchange, the process of enrolling in an exchange plan may seem daunting.
“But it’s user-friendly and it’s tailored to each individual’s needs,” said Brandon Elliott, Director of Hospital and Transplant Contracting at UCHealth.
How do I choose the right plan?
The exchange allows prospective participants to navigate its site and review its plans without formally enrolling.
“It asks for basic information such as your age, residence, and if you’re a tobacco user,” Elliott said. “Then it asks you to name the specific providers you’re looking for and the specific prescription drugs you’re taking.”
Then it displays the plans that may work for you and allows you to compare their benefits.
If you want a plan that includes UCHealth, CU Medicine, and other in-network affiliates, you have two options for the 2022 plan year: Anthem Pathway and the new Oscar Colorado Partners Choice.
Since a big part of Elliott’s job is overseeing the managed-care contracting for all 12 of UCHealth’s acute-care full-service hospitals, we asked him for tips on how to choose a health insurance plan through the exchange.
What is the most important consideration in picking a plan on the Colorado health exchange?
“Make sure your preferred providers are in-network with the plan that you’re interested in,” Elliott said.
That includes your primary care physician and all of your specialists as well as your preferred hospitals, ancillary locations, and clinics.
“If you go to a provider that is out-of-network, you’re opening yourself to a considerable cost risk,” Elliott said.
If all your providers are in-network, does that mean you won’t incur any unexpected charges?
When negotiating with health insurers, Elliott and his team make best efforts to ensure the agreement covers UCHealth facilities and corresponding affiliates, including PCPs (primary care providers), specialists, and ancillary locations, but there are some exceptions.
“If you see your preferred providers are in-network, including facilities and affiliates, you can feel confident that you’re going to be covered,” Elliott said.
“But the only way to be certain is to confirm with the health insurer, “ he explained.
What else should you consider when picking a plan on the Colorado health exchange?
”Consider the aggregate total cost,” Elliott said. “You should compare the costs among the plans, including premiums, deductibles, copays, and co-insurance,”
Be sure to add in the annual out-of-pocket maximum costs.
“That’s another factor I always like to consider when I’m looking at a plan,” he said. “It gives you an overall sense of whether or not you can afford the plan.”
Another important cost consideration is prescription medications. On the exchange website, you can list your medications to see how much of the expense – or how little – the plan will cover.
If you meet the criteria, you may also be eligible to lower your monthly premiums through the premium tax credit. “You can apply for premium tax credits through Connect for Health Colorado,” Elliott said.
Are there any additional considerations?
“You may qualify for a Special Enrollment Period which is separate from the traditional open enrollment period,” Elliott said. “Coloradans who experience a Qualifying Life Change Event during or outside of the open enrollment period have a 60-day window to buy or change plans.”
You can enroll in Medicaid or the Child Health Plan Plus (CHP+) program any time of year, whether you qualify for a Special Enrollment Period or not.
“In some cases, it may also be cost-effective to set up a Health Savings Account (HSA) to help pay for out-of-pocket costs,” Elliott said.