Health Insurance

> CONFUSED? I SPEAK HEALTH INSURANCE. LET ME SIMPLIFY THE PROCESS

> LOST YOUR HEALTH INSURANCE? I CAN HELP!

> HMMM… COBRA OR MARKETPLACE PLAN? CONTACT ME!

> I SPECIALIZE IN PLANS FOR INDIVIDUALS & FAMILIES

 

The health insurance landscape continues to change with the Affordable Care Act (ACA), aka Obamacare, and now ARPA.

Whether you are an individual or a family, self-employed or just can’t get coverage through your employer (or it’s crazy expensive for you or family members!), I can find the most appropriate insurance for you, at the best value.  If you already have insurance in place, I can review your current policy to make sure it is the best one for you and your family.

The American Rescue Plan Act (ARPA) expands the advance premium tax credit, aka APTC. People who previously did not qualify for APTC now might, as the calculation is based on the cost of the second lowest Silver plan in your zip code. Please use the Connect for Health Colorado calculator to see if you qualify and be in touch if you need help.

The allowable max out of pocket in 2023 is $9100! So consider an accident plan to manage this high number.  Get an accident quote with this link. Accident insurance reduces high deductibles to just $250 for around $20 per month (or less)!

My goal is to simplify this confusing process for you! Consider me your “easy button.”

If you live in Colorado and need insurance, it’s most likely free to work with me. Usually I am paid by the insurance carrier when you enroll in a plan, which does not affect the price of your health insurance premium in any way. If not, let’s discuss how I can help you. After I understand your needs, I will find the best policy for you at the best price. It’s easy – all you have to do is answer some questions and provide some basic information about yourself and your family. We can get you enrolled entirely over the phone.

Please note: I work with all ACA-compliant carriers that offer individual health plans in Colorado.  Contact me today! I work through my agency Healthfull, LLC (Colorado license #481075), hold an individual Colorado health and life insurance license (license #437038), and am certified by Connect for Health Colorado, Colorado’s health insurance marketplace

health insurance faq

There is a lot of confusion around health insurance— rightly so as it can be complex. So that we don’t have to spend our appointment time understanding how health insurance basically works, PLEASE READ THESE FAQ BEFORE WE TALK.

BIG PICTURE HOW IT WORKS

What is Connect for Health Colorado?

Connect for Health, or C4, is Colorado’s marketplace for insurance. Even if our federal government does away with the ACA (Affordable Care Act) aka Obamacare, Colorado has its own health insurance marketplace. (Thank you to our great state of Colorado for taking care of us and ensuring we have access to health insurance!)

Can anyone get health insurance? I have an illness — will I be denied?
Yes anyone can get health insurance! Pre-existing conditions and underwriting are things of the past. Nobody is denied and this is the greatest thing about the ACA.
How come I can’t get insurance any time I want it — what is “open enrollment?”
Open enrollment is every year from November 1 to December 15 for a January 1 start date. OE officially closes January 15 (for a Feb 1 start date). You must get insurance within this time, or you are out of luck for the rest of the year. If you lose your insurance during the year, like from a move to a new state or job loss, a special enrollment window will be opened for you and you have 60 days from the time you lose your insurance to get new coverage. You must provide proof of your loss of insurance or your application will not be approved by the carrier.

If they let us get insurance any old time we felt like it, most people would just wait until they were sick or needed it to get it, and that’s not how insurance works (you’d never go around without auto insurance and just get it the minute you had an accident — the insurance companies would go out of business fast).

I want to work with you, how do I do that?

If you have a Connect for Health account, you can authorize me as your broker, and then I can help you choose a plan. (If you don’t yet have a C4 account, I can help you create one.) Here is how to do that:

Log in to your C4 account
In the upper right click on GET ASSISTANCE
Then FIND EXPERT ASSISTANCE IN MY AREA
Then BROKER/AGENT
Then type in my name ADDIE and click on search (small square button with magnifier, may have to scroll down a little to see it)
My name will be hyperlinked, click on it
Then AUTHORIZE BROKER (again, may need to scroll down)
Then click CONTINUE

If you already have a broker listed and you no longer wish to work with that broker, you need to revoke their authorization before you can add me.

What does it cost to use you as my broker?
Usually, nothing. In August 2018, a Colorado law went into affect allowing brokers to charge a fee for their time if they are not compensated by the carrier. What this means is, if you choose a plan where I don’t receive a commission, then I charge a consulting fee for my time and advice. I will give you an agreement to sign to this affect before we meet that discloses my fee, and collect payment information from you. If you don’t wish to possibly have to pay for advice (if you choose one of the plans that don’t pay me), you can call Connect for Health Colorado and get help that way. Note that Connect for Health reps are NOT allowed to make recommendations about what may be the best plan for you.

TLDR: The only carrier that doesn’t pay me is Kaiser Permanente. So you don’t have to worry about paying a consulting fee with any other carrier.

INSURANCE TERMS

HMO, PPO, EPO… what does it all mean?!
Don’t get bogged down by these terms. Basically, all plans in Colorado with the exception of Kaiser Permanente operate in a similar manner: you are limited to a LOCAL network of providers to get care. There are no PPOs on the individual market. You can get care for urgent and emergency matters outside of the local coverage area, but you may be charged more than if you were in network, and the amount you are charged may not all be applied to your deductible and out of pocket max. For example, you are traveling outside of your coverage area and have to go to the ER. You get a bill for $3000, but only $900 is applied to your deductible.

Kaiser is a “true” HMO in that you get care within their system only (with the exception of urgent and emergency care as stated above).

Do I need a referral to see a specialist?

No carrier requires a referral to see a specialist any more!

How does a deductible work?
You are responsible for all costs up to the amount of the deductible. For example, if your deductible is $4000, and you have health costs of $3000, you pay $3000.
How do I know what the deductible is?
The name of the plan usually contains a number, and that number defines the amount of the deductible. For example BrightHealth Silver 4000 means it has a $4000 deductible.
How does the out of pocket maximum (or OOP) work?
Nine times out of ten, this is your maximum liability for health care costs. In 2020 this amount is $8150. This means if something catastrophic happens and you have very high medical bills, you will pay a maximum of $8150 in 2020 and the plan pays 100% of the rest. In my opinion, this is one of the most important numbers to look at. The out of pocket max is lower on HSA plans (keep reading for definition)
What is meant by coinsurance?
This is the percentage that you pay and the percentage that the carrier pays, and it comes into play AFTER the deductible is reached and BEFORE the max out of pocket is reached. If the deductible and the OOP max are the same number, there is no coinsurance. It’s very simple in this case. You are 100% responsible up to the OOP max, and the plan is 100% responsible for everything beyond the OOP max.
What is meant by a copay?
This is a set, pre-determined amount you pay to go to the doctor, urgent care, emergency room, prescriptions, etc. Copays do not apply or affect the deductible, but DO accrue toward your OOP max. For example, a plan might have a co-pay of $50 for a doctor appointment. Without the copay, the cost might be $100 — whatever the contracted price the doctor and health insurance carrier have arranged. Even if you don’t have a co-pay on your plan, you still get the benefit of a discounted price that the doctor or pharmacy and health insurance carrier have arranged.
Can you give me some examples to understand?
Sure. Assume a $4000 deductible, $8150 max out of pocket, and 30% coinsurance. Note that these numbers vary by plan, of course.

1. You have medical costs of $5000.
You pay $4000 (100% up to the deductible). Then you pay $300 (30% coinsurance of the remaining $1000) for a total of $4300. The plan pays $700 (70% coinsurance after the deductible)

2. You have medical costs of $8000.
You pay $4000 (100% up to the deductible). Then you pay $1200 (30% coinsurance of the next $4000 for a total of $5200. The plan pays $2800 (70% coinsurance after the deductible)

3. You have medical costs of $20,000.
You pay $4000 (100% up to the deductible). Then you pay $4150 (30% coinsurance); you don’t pay MORE THAN your OOP max of $8150. So you pay $8150 and the plan pays 100% of the rest.

TAX CREDIT, or LOWERING THE COST OF YOUR PREMIUM

 How does the tax credit work?

The tax credit calculation was changed with the American Rescue Plan Act. You will qualify for assistance at much higher income levels than before, depending on your age and zip code. These credits are set to continue through 2025.

As an example, if you are in your early 60’s and your adjusted gross income is $125,000 you’d likely qualify for around $500/month of APTC. The best way to know exactly how much you qualify for is to contact me and/or try this calculator.

It all gets reconciled when you file your tax return for the year. You will get a 1095-A tax form from Connect for Health Colorado, stating how much premium you paid and how much APTC you took (maybe you took $0). Then your ACTUAL AGI for that tax year is compared to the amount of APTC you took.

If you took $0 APTC but your income fell into the range, you will get money back on your tax return. Conversely, if your income falls below the range, or was outside of the range, or even within the range but a different amount than stated on your application, you may owe some of the APTC back, or get more APTC, depending if your guesstimate was too high or too low.

You must buy your plan on Connect for Health to get the APTC or to get the tax credit when you file your taxes.

HSA

What is an HSA Plan?

To be an HSA plan, it must have HSA in the title (or sometimes HDHP for high deductible health plans)… but it can’t be just any-old high deductible plan. HSA plans are designed specifically per IRS regulations. They do not have co-pays for services. They have lower OOP max amounts. So if you are healthy and just want to be covered in case of catastrophe, these are a good way to go because they usually have lower premiums. They also offer you the privilege of opening an HSA ACCOUNT at a bank and contributing with PRE-TAX DOLLARS money that can be used on qualified medical expenses, including acupuncturists, dentists, vision, chiropractic and therapy! Check out this tool to see what expenses are eligible.

Note that the HSA health insurance plan and the HSA account that you open at the bank are separate. Having an HSA plan allows you to open an HSA account and contribute to it, but it is not required, and the insurance company could care less whether you have an account and/or whether you contribute to it.

The amazing thing about HSA money is that as long as you use it for qualified medical expenses, it is NEVER TAXED! It is the only investment vehicle that exists where your money is neither taxed going in or coming out, as long as you use it properly.

How much can I contribute to my HSA?

In 2022, the maximum amount you can contribute to an HSA account is $3650 for a single person, and $7300 for a family (2 or more related people). These amounts are going up substantially, to $3850 and $7750 in 2023, and you have until April 15 to contribute for the prior year. If you are 55 or older, you can contribute an extra $1000. You can’t contribute to an HSA once you are on Medicare. Check with your CPA or tax preparer.

All right I’m in. How do I open an HSA account?
I recommend you first check with your bank to see if they offer a fee-free HSA (many charge fees). If they don’t, or they charge a fee, I recommend a credit union. Credit unions almost always offer HSA accounts and they do not charge fees. You can’t contribute to the HSA until you actually have the HSA health insurance plan in place.
Do I have to have earned income to contribute to an HSA?
No…the deduction for the contribution can be used to offset any kind of income, like dividend income or rental income, but you need to ask your CPA or tax advisor if contributing to an HSA makes sense for your situation.
Why are you such a fan of HSAs?
  • They are great if you are looking for a tax write-off (remember, the contribution amount is pre-tax; it doesn’t matter how much of the money you actually USE for healthcare) especially since it’s hard to itemize deductions anymore. This reduces your income without having to itemize!
  • It is your money, you don’t “lose it” if you don’t use it (that’s an FSA)
    The out of pocket max is considerably lower than a non HSA plan, which can save you money if you have catastrophic medical costs (usually $6750 vs. $7900 in 2019; in 2020 $6900 v. $8150)
  • A bronze HSA plan has almost the lowest premium you can get. For many people, it makes sense to hedge your bets with the known cost — the premium.
  • When you open an account, you are issued a debit card that is linked to your account, so it’s so easy to pay for your medical costs with the money in your account.

I’ve tried to give you the basics here, but you should discuss the details with your CPA or tax preparer, and do your own research. If you need a CPA, just let me know and I can refer you.

SUPPLEMENTAL PLANS

Are dental and vision benefits included in my plan?

Usually only pediatric dental and vision are included. Friday Health plans offer an annual vision check up for children and adults. If you need dental and/or vision coverage, we can add on a Delta Dental or VSP vision plan for about $25-$40 and $18 respectively.

What is an accident plan?
An accident plan might be a good thing to add on. They basically cover your large deductible and max out of pocket in the case of an accident (basically anything that is not a sickness) for just a $250 deductible instead. They are not expensive to add — about $25-$30/month. BrightHealth offers a combined accident/hospitalization plan which in addition to covering many accident related costs, also has a hospital benefit, even in the case of hospitalization for sickness. Hence this plan usually cost more than just a pure accident plan, but not always.

For international health insurance, click below.

For short term travel insurance, click below.

For dental insurance, click below.

For accident insurance, click below.

Are You a Do-It-Yourselfer?

You can get your own quotes! Click the button below and you’ll be directed to my online quoting system. (You will need to do a quick registration and enter your age and zip code for the quote.)  If you get stuck, just let me know and I can help.