> 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)!
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?
How come I can’t get insurance any time I want it — what is “open enrollment?”
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 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?
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.
HMO, PPO, EPO… what does it all mean?!
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?
How do I know what the deductible is?
How does the out of pocket maximum (or OOP) work?
What is meant by coinsurance?
What is meant by a copay?
Can you give me some examples to understand?
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.
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?
Do I have to have earned income to contribute to an HSA?
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.
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.