Health Insurance Plans

How are premium rates calculated?

Premium rates are calculated using three criteria: age, the region of the state you live in, and tobacco use. Your gender, pregnancy status, health history, and other personal information will not be considered in the calculation of rates.

All rate and plan information can be found at the Colorado Division of Insurance website.

Health plans are categorized as Bronze, Silver, Gold, or Catastrophic. What does this mean?

Health insurance companies organize their plans into these different coverage levels (sometimes called “metal tiers”): Bronze, Silver, Gold, and Catastrophic. Each level represents a plan’s general approach to sharing costs with you.

You can apply your financial help to any one of the metal tier plans, except for the Catastrophic plans. Although prices vary between plans and insurance companies, all Colorado Option plans have the same benefits, copayments, deductibles and out-of-pocket maximum costs within a specific coverage level across all health insurance companies.

Learn more about the difference between metal tiers.

How can customers get help understanding and using their health insurance?

Check out our guide to using your health insurance. We offer helpful suggestions and tips about how to get the most value from your health insurance. Also, your health insurance company can help you understand and use your health insurance. Contact your health insurance company’s customer service center with questions regarding what doctors you can see, how much certain services or medications may cost you, or other health plan-specific questions.

Can a health insurance company deny my health coverage for any reason?

No. As part of the Affordable Care Act, a health insurance company cannot deny your health coverage for any reason, including your health history, a high risk job, or a preexisting condition.

What does the Quality Rating of a health plan indicate?

The quality ratings are based on the experiences reported by customers and are rated from one to five stars.  A one star rating is the lowest and a five star rating is the highest. The experiences reported come from customer survey results and measurements of clinical quality.

What health plans are offered through the Marketplace?

Connect for Health Colorado offers a variety of health insurance plan types, including HMOs, EPOs, and HSAs, from a total of 6 health insurance companies. The health plans available to you are based on where the health insurance companies choose to sell. All Marketplace health plans are submitted to and approved by the Division of Insurance.

New this year: Colorado Option plans. The benefits, copayments, deductibles and out-of-pocket maximum costs are the same for all Colorado Option plans within a specific metal tier (Bronze, Silver, or Gold) across all health insurance companies. This makes it easier to compare plans and know how much you’ll pay for the most common services.

What services do health plans sold on the Marketplace cover?

All health insurance plans offered by our Marketplace include Essential Health Benefits, including:
• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and Habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care

Most plans from health insurance companies have flexibility in determining how these benefits are covered, and some offer additional services like chiropractic care.

However, Colorado Option plans within each coverage level cover all the same benefits for the same prices, no matter what company you buy from.

You also may have the option to buy stand-alone dental or vision care through Connect for Health Colorado.

How do I purchase dental coverage?

You can sign up for a dental plan through Connect for Health Colorado during the annual Open Enrollment Period (November 1—January 15) or if you have a Qualifying Life Change Event. You do not need to buy a health insurance plan through Connect for Health Colorado to buy a dental plan.

We offer dental plans that cover children only, or children and adults. Some health insurance plans sold through Connect for Health Colorado offer dental coverage for children under 19 years of age.