Health Insurance Plans

What does the Quality Rating of a health plan indicate?

Health insurance plans offered through Connect for Health Colorado display quality ratings from one to five stars. The quality ratings are based on the experiences reported by customers. The experiences reported come from customer survey results and measurements of clinical quality. A one star rating is the lowest and a five star rating is the highest.

There are some health insurance companies that are new to the Marketplace and, therefore, do not yet have enough data to establish a quality rating. In these instances, a health plan’s quality rating may be listed as “In Progress”.

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

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How are premium rates calculated?

Premium rates are calculated using three criteria: age, the region of the state you live in, and tobacco use. Unlike in the past, 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.

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What health plans are offered through the Marketplace?

Health insurance plans from a variety of insurance companies are offered through Connect for Health Colorado. All health insurance plans include comprehensive coverage (called Minimum Essential Coverage), covering services such as hospital stays, prescription drugs, and mental health. Connect for Health Colorado also offers a variety of plan types, including HMOs, EPOs, and HSAs. These and other plan types are defined in our Glossary of Terms. After you fill out an application, you will be able to see all health insurance plans available to you and shop for the plan that best fits your needs.

Related FAQs:
Am I eligible for financial assistance to help pay for health insurance?
How do I purchase dental coverage?
What is Minimum Essential Coverage?
What information is available to help customers choose a health plan?

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What services do health plans sold on the Marketplace cover?

All health insurance plans offered by the Individual and Small Business Marketplaces include a comprehensive set of benefits, as required by federal regulations, and are considered Minimum Essential Coverage. These comprehensive benefits fit into the following 10 categories:

  • 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

Health insurance companies have flexibility in determining how these benefits are covered. Health insurance plans may cover additional services, such as chiropractic care. In addition, you may have the option to buy stand-alone dental or vision care through Connect for Health Colorado.

Related FAQs:
What is Minimum Essential Coverage?
How do I purchase dental coverage?

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

Bronze, Silver, Gold, and Catastrophic are coverage levels. A health insurance plan’s coverage level represents the expected portion of total health care costs a health insurance company will pay. This is also referred to as the plan’s actuarial value. These coverage levels are indicated by metal tiers, as described below. If you qualify for financial help through Connect for Health Colorado in the form of Premium Tax Credits, you can apply that financial help to any one of the metal tier plans, except for the Catastrophic plans. If you also qualify for Cost-Sharing Reductions, it is automatically applied when you select a Silver-tier plan.

 

 

-Bronze Plan: 60% of total health care costs will be paid by the health insurance company, meaning you will be responsible for approximately 40%. Bronze plans generally have the lowest premiums and the highest levels of cost-sharing (deductibles, co-payments, etc.). Individuals who don’t utilize health services often may find a Bronze plan is the best fit for them.

-Silver Plan: 70% of total health care costs will be paid by the health insurance company, meaning you will be responsible for approximately 30%. Individuals who qualify for Premium Tax Credits may also qualify for additional financial help in the form of Cost-Sharing Reductions.

-Gold Plan: 80% of total health care costs will be paid by the health insurance company, meaning you will be responsible for approximately 20%.

-Catastrophic Plan: A plan available to individuals under the age of 30 at the start of the plan (calendar) year. (You can also buy a Catastrophic plan if you are age 30 and older and you qualify for a hardship exemption.) This plan generally has a low monthly premium and only covers a limited amount of benefits. Learn more about Catastrophic plans in our Glossary.

Related FAQs:
What health insurance plans are offered through Connect for Health Colorado?

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

Check out our quick 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.

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What is Minimum Essential Coverage?

“Minimum Essential Coverage” is a standard or type of coverage you need to meet the individual mandate requirement under the Affordable Care Act. Some examples of health insurance plans that qualify as Minimum Essential Coverage are:

  • Any Connect for Health Colorado plan
  • Medicare (certain Parts and conditions apply)
  • Children’s Health Plan Plus (CHP+)
  • TRICARE (for veterans and veteran families)
  • Peace Corps
  • Volunteer plans

Some examples of coverage that doesn’t qualify as Minimum Essential Coverage are:

  • Coverage only for vision care or dental care
  • Workers compensation
  • Coverage only for a specific disease or condition
  • Plans that offer only discounts on medical services
  • Short-term, limited-duration insurance

Related FAQs:
Am I eligible for financial assistance to help pay for health insurance?
Am I required to have health insurance?
What is Medicare and how do I find out if I’m eligible?

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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.

Related FAQs:
What is the Affordable Care Act?

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