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7 things you need to know about enrolling in Colorado’s health marketplace Who can buy Colorado’s health marketplace insurance? To sign up for private health coverage through Connect for Health Colorado, you must: • Live in Colorado • Not be incarcerated • Not be enrolled in Medicare How do I qualify for financial assistance? To qualify for income-based Advance Premium Tax Credits (APTC), federal cost-sharing reductions (CSR), or Colorado’s state-funded cost-sharing subsidies, you must: • Not have access to an affordable employer-sponsored health plan • Not be eligible for Health First Colorado (Colorado Medicaid) or Child Health Plan Plus (CHP+).
Subsidies through Connect for Health Colorado depend on your household earnings, age, and location. When can I enroll in an ACAcompliant plan in Colorado? Colorado’s open enrollment period runs from Nov. 1 through Jan. 15. For coverage to start on Jan. 1, you must complete your application by Dec. 15. Coverage begins Feb. 1 for applications submitted from Dec. 16 to Jan. 15. If you qualify, you can enroll year-round in Health First Colorado (Medicaid) and Child Health Plan Plus (CHP+). How do I enroll in a Colorado Marketplace plan? You have a few options to enroll in an ACA Marketplace/exchange plan in Colorado. You can use Connect for Health Colorado, the state’s health insurance Marketplace, to
October 22, 2023 compare different plans and check your eligibility for financial aid before enrolling during open enrollment or a special enrollment period.
• Anthem
Alternatively, you can seek assistance from an insurance broker or certified enrollment assistant to enroll in a Connect for Health Colorado plan. For further support, contact Connect for Health Colorado’s call center at 855752-6749 (TTY line: 855-346-3432).
• Kaiser
How can I find affordable health insurance in Colorado? The Affordable Care Act offers income-based subsidies to help lower health coverage costs for eligible individuals through Connect for Health Colorado. These subsidies and federal cost-sharing reductions are available to those who choose a Silver-level plan and have a household income below 250% of the poverty level. Colorado also provides additional costsharing subsidies to some silver-plan enrollees, including undocumented immigrants, through a separate public benefit corporation. Eligible individuals can also enroll in free or low-cost coverage through Health First Colorado or CHP+. How many insurers offer Marketplace coverage in Colorado? Six insurers will offer health plans through Connect for Health Colorado for 2024:
Ready to enroll in a health plan? Ask 9 questions first To choose the right health insurance plan for you and your family, understand the available choices and determine how they best meet your needs. Review your coverage options When choosing a health insurance plan, consider the level of coverage you require. Individual or family plans are classified by coverage levels, such as platinum, gold, silver, and bronze. Additionally, some individuals may qualify for catastrophic plans on the Health Insurance Marketplace. It’s important to note that these categories do not affect the quality of care provided but rather how costs are divided between you and your plan. What do health plan coverage levels mean? What’s the difference between a bronze, silver, gold, platinum, or catastrophic health plan? These categories, or “metal levels,” show how costs are split between you and your insurance plan. However, it’s important to note that the classification does not necessarily reflect the quality of care. Some individuals may also have access to “catastrophic” plans, which are open to people under 30 or with a hardship exemption.
You can apply financial help to any metal tier plan except for catastrophic plans. Check premiums, copayments, and deductibles All insurance plans include multiple out-of-pocket expenses, including: • Premium: A set monthly cost for coverage, regardless of services used. • Copay: Additional fixed-fee payments charged for care, such as office visits and prescriptions. • Deductible: Fees you must pay before your insurance coverage begins. • Coinsurance: Most plans cover a percentage of costs (for example, 80%), while you are responsible for paying the rest. Assess your potential needs and compare the associated plan costs over the next year. Check provider networks List healthcare providers you and your family use or might need in the coming year. That can include physicians, specialists, hospitals, clinics, and pharmacies. When evaluating plans during open enrollment, check if they cover your preferred providers. Understand contracts between medical professionals and insurance companies are subject to change. Providers your
plan covered last year may not be included in the future. Make sure your plan covers your medications Compile a list of your medications and know whether they are brand name or generic. As brand-name drugs can be expensive, securing a policy that covers them is essential. Generic medicines are cheaper, so if your prescriptions mainly consist of generics, you may have more options or be comfortable paying them out of pocket. Call the insurance company to confirm coverage for your medications and inquire about copay fees for filling and refilling prescriptions. Consider enrolling in HSAs and FSAs Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) set aside pre-tax money to pay for qualified healthcare costs, including copays, medications, and medical devices. Not everyone can participate in these programs. HSAs necessitate enrollment in an HDHP or catastrophic plan, while FSAs are exclusively accessible through employers (and may not be an option at all workplaces).
• Cigna • Denver Health • Rocky Mountain Health Plans • SelectHealth What health insurance resources are available to Colorado residents? Connect for Health Colorado: This is the state’s marketplace/exchange. Residents can use Connect for Health Colorado to enroll in individual/family health plans, receive income-based subsidies, and enroll in Health First Colorado. You can contact Connect for Health Colorado at 855-752-6749. Colorado Division of Insurance: Regulates the insurance industry in Colorado and assists consumers and businesses with insurance-related questions and concerns. Colorado Department of Health Policy and Financing (HCPF): Administers Medicaid (Health First Colorado), Child Health Plan Plus (CHP+), and other health care programs. Colorado Senior Health Care and Medicare Assistance: A service for Colorado Medicare beneficiaries and their caregivers, providing information and assistance with questions related to Medicare eligibility, enrollment, and claims.
Verify the contribution restrictions and rollover regulations before enrolling in an HSA or FSA. Also, determine your expected medical expenses for the coming year. Understand the difference between HMOs and PPOs Health Maintenance Organizations (HMOs) limit coverage to innetwork doctors. Preferred Provider Organizations (PPOs) offer partial coverage for out-of-network services. HMO networks are typically smaller and require your primary care physician to refer you to a specialist. HMO plans generally have lower premiums and deductibles. PPOs usually have larger networks and do not require referrals, but they tend to be pricier. When is the open enrollment period? Colorado’s open enrollment period runs from Nov. 1 through Jan. 15. For coverage to start on Jan. 1, you must complete your application by Dec. 15. Coverage begins Feb. 1 for applications submitted from Dec. 16 to Jan. 15. If you qualify, you can enroll yearround in Health First Colorado (Medicaid) and Child Health Plan Plus (CHP+). What is a special enrollment period? If you experience a major life event, like pregnancy, losing health coverage from a job, or moving to a new area, you may qualify for a Special Enrollment Period. This allows you and your family to shop for and enroll in a new health insurance plan.
Make sure your Medicare coverage still serves your needs Fall is the ideal time to consider whether you need to change your Medicare coverage for 2024.
Part A covers hospital stays, skilled
out-of-pocket expenses than traditional Medicare.
The non-profit Kaiser Family Foundation, which specializes in healthcare policy, reported more than 4,000 Medicare Advantage plans were available in 2023 across the U.S. That’s more than double the number available in 2018.
Part B covers doctors’ services, outpatient
Additionally, these plans may provide additional benefits such as vision, hearing, and dental services that original Medicare does not cover.
With so many options, it’s vital to do research. Start by understanding the differences between original or traditional Medicare and Medicare Advantage plans. Traditional Medicare offers a comprehensive coverage plan that includes multiple parts.
nursing facility care, hospice care, and some home healthcare services.
care, medical supplies, and preventive services.
Part D covers prescription drug costs. With traditional Medicare, you can access any doctor or hospital across the United States that accepts Medicare without needing a referral for specialist visits. Another option is to choose a Medicare Advantage or Part C plan. Medicare Advantage is a comprehensive plan that typically includes Part A and B and Part D coverage. It often requires using in-network doctors and may have lower
While non-emergency coverage may be available out of network with some plans, it usually comes at a higher expense. And seeing a specialist may require a referral. According to experts, evaluating your current plan and its suitability is crucial before considering a switch. Review three critical factors:
1. Medications: Catalog names, dosages, and brand name or generic status of prescribed drugs. Confirm the drugs will
continue to be covered by your plan and the expected costs using the government’s Medicare plan finder tool.
2. Doctors: If you have a Medicare Advantage plan, you must ensure your doctors remain within the network. If you have traditional Medicare, all doctors who accept Medicare are automatically covered.
3. Costs: Compare premiums and out-ofpocket maximums between plans. Consider all expenses, especially for Medicare Advantage plans advertising $0 or low premiums. Also, remember everyone must pay the monthly Medicare Part B premium. People with higher incomes may pay additional costs for Part B.
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Understand how Medicare works: 18 common questions Do I need to sign up, or am I automatically enrolled in Medicare? When turning 65, most individuals are automatically enrolled in Medicare Part A and Part B if they receive benefits from Social Security or the Railroad Retirement Board. If their birthday falls on the first day of the month, benefits will begin the month prior. However, if they do not receive benefits from these sources, enrollment is required. The enrollment window is seven months, including the birth month and three months before and after. When wanting to maintain private insurance through an employer, individuals must inform Medicare that they will not be retiring. They can later schedule a special enrollment period. When is Medicare open enrollment? Medicare’s open enrollment period runs from Oct. 15 to Dec. 7. During that window, you can change Medicare and prescription drug plans. How can I qualify for premium-free Medicare Part A coverage? To get premium-free Medicare Part A, you must be 65 or older, and you or your spouse must have paid Medicare taxes for at least 10 years. You may also qualify for premium-free coverage if you’re 65 or older and meet one of three requirements: • You receive Social Security or Railroad Retirement benefits. • You are eligible for Social Security or Railroad Retirement benefits but haven’t applied yet • You or your spouse were employed in a government job that was Medicare-covered. What are standard Medicare premiums? Most people don’t pay a monthly premium for Medicare Part A, which covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. The monthly premium for Medicare Part B hasn’t been finalized but is expected to be $180 monthly. Part D drug plan premiums are expected to be $55.50 monthly. Premiums for Medicare Advantage or Part C plans vary depending on the plan. Can I deduct Medicare premiums from my taxes? You may be able to deduct some Medicare premiums from your federal taxes if you are self-employed. If you are not self-employed, you can file an itemized Schedule A (1040) tax return listing all your medical expenses for the tax year. But you can only deduct expenses over 7.5 percent of your adjusted gross income.
Does Medicare Part D cover medication costs? Medicare Part D prescription drug coverage extends to generic and brand-name medications. Each plan has an approved list of covered medications. You can use Medicare’s Plan Finder tool to review different Part D plans and see which ones include coverage for your desired medication. How much do Part D prescription drug plans cost? When shopping for a Medicare Part D plan, compare prices and coverage options to find the best fit. What are the most popular Medicare supplement plans? Plan F: This popular plan covers out-of-pocket expenses for Medicarecovered services like deductibles, copays, and other costs. Plan F is no longer available to beneficiaries who became eligible for Medicare on or after Jan. 1, 2020. Plan G: Plan G beneficiaries must pay the annual deductible under Medicare Part B. After that, all medical expenses that fall under Medicare coverage will be covered at 100%. Plan N: Plan N covers all Medicare Part B coinsurance costs, except $20 for office visits and $50 for emergency room visits. Beneficiaries still must meet the annual Part B deductible. Is there financial help to cover Medicare costs? Several programs help cover healthcare costs for seniors. The PACE program provides all-inclusive care for elderly patients. Medicare’s Extra Help program also helps with expenses. For those who need help with insurance premiums and other related costs, the State Health Insurance Assistance Program (SHIP) may help. Medicaid covers many healthcare costs for low-income individuals, including those eligible for Medicare and Medicaid. Medicare Savings Programs (MSPs) are also available, which provide financial assistance to qualified individuals based on need. Finally, Supplemental Security Income (SSI) is a needs-based program administered through the Social Security Administration that can help cover healthcare costs for seniors. Can I enroll in Medicare and keep my health savings account? The simple answer is no. You can’t contribute to a health savings account (HSA) after you enroll in Original Medicare. An HSA lets you set aside tax-free money for medical expenses associated with high-deductible health plans.
If you delay enrolling in Medicare until after you retire, stop contributing to your HSA at least six months before enrolling in Medicare to avoid tax penalties. When is the best time to enroll in a Medicare supplement plan? Enroll in a Medicare supplement plan during your Medigap open enrollment period. That starts when you are 65 or older and enrolled in Medicare Part B. Can I enroll in both Medicare and Medicaid? You may be eligible to enroll in both Medicare and Medicaid if you meet specific financial eligibility requirements. Even if you don’t qualify for Medicaid while enrolled in Medicare, you may still be eligible for a federally funded Medicare Savings Program to help people with limited income and resources. Check with Colorado’s Medicaid office to determine if you qualify. How do I qualify for Medicare? You may be eligible for Medicare coverage if you are 65 years or older and a United States citizen or permanent resident. To qualify, you must have worked in the U.S. for at least 10 years or be a government employee or retiree who has paid Medicare payroll taxes. Use the Medicare Eligibility Premium Calculator on Medicare’s website to determine your eligibility for coverage. To get Medicare, do I need to be on Social Security? You don’t have to wait until you’re on Social Security to enroll in Medicare. But you must sign up during your initial enrollment period, a sevenmonth window that includes your 65th birth month and the three months before and after. If you miss this enrollment period, you may have to pay a permanent surcharge on your Medicare Part B and Part D premiums. Am I eligible for a Medigap plan? You can’t get a Medicare supplement insurance plan (Medigap) unless you enroll in Medicare. You can buy Medigap coverage during a six-month open enrollment period. If you wait to enroll, you may have to pay more for a Medigap policy. You also can be denied coverage due to current or past health conditions. You can’t simultaneously have a Medigap policy and a Medicare Advantage (Part C) plan. What is the difference between Original Medicare and Medicare Advantage? Original Medicare, which includes Part A and Part B, is a federal government program. Private insurance companies contract with the federal Medicare
program to administer Medicare Advantage plans. There are several key differences. Under Original Medicare, you can visit any doctor, hospital, or other healthcare provider that accepts Medicare. But if you go outside your Medicare Advantage plan’s provider network, you may be charged more or must pay the total cost out of pocket. Medicare Advantage plans must provide all coverage offered in Original Medicare, but some plans include additional coverage such as vision, dental, hearing, and prescription drug benefits. Does Medicare cover nursing home care or assisted living services? Although Medicare does not cover most nursing home care, it may in some circumstances. For example, Medicare Part A may cover skilled nursing facility care if it is medically necessary and has been certified by a doctor. Additionally, original Medicare may provide home health care coverage, including injectable osteoporosis drugs for women, occupational therapy, physical therapy, and speech-language pathology services. Does Medicare cover medical expenses while traveling outside the United States? If you’re traveling outside the United States, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, Medicare usually won’t cover medical care. However, it may pay for the care you receive on a ship in U.S. territorial waters if it is at most six hours from port. In some circumstances, Medicare may also pay for inpatient hospital care, ambulance services, or dialysis you receive in a foreign country. For example: • Medicare may cover care at a foreign hospital if a medical emergency requires immediate attention and the nearest U.S. hospital cannot treat your condition. • Travel through Canada without delay on the most direct route between Alaska and the lower 48 states, and a medical emergency occurs. Medicare may cover treatment at a nearby Canadian hospital. • If the nearest hospital to your home is closer than any in the United States that can treat your condition, Medicare may cover your care at that hospital.
Find the Right Medicare Insurance Agent for You During Medicare’s Annual Enrollment Period (AEP)—October 15 through December 7—an insurance agent can help you understand your options and determine the right plan for your health needs. Here are some tips to help you find the right agent for you. Understanding the different types of agents There are several different types of insurance agents that can help you during AEP.
What to look for in an agent When considering an agent, ask yourself: • Do you want someone who is more relationship based, or would you prefer a more hands-off approach with a call once or twice a year? • Do you need extra support to understand and use your plan benefits, or do you prefer to be more selfdirected?
• Carrier agents work for an insurance carrier such as Humana and only sell this carrier’s insurance plans in their specified geographic region.
• Do you want someone who can help connect you to community resources or would you rather do that research on your own?
• Independent agents work for themselves or an independent insurance brokerage. They contract with multiple carriers in a certain geographic region.
Ask prospective agents about their communication style and process to decide whether or not they might be right for you.
• Third-party call center agents work for companies who contract with a wide range of carriers in multiple geographic regions.
How to find an insurance agent
If you like to develop personal relationships with service providers and want additional help understanding or using your plan throughout the year, you might like working with a carrier or independent agent best. If you want to have a lot of options to choose from, and do not need help understanding or using your plan, you might consider an independent or thirdparty call center agent.
Ask your friends and family if they can recommend any Medicare insurance agents. You can also research agents using a search engine or on social media platforms like Facebook. Agents are under strict rules about when and how they can reach out to you, so you should call or email them if you are interested in working with them. Working with an insurance agent can help you: • Find the right plan and pricing for your healthcare needs.
• Determine monthly premium costs as well as your copay, deductibles and maximum out-of-pocket costs per year. • Understand your key plan benefits and how to maximize them. • Connect to community resources for your nonclinical needs and determine your eligibility for additional government services. • Understand which providers and facilities are in your plan’s network. • Find doctors in your area with Humana’s Find a Doctor tool. Because they help people like you every day, insurance agents can be a great resource during AEP and all year long. Learn more at healththatcares.com/humana-agents.
Call a licensed sales agent
1-844-224-8993 (TTY:711) Monday–Friday 8 a.m.–8 p.m.
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Find the right doctor for you. Start with your Humana plan. As each of us gets older, what we need for our healthcare changes— sometimes more than once. That’s why Humana has providers in our network that specialize in geriatric care. We connect you with doctors who take time to get to know you, offering care that evolves alongside you and a dedicated team who prioritizes your whole health.
An emphasis on treating every patient with respect and compassion
A professional care team that takes the time to listen
Care beyond the clinical, with mental health and social wellness support
Visit HealthThatCares.com or scan the QR code to learn more about the doctors in our network Call a licensed Humana sales agent 1-844-224-8993 (TTY:711) Daily, 8 a.m.–8 p.m.
Other Providers are available in our network. Provider may also contract with other plan sponsors. Important! At Humana, it is important you are treated fairly. Humana Inc. and its subsidiaries comply with applicable Federal Civil Rights laws and do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender, gender identity, ancestry, marital status or religion. ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call 1-855-360-4575 (TTY: 711). Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingü.stica. Llame al 1-800-706-6167 (TTY: 711). 繁體中文 (Chinese): 注意：如果您使用繁體中文，您可以免費獲得語言援助服務 。請致電 1-855-360-4575 (TTY: 711)。 Y0040_GHHLZH6EN_C
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