Connect For Health Colorado
Martin Insurance Group is proud to be a Certified Connect for Health Colorado agency. That means we offer you all the same health insurance plans available through Connect for Health Colorado at no cost to you. In addition, we offer hundreds of options that that are not available through Connect for Health Colorado so you can rest assured you will get the facts about the options available to you.
As a certified broker with Connect for Health Colorado we will guide you towards making good enrollment choices by properly explaining the new plans, advanced premium tax credits, and public program options.
Whether you are an individual or business looking for affordable, reliable health insurance, it doesn’t have to be confusing or difficult. Let our experienced agents make the process of shopping insurance through the Colorado Health Benefit Exchange as simple as possible. Our goal is to help you get the medical protection you deserve.
Many of our clients have already qualified for subsidized coverage available to individuals with incomes from 133% of the federal poverty level up to 400% of FPL who do not have affordable minimum coverage through their employers. According to Kaiser Family Foundation, as many as 59% of Coloradans will qualify for subsidized health insurance. To see if you qualify, take a look at the subsidy chart by clicking here.
On the chart you will want to look at your income and the number of dependents that you have when you file your taxes. If you believe your 2016 income will be within numbers on the chart, you should take action now to learn about your options before January 31, 2016.
2016 Annual Open Enrollment Period
Under The Affordable Care Act, there are only certain times of year when you can apply for new coverage or change your health plan. For 2016 the Open Enrollment dates are:
November 1, 2015 – January 31, 2016
During this time, you may shop for and apply for an individual health plan and have guaranteed issue health insurance available to you. If you do not apply or change your health plan during the Open Enrollment period, you may still be eligible to enroll if you have a “Life Change Event” as described below in the FAQ section.
We are committed to educating the entire community on how the Colorado Health Benefit Exchange and Affordable Care Act will operate so that Coloradans can obtain the health care they need. Contact us today to learn more about the options you may be eligible through the exchanges.
If you have any questions on how these changes are affecting your current coverage, or about the enrollment process, give our knowledgeable agents a call or email today!
For more information, we’ve included a list of frequently asked question. Click the question to get an answer:
- How do I purchase health insurance in Colorado?
- What is Connect for Health Colorado?
- How do I know which health insurance plan is right for me?
- What are premium tax credits?
- Who is eligible for premium tax credits?
- What happens if I miss the open enrollment period?
- What is a Qualifying Life Event?
- What are the new health plans available?
- Do I need to apply for Medicaid to get a tax credit?
- If I am enrolled in Medicaid, where do I call for assistance?
- Where can I apply for health insurance in person?
- Why should I consider using Martin Insurance Group as my health insurance broker?
- What does cost share reduction mean?
- How much is the penalty for not having health insurance?
- What if I have a gap in coverage this year before open enrollment begins?
- Are there exemptions to the penalty? What are they?
- When can I take my premium tax credit?
- What if I take an advanced premium tax credit and estimate wrong?
- Do Colorado residents use Healthcare.gov?
- I can’t afford to buy health insurance. What should I do?
- Who is exempt from paying the penalty for not having health insurance?
- I’ve had the same policy for years. Does health care reform affect my plan?
- How can I be sure that my current coverage will allow me to avoid the Affordable Care Act penalty?
- Does the Affordable Care Act affect my employer’s group plan?
- I didn’t find an answer to my question, what should I do?
During annual open enrollment periods, health insurance is guaranteed issue for all applicants regardless of your health history. Between individual policies, group, short term, and subsidized insurance, there are many options to consider. Martin Insurance Group is a licensed broker and can help you purchase all types of coverage at no cost to you.
2. What is Connect for Health Colorado?
Connect for Health Colorado the place to buy subsidized health insurance. It is a website sometimes referred to as the “exchange” which can be accessed directly or with a broker’s assistance. Colorado residents should not use healthcare.gov since our state manages its own exchange (called Connect for Health Colorado).
3. How do I know which health insurance plan is right for me?
Your local broker at Martin Insurance Group can help you compare and select a plan. Your broker is certified to sell on the Connect for Health website as well as numerous plans not offered through Connect for Health Colorado and the best part is our service does not cost anything to you.
4. What are premium tax credits?
Premium tax credits reduce your premium. The amount of the tax credit you may receive depends on your income and the cost of health plans in your area. Connect for Health Colorado will determine the expected contribution you are required to pay toward the premium for a mid-range (Silver) benchmark plan. The expected contributionwill increase on a sliding scale based on your income. If your income is near the poverty level, the expected contribution you would be required to pay toward the benchmark plan is 2 percent of your income. As your income gets closer to 400% of the poverty level, the expected contribution you would be required to pay toward the benchmark plan is 9.5% of your income. The difference between the premium for the benchmark plan and your expected contribution equals the amount of your tax credit. (You do not have to pay more than the actual premium for the plan.) Your health rates calculated to include any tax credits.
5. Who is eligible for premium tax credits?
Premium tax credits will be available to U.S. citizens and lawfully present immigrants who purchase coverage in the Marketplace and who have income between 100% and 400% of the federal poverty level as outlined below:
- $15,655 to $47,080 for an individual
- $21,188 to $63,720 for a family of 2
- $26,721 to $80,360 for a family of 3
- $32,254 to $97,000 for a family of 4
- $37,786 to $113,640 for a family of 5
- $43,319 to $130,280 for a family of 6
Premium tax credits are also available to lawfully residing immigrants with incomes below 100 percent of the poverty line who are not eligible for Medicaid because of their immigration status. (Generally, immigrants must lawfully reside in the U.S. for five years before they can become eligible for Medicaid.) In addition, to be eligible for the premium tax credits, individuals must not be eligible for public coverage—including Medicaid, the Children’s Health Insurance Program, Medicare, or military coverage—and must not have access to health insurance through an employer. (There is an exception in cases when the employer plan is unaffordable because the employee share of the premium exceeds 9.5% of the employee’s income. There is also an exception in cases where the employer plan doesn’t provide a minimum level of coverage.)See income limits below
6. What happens if I miss the open enrollment period?
If you miss the deadline for open enrollment you are unable to sign up for an ACA compliant plan unless you have a “qualifying event”. However, you can sign up for a non-compliant short-term plan any time. However, some short term plans only offer 6 month terms and they do not count as creditable coverage to avoid being fined.
7. What is a Qualifying Life Event?
A Qualifying Life Event is any of the situations below which would create an open enrollment opportunity within 60 days of the event regardless of the time of year. This unique situation would allow someone to purchase guarantee issue insurance as if it were the annual open enrollment period.
Qualifying Life Events can include:
- Marriage/civil union
- Death of spouse
- Divorce/legal separation/annulment
- Death of dependent child
- Loss or gain of Advance Premium Tax Credits (APTC)/Cost-Sharing Reduction (CSR)
- Dependent child ages out of dependent status (>26 years of age/loss of student status)
- Loss or gain of spouse’s health insurance coverage
- Loss or gain of Minimum Essential Coverage
- Pregnancy status change
- No longer incarcerated
- Change in American Indian (AI)/Alaska Native (AN) status
Now all health plans have a “metal” label to indicate their level of coverage. The levels of metal plans are:
- Bronze- provides 60% coverage on average
- Silver – provides 70% coverage on average
- Gold – provides 80% coverage on average
- Platinum – provides 90% coverage on average
- Catastrophic – a very specific plan similar to an HSA an only available to individuals under the age of 30
Yes. As part of the Connect for Health Colorado application you will be submitting an application for Medicaid (free or low-cost public health insurance). A tax credit cannot be given if you are eligible for Medicaid or Children’s Health Plan Plus(CHP+). Keep in mind that you and/or your dependents may end up enrolled in Medicaid or CHP+.
10. If I am enrolled in Medicaid, where do I call for assistance?
- Garfield County Human Services – 970-945-9191
- Eagle County Human Services –970-328-8840 or 970-704-2767
- Pitkin County Human Services – 970-429-2040
- Mesa County Human Services – 970-241-8480
At Martin Insurance Group, we are a certified broker trained to help you through the process and we can help you with any questions about your healthcare. We’ve also seen some people choose plans on their own that had a very limited provider network. What good is a plan if you can’t see a local doctor? Not only can we advise you through the selection process but we can also assist you with claims at no additional charge.
13. What does cost share reduction mean?
- 2014 $95.00 or 1% of your income
- 2015 $325.00 or 2% of your income
- 2016 $ 695.00 or 2.5% of your income
The penalty is assessed based on “coverage months.” This means that each month you are uninsured, you may owe 1/12th of the annual penalty. However, short spells of no insurance may not be subject to a penalty.
15. What if I have a gap in coverage this year before open enrollment begins?
It varies, if your gap is less than three months, there is no penalty. If you are covered for even one day out of one month you are considered covered for that month. Continuous coverage gaps during the year could result in a fine.
16. Are there exemptions to the penalty? What are they?
Yes. You may be eligible for an exemption if you:
- Cannot afford coverage (defined as those who would pay more than 8 percent of their household income for the lowest cost bronze plan available to them through the Marketplace)
- Are not a U.S. citizen, a U.S. national, or a resident alien lawfully present in the U.S.
- Had a gap in coverage for less than 3 consecutive months during the year
- Won’t file a tax return because your income is below the tax filing threshold (In 2013, the tax filing threshold is $10,000 for individuals and $20,000 for a couple)
- Are unable to qualify for Medicaid because your state has chosen not to expand the program
- Participate in a health care sharing ministry or are a member of a recognized religious sect with objections to health insurance
- Are a member of a federally recognized Indian tribe
- Are incarcerated
Others who do not qualify through these categories but have experienced a hardship that makes it difficult to purchase insurance may apply through the health insurance marketplace for an exemption to the individual responsibility requirement.
17. When can I take my premium tax credit?
Premium tax credits may be claimed at the end of the year, or you can apply for an advanced premium tax credit based on your estimated income for the up-coming year. If you elect to receive an advanced credit, the government will pay 1/12 of the credit directly to your insurance company each month and the insurer will bill you for the rest of the premium.
18. What if I take an advanced premium tax credit and estimate wrong?
It’s important to keep in mind that when you apply for an advanced premium tax credit, you won’t necessarily know for sure what your 2016 income will be, so you will apply based on your best estimate of your 2016 income. Later, when you file your 2016 tax return, the IRS will compare your actual income to the amount of premium tax credit you claimed in advance. If you underestimated your income and claimed too much premium tax credit, you might have to pay back the difference. If you didn’t receive all of the premium tax credit you’re entitled to during the year, you can claim the difference when you file your tax return. You should report any changes in your income during the year to the Marketplace, so your credit can be adjusted and you can avoid any significant repayments at the end of the year.
19. Do Colorado residents use Healthcare.gov?
No. If you live in Colorado, Connect for Health Colorado is the Health Insurance Marketplace to serve you. Instead of HealthCare.gov, you’ll use the Connect for Health Colorado website to apply for coverage, compare plans, and enroll.
20. I can’t afford to buy health insurance. What should I do?
Depending on your income, you may be eligible for lower-cost, subsidized coverage purchased through Affordable Care Act’s state health insurance exchanges. Or, you may qualify for free or low-cost coverage through Medicaid or Children’s Health Insurance Plus, aka CHP+.
21. Who is exempt from paying the penalty for not having health insurance?
The law excuses certain individuals from the penalty, including members of religious sects that have religious objections to health insurance, participants in health care sharing ministries, and those who are uninsured for less than three months of the year. You also could be exempt if your income is too low to require a federal tax return, you can’t reasonably afford coverage, or you would have qualified for Medicaid had your state elected to expand the program as provided for under the Affordable Care Act.
22. I’ve had the same policy for years. Does health care reform affect my plan?
Some provisions of the Affordable Care Act do not apply to so-called grandfathered plans written before the law took effect. These include the freedom to choose your own doctor, preventive services at no additional cost, and the right to appeal if your insurer denies a claim. However, as with new policies, grandfathered plans are required to cover children up to age 26, provide a simple summary of coverage and costs, and cease any lifetime limits on benefits.
23. How can I be sure that my current coverage will allow me to avoid the Affordable Care Act penalty?
You’re OK if you are currently insured through: an individual or group plan (grandfathered or not); a veterans health care program, including Tricare; Medicare; Medicaid; the Children’s Health Insurance Program, or CHIP; Peace Corps volunteer plans; or COBRA continuation coverage for the unemployed.
24. Does the Affordable Care Act affect my employer’s group plan?
Yes. For employer-based insurance, it means: preventive services at no additional cost (unless you have an older, grandfathered plan); an end to lifetime/annual dollar limits and guaranteed coverage for your adult children until age 26. If your employer’s plan costs more than 9.5 percent of your income or doesn’t meet the law’s minimum coverage requirements, you might qualify for subsidized coverage on your state health marketplace, or exchange.
25. I didn’t find an answer to my question, what should I do?
Call our office at 888-872-7115 and one of our licensed professionals will be happy to assist you.