For Individual Health Insurance: November 1 – January 15
If you do not buy Health Insurance at this time, you cannot purchase Health Insurance later in the year (until the following open enrollment) unless you have a qualifying event. You also cannot switch plans mid-year without a qualifying event.
For a full list of qualifying events, click here.
Rules: You MUST notify your agent and complete your change within 60 days of the event! If it isn’t completed in that time, you lose the opportunity to switch.
Depending on income, you may be able to qualify for Medicaid or CHP+ outside of open enrollment and then if your income changes for the better, you then may be able to qualify for a tax credit instead as a change in the status of a subsidy is a qualifying event.
Remember, if you are not applying for assistance now, you cannot apply later based on a financial change.
If you could possibly be eligible for financial aid throughout the year, A+ Smart Health Insurance Agency strongly recommends that you apply with connectforhealthco.com during open enrollment.
We also are able to help small business owners purchase a business group of two or more employees to gain coverage outside of open enrollment. Beyond those possibilities, we suggest you contact our office to determine if we can ferret out a true qualifying event, it is our pleasure to help you!
Plan | Requires Primary Care Physician |
Requires referrals |
Requires pre-authorization |
Pays for out-of-network care |
Do you have to file claim paperwork? |
---|---|---|---|---|---|
EPO | No | No | Yes, for non-emergency events. Emergency visits are covered worldwide without authorization. |
No | No |
PPO | No | No | Yes, for non-emergency events. Emergency visits are covered worldwide without authorization. |
Yes | Only for out-of-network claims |
HMO | Yes | Yes | Not usually required. | No | No |
Health Savings accounts are bank accounts that are stipulated for use with a Health Savings compliant Health Plan. Your agent will walk you through a Health Insurance Plan that is HSA compliant but it is up to you to open the bank account with the bank of your choice for the tax savings. For more information, please contact your tax preparer or the IRS.
Rating factors that determine individual health insurance premium are no longer based on a person’s health conditions.
In Colorado, your individual health premium will be based on age, geography (the zip code of your home address), and tobacco use.
Once enrolled, the company cannot change the price of your individual premium until the following calendar year and you, the client, are not able to change plans until January, unless you have a qualifying event.
Common Outcomes Examples for people who may or may not qualify for a subsidy.
Example 1
Income Stated for 2022, $30,000.
Based on zip code and DOB Subsidy determined $200 per month benefit.
Income Determined at Tax Time = $30,000
Client keeps Subsidy
Example 2
Income Stated for 2022, $30,000.
Based on zip code and DOB Subsidy determined $200 per month benefit.
Income Determined at Tax Time = $50,000
Client must repay Subsidy
How to avoid this: Please contact agent if income is in excess of statement to Department of Medicaid.
Example 3
Income Stated for 2022, $50,000
Based on income stated, no subsidy provided.
Income determined at tax time = $30,000.
Client received no subsidy but was technically eligible.
How to avoid this: If there is any possibility of income dipping below subsidy guidelines, apply with ConnectForHealthCO to be able to gain Premium Tax Credit at a later time.