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F.A.Q.

Frequently Asked Questions

General Health Insurance Questions

When is the open enrollment period?

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.

What are Qualifying Events?

  • Married or divorced and lost qualifying insurance.
  • Have a child, adopt a child, or place a child for adoption
  • Have a change in income (this is based on applying for a subsidy during open enrollment and then having a change in income throughout the year, unless you qualify financially for Medicaid)
  • Get health coverage through a job or a program like Health First Colorado (Medicaid)
  • Move
  • Have a change in disability status
  • Have a change in status as an American Indian or Alaska Native or change your tribal status
  • Have a correction to your name, date of birth or Social Security number
  • Experience any other changes that may affect your income and household size
  • Gain or lose a dependent
  • Have a change in tax filing status
  • Have a change in citizenship or immigration status
  • Are incarcerated or released from incarceration

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.

If I don’t have a qualifying event, and I missed the enrollment period, can I still sign up for health insurance coverage off Marketplace?

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!

What is the difference between EPO, PPO and HMO plans?

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

What is a Health Savings Account (HSA)?

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.

What are HSA contribution limits?

Federal Healthcare Reform and Marketplace Questions

Is my health insurance rated on my preexisting health condition?

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.

Who is is eligible for a subsidy?

Should I apply for a subsidy?

Common Outcomes Examples for people who may or may not qualify for a subsidy.

Example 1
Income Stated for 2015, $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 2015, $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 2015, $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.