If you’ve been declined for an individual policy by a private health insurance company in Colorado, you do still have other options. I’ll outline them here, and provide links to detailed information that you might find helpful.
1. It’s important to know that each health insurance carrier has its own underwriting guidelines. Just because you’ve been declined by one carrier, does not necessarily mean you’ll be declined by all of them. We can give you an idea – based on your specific health history – of whether you might have better luck with a different carrier.
2. Cover Colorado is available for most people who have been declined by a private health insurance carrier. Cover Colorado is the state high risk pool, and has been providing health insurance for people with pre-existing conditions since 1991. They offer premium discounts if your household income is below $50,000/year. Applications must be received by the 15th of the month in order to qualify for a 1st of the following month effective date.
3. Are you self-employed? You may qualify as a business group of one. You must have been in business for at least one year in order to qualify as a business group of one. The state mandated Basic and Standard health insurance plans are guaranteed issue for a group of one during specific open enrollment periods, defined as 31 days from one of the following events: the one year anniversary of the opening of your business, your birthday, or the loss of other coverage. You can contact the Colorado Division of Insurance for more information about group of one regulations. Like most group policies, group of one coverage is more expensive than most individual policies. The notable exception is in the case of large families. Individual health insurance premiums are calculated on a per-person basis, whereas group premiums have “family” rates that don’t vary with the number of children. Group of one policies are offered by all carriers that offer group health insurance policies in Colorado. The state mandated benefits in the Basic and Standard plans are the same regardless of what carrier you choose, but the price varies from one carrier to another.
4. Have you recently left a job? You may qualify to continue your coverage under COBRA or Colorado state continuation regulations. COBRA applies to people who worked for a company with 20 or more employees, while state continuation applies to people who worked for a company with 2 – 19 employees. In both cases, you’re allowed to continue your group coverage for up to 18 months (or more, depending on some specific circumstances), but you will be required to pay the entire premium, including the portion that your employer was paying on your behalf. If you’re covered under COBRA regulations, you have 60 days to elect to continue your policy after you leave your job. In the case of state continuation (if you were working for a company with fewer than 20 employees), you have 30 days to elect to continue your coverage.
5. Depending on your income, and several other factors, you or your dependents may qualify for Medicaid. In addition, children and pregnant women in Colorado may qualify for Child Health Plan Plus (CHP+) if their household income is less than 200% of the federal poverty level.
6. Do you work for a small company that does not provide health insurance? You could discuss the issue with your employer, and see if you can convince them to enroll in a small group plan. Groups of 2 – 50 employees are guaranteed issue in Colorado, and with the passage of HB 1355, small group premiums cannot be adjusted either up or down during enrollment based on the medical history of the group members.
Thankfully, we live in a state where there are several options for people who are unable to qualify for private individual health insurance. This is not the case in all states, although maybe the ongoing health care reform debate will eventually add options where there currently are none.