Welcome Connect For Health Colorado: Individual and Small Group Clients

Useful Information and Answers to Your Important Questions!   Call 303-471-9424

Your Connect For Health Colorado Certified Broker with over 15 years of experience with Health Insurance and Employee Benefits to the Fortune 100 level! Experience includes working for two different health insurance companies.   Why me?   It's not just the years of experience.  My mission is to find you the best solutions, make sure you are fully covered and SAVE you money.  Every coupon, discount and tax credit….I'll find it for you!

Frequently Asked Questions:

Do You Qualify For The Colorado Health Care Marketplace/Exchange?  Scroll down to see the chart for qualification and subsidy.

Who must use the Connect For Health Colorado Exchange?      No one is required to use the exchange. However, small businesses and individuals can only receive federal tax subsidies if they sign up for insurance through the exchange.    Note: If you do not qualify for a subsidy or tax credit you have better options outside the exchange with richer benefits and networks and a layer or bureacreacy you don't need to deal with.

What Are My Options If I Do Not Qualify (based on income) For the Marketplace/Exchange? There are many options that we can help you with for coverage that meets the ACA guidelines outside of the Colorado Healthcare Exchange.  You will have a variety of insurance companies and plan designs to choose from, you just will not be eligible for a subsidy from the exchange.   See the chart below

Why Do I Need A Broker?  How does a Licensed Broker differ from a Navigator on the Colorado Healthcare Exchange?   A licensed broker must go through 40 hours of classroom time to obtain a life and health license.  Most Licensed Brokers  (some go by the title "agent", especially if they are "captive" to one company) have years of industry experience and understand health insurance policies because they have been selling them for many years. Brokers have knowledge of the plan designs, the networks, how coverage works in and out of network, which plans and companies have limitations on certain benefits and which ones have richer benefits.  They can also visit with you about how a plan might cover certain health conditions and be able to advise that one company and or network might help you better than another because of the years of working with these insurance companies.  To work with the Colorado Healthcare Exchange in addition to handling life and health plans outside of the exchange, a broker must go through online and classroom training to be a "certified broker", listed on the Colorado Healthcare Exchange website and certified to work with you.   Brokers also know the history of the companies when it comes to rate increases on blocks of business or even if the company has pulled out of certain markets.    A broker can find you coverage if you are not eligible for the exchange.  A broker is paid by the insurance company either way so it costs you the client nothing to assign a broker and work with that broker.

A Navigator is a new title bestowed upon employees hired by the Colorado Healthcare exchange in an attempt to have some people in an office fielding calls from the public for the over 1/2 million people that will now be flooding the marketplace looking for coverage that were previously not covered. Many of these employees are new to this field, are temporary or seasonal to this open enrollment period and do not have the years of knowledge to answer your questions.  Navigators are NOT licensed insurance brokers/agents, they cannot advise you about an insurance plan (it's against the law as they are not licensed agents or brokers),  they can only help you set up your account if you are having a technical glitch, help you see if you qualify for a subsidy or Medicaid and refer you to links to look up providers. Navigators are on a 1-800#, are not allowed to call out, or call back.  It's a call center with a different person answering each time you all.  The Colorado Healthcare exchange is advising most folks coming to the exchange to pick a broker as they do not have the staff to field all the calls.

How can we select you as our broker on the Connect For Health Colorado?   

A client may select a broker by clicking on the “Get Assistance” menu button on the upper right hand corner of their account screen.   They may then select me as the broker of their choice by last name or license number.     Brokers may also set-up an account for a client and send an invitation to the client to authorize them as their broker.     You can select me by going to ZIP CODE: 80126 and find me in the list or type in STACEY GILBERT in search

How Do Health Insurance Plans Differ Inside and Outside of The Colorado Healthcare Exchange?  Insurance companies have filed plans both inside and outside of the Colorado Health Care Exchange.   The plans for individuals inside the exchange are mostly HMO except for one insurance company and in most cases have a smaller network of MD's and hospitals.   A few insurance companies like Assurant (Time) and United Healthcare have chosen to "wait out" until 2015 and watch the exchange and only sell policies outside of the exchange for 2014.

Is My Doctor/Hospital On the Network?  Some of the insurance plans on the Colorado Healthcare Exchange have limited networks for both doctors, specialists and hospitals.  Please make sure when you look at networks online that you are choosing 2014 and "exchange" to make sure the MD or hospital is in the network if it's an "exchange" insurance plan.

This is an IMPORTANT QUESTION-Please Read!  I Travel Around The US For Work…What are my best options for coverage? AND/OR, I have a health condition and want the best care (cancer, heart, neurological, etc.), I run marathons or I am involved in sports nationwide:   Make sure you choose a PPO to have the best options to CHOOSE your care.  Although an HMO is supposed to cover you in an emergency when you are out of town, some HMO's will require you to return to the area to receive care once you are stabilized. 

In addition, you lose choice when you choose an HMO. Let's take an example, 6 months into a plan, you come down with an odd type of cancer and the oncologist in Denver tells you your best shot at treatment is a new drug only available at MD Anderson Cancer Center in Houston or your heart specialist in Denver says you need a valve replacement and the best care is at Cleveland Clinic.  With an HMO you have to submit to a Medical Director (the dreaded "death squad") and he/she and a board sit every week to decide if they are going to provide treatment outside of the realm of the HMO contract.  I worked for an HMO and used to visit with our in house MD. This is not the government making these choices (regardless of what has been in the media)…. it's your choice to give that power to them when you choose the HMO.  It's only in very unique circumstances that you get approved.  I am sharing this because YOU want to have the option to get on a plane and from the time you land know that all your cost are covered either in network (because it's a national network like Cigna with Centers of Excellence coverage) or under an out of network benefit to the annual cap on your policy (even if it means $15000-$25,000 out of your pocket vs. a medical director stamping "denied" and 100% out of your pocket.  These are life and death decisions most people just don't think about when they are selecting a policy and you will not be able to "switch" mid year as it's adverse selection for an insurance company.

If you are a family with a child living outside of Colorado, again a PPO with a National network will be your best option.

I am Healthy and don't qualify for the exchange. Can I purchase coverage for 12/1/13 and keep those rates for the next year? How will I save money compared with purchasing 1/1/14? Purchasing coverage before 1/1/14 will save you money.  It could be anywhere from $80-$400 (individual and family size affect rates) a month in savings as the rates will go up 1/1/14 inside and outside of the exchange.   You can lock in rates for 12 months to 12/1/14 and save some money for the next year.   Some insurance companies including Cigna are allowing you to purchase for 10/1/13-12/1/13 and will "auto renew" at the same rate for 12/31/13 so you are covered for the full year at 2013 pricing.

How much is the tax subsidy for health insurance coverage for Individuals?    Tax subsidies will be set based on a person's income level, his or her location and age. Subsidies will be greater for older Coloradans. A single person making from 133 percent to 400 percent of the federal poverty level will be eligible for a tax subsidy. A person making less than 133 percent of the federal poverty level will be covered by Medicaid, he said. The 133 percent-of federal-poverty-level amount is about $13,000 for a single person.

An example from the U.S. Treasury Department: A family of four with an income of $50,000 would be expected to pay no more than $3,570 toward health insurance, under new rules. If a health insurance plan on the exchange turns out to cost $9,000, then the family's subsidy would be $5,430 ($9,000 – $3,570).

How do you receive the tax subsidies? The tax subsidy on health-insurance premiums bought through the exchange can be received every month starting Jan. 1, 2014. Subsidies also can be received through tax returns filed at the end of the year.   Please scroll down to the bottom of this page to see an example subsidy chart for individuals and families.  This is subtracted off your premium.

Please Note:   Qualifying for the subsidy requires you to APPLY FOR MEDICAID through PEAK and get DENIED by PEAK.  The process is 45 minutes to an hour online to fill out the required data and then 2 weeks to 45 days until you can APPLY for medial coverage with the allowable subsidy amount

Can I purchase through Connect For Health Colorado if I have coverage through my Employer?  You can shop through the Marketplace but unless your coverage is considered unaffordable, you will not be eligible for the financial assistance through the Connect for Health Colorado Marketplace.   Premiums are considered unaffordable if they are more than 9.5% of your wages.

To figure out if our company's insurance is more than 9.5% of our income, is that the quote for just my husband or with everyone added onto the policy? It is affordable for just him but once he adds me it is more than 9.5%. No, It would be just the employee only.

Tax credit calculations are based on your Modified Adjusted Gross Income. That is your Adjusted Gross plus foreign income, tax exempt interest and non-taxable social security benefits.

How to Qualify For the Subsidy and Not Get Kicked Into Medicaid  Medicaid is expanding its coverage for adults without kids and parents who have kids on Medicaid. You could be eligible for new coverage beginning in January if you earn less than $1,250 a month. You can apply starting in October.

To qualify for the subsidy, you MUST apply for Medicaid FIRST.   Once you apply you will either get an approval immediately, a denial immediately from the PEAK Medicaid site or you can get a pending status with a tracking number where Medicaid will send them a letter will let them know if they are approved or denied.  This is a few weeks to 45 days.  For individuals $15,000 and under and some who make they will be in Medicaid.  Medicaid will be asking about household family members, employment.  It's rare to get approval or denial immediately.   You need to fill out the Medicaid application ASAP so there is time to get qualified.  $18,000-$20,000 input of income is probably the lowest you can put on the app to not get kicked into Medicaid.  For couples or single parents, earned income of over $30,000 should qualify for a subsidy and not get kicked into Medicaid.  For families with 2 adults and one child over $37,000 and for families with 2 children (4 household) over $44,000 income will get you a subsidy and not kick you into Medicaid.  For 5 household $52,000,   6 in the household $60,000

Information will confirmed by the IRS.  This just based on EARNED income for 2014 (estimated), use your 2013 earned income to get a ball park figure.   This does not include savings and investments.  For instance, someone taking early retirement and drawing an "income" from retirement funds, that is their "earned income".   A business startup that is not taking salary at the beginning of the year but will take income that over the 2014 plan year is over these amounts will qualify for a subsidy.

How does the subsidy work for a family where one spouse is covered at work?  How do we input the data?  If the employer offers coverage to the family that is affordable, then they are not eligible.  If it's not affordable through the spouse's employer, and you have a family of 4, you would input one spouse, plus two children or three to get the subsidy amount that amount that will be applied.

What if I don't make enough money to have to file taxes or a tax return, will I still be eligible for financial assistance?  

Yes. You can receive the advanced premium tax credit if you haven't paid taxes in the past or have not earned enough money to file taxes or a tax return. However, if you receive the tax credit, you will need to file a tax return the following year.

If a customer is determined eligible for Medicaid or CHP+ can they chose to purchase a private health insurance plan through the Marketplace? Individuals may dis-enroll from Medicaid or CHP+ and purchase a health plan through the Marketplace. However, these individuals will not be eligible to receive tax credits or cost sharing reductions to help lower their costs of coverage.

I am experiencing technical problems with the Colorado Healthcare Exchange?  What's going on and can you help me?  The exchange is new, it's clunky and has numerous problems with error messages.   There have been statements made on CNN and Fox News that nationally, it's questionable about what is going on with the data that has been entered.  It's one of the reasons you want to have a broker involved as an extra person to make sure your coverage is entered and approved.  The broker will make sure that your coverage is in place and follow up with the exchange to get reports on approval for coverage, proof of coverage and making sure you get your new insurance ID card.

When is open enrollment for Individuals?  For coverage starting in 2015, the Open Enrollment Period for Individual/Family Coverage is November 15, 2014–February 15, 2015. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events

I have a health condition.  Can I qualify now?   If you have a health condition you and you have a qualifying event you may be able to enroll outside of open enrollment. Otherwise you can enroll for 2015 during open enrollment. You may enroll GUARANTEE issue with NO Health questions.

I am on Specialty Level Medications or Injectables.  How will they be covered?   Please check the Prescription Formulary for the insurance plan you are evaluating.  If you are taking a tier 4 or tier 5 level medication some of the new insurance plans both inside and outside the exchange have a CLOSED FORMULARY.  If the medication is not listed, it's NOT covered.   Please, please make sure your meds are covered by that insurance company before you enroll for 2014.

I am on maintenance drugs for: Asthma, Allergies, High Cholesterol, Menopause, Diabetes, etc.   What limitations do I have when I pick a plan?   Anthem Clear Protection is Generic Only. Some of the other plans are Generic (Tier 1) only.  This means after the Rx copay for generic, Tier 2-5 drugs are NOT COVERED on a plan that says "GENERIC ONLY".  Please be aware as you pick a plan.    If you choose a plan with Deductible and co insurance and no Rx copay plan, your Rx will be under that deductible.  For example the Asthma drug Advair might cost $400  with a contract amount from the insurance company might be $180 which would apply toward combined and Medical/Rx deductible.  Several of the health insurance plans both on and off the exchange say N/A for Tier 5 drugs.  This means it's not covered and you need to find a different health insurance provider.

I have an HSA now and may switch to a non HSA plan what happens to the money in my account?  You can keep the account but it's not tied into a plan.  The bank will audit.  If there is no medical plan associated with the account, it may be converted to a regular savings account. You cannot fund the account but can spend the funds down to zero for qualified expenses for any qualified medical expense billed by the MD or hospital but not towards the deductibles or co-pay.  You use this instead of your copay or deductible until the account is emptied out.

Are Smokers charged more for health insurance?   Each family member who smokes will have a smokers load on their rates.   Anthem will load 10%, all others are loading 15% on their rates.

What health insurance companies are on the Colorado Healthcare Exchange?

  • All Savers Insurance Company (Individual) New
  • Anthem (HMO Colorado and Rocky Mountain Hospital & Medical Service) (Individual & Small Group)
  • Cigna Health and Life Insurance Company (Individual) PPO
  • Colorado Choice Health Plans (Individual & Small Group)
  • Colorado Health Insurance Cooperative (Individual & Small Group) PPO and EPO utilizing Cigna (Gold Plans) and Cofinity Networks
  • Denver Health Medical Plan HMO (Individual)   (note this is limited to Denver Health and associated hospitals)
  • Kaiser Foundation Health Plan of Colorado HMO (Individual & Small Group) (note this is limited to Kaiser clinics and Kaiser contracted hospitals)
  • New Health Ventures HMO (Individual)
  • Rocky Mountain HMO (Individual & Small Group)
  • Rocky Mountain Health Care Options (Small Group) PPO 2+ employees

What health insurance companies are writing coverage OUTSIDE the Colorado Healthcare Exchange?

  • Anthem PPO and HMO
  • Assurant  (Individual/Family) and Partially Self Funded 10+ Groups utilizing Aetna and Cigna Networks
  • Cigna PPO Individual/Family and Groups of 20+
  • Colorado Health Insurance Cooperative
  • Rocky Mountain Health Plan  (Individual and Group-HMO and PPO)
  • Kaiser Permanente HMO (Individual and Group 2+)
  • Humana Individual and Group (HMO and PPO)
  • Golden Rule Individual/Family (United Healthcare Network-PPO)
  • United Healthcare HMO/PPO

I live in outside of the Denver/Colorado Springs area.  What are my choices?  Anthem HMO and RMHP HMO for individuals.   Anthem HMO and RMHP HMO and See Change PPO for Groups.   If you currently have a Cigna individual plan and "early renew" for 12/31/13, Cigna will allow you to stay on the plan but they are not selling Cigna Individual in 2014 outside of Denver and Colorado Springs metro counties.

Anthem HMO and RMHP HMO for individuals are statewide.   Anthem HMO and RMHP HMO and See Change PPO for Groups.   If you currently have a Cigna individual plan and "early renew" for 12/31/13, Cigna will allow you to stay on the plan but they are not selling Cigna Individual in 2014 outside of Denver and Colorado Springs metro counties.

Colorado Health OP is Colorado's new Health Cooperative with  PPO/EPO  PPO Networks:  Cigna for GOLD plan and  Cofinity Network for Bronze and Silver plans (Cofinity is Aetna).    The EPO will have their provider spend more time with you.  EPO is a smaller network that is only available in Arapahoe, Boulder, Broomfield, Clear Creek, Denver, Douglas, Gilpin, Grand, Jefferson, La Plata, Larimer, Logan, Morgan, Park, Summit and Weld counties.  EPO works like an HMO has NO out of network coverage, but you may choose a specialist without permission from a PCP.  Out of network and out of state is considered out of network unless it's an emergency, just as it is with any HMO.  This may not be appropriate for folks with children who live out of state.  Chiropractic is covered if it's a Cigna or Cofinity network provider depending on the network as an "other office visit" copay

How Do I Find Out If My Doctor is In The Network?  Don't assume that your MD is in the network in 2014 if you stay with the same insurance company.  A switch to the exchange and/or individual plans outside of the exchange may have a different network that is smaller than the network used in 2013.

Anthem Blue Cross and Blue Shield / HMO Colorado  Individual HMO Exchange,  Exchange/Non Exchange Individual/Group HMO/PPO

Cigna  Individual Only PPO Exchange/Non Exchange

Colorado HealthOP Exchange/Non Exchange Individual/Group EPO/PPO Utilizes the Cigna Network for GOLD plans and Cofinity Network for Silver and Bronze Plans

Denver Health Medical Plan  Exchange/Non Exchange Individual/Group

Humana   Individual HMO Exchange, Non Exchange Individual/Group HMO, PPO

Kaiser Permanente

Rocky Mountain Health Plans Individual HMO Exchange, Non Exchange Individual/Group HMO, PPO

SeeChange Health   Group 2+ Exchange/Non Exchange  Utilizes the Cigna Network

United Healthcare   Group 2+ Non Exchange  UHC

Access Health Colorado   Medicaid/Medicare and CHip

Colorado Choice Health Plans   Outside of Front Range

All the questions about health insurance and health care reform have me thinking about all of my coverage.  What other options are available to help my family and I round out our coverage and fill the gaps?   As your broker, we can look at all the coverage you currently have in place and supplement your health insurance where needed.  Items we think should be reviewed/audited yearly:

  • Are you and/or your children active in sports, sports leagues, skiing, mountain biking, dirt biking, etc?  Have you experienced a sports injury? What did you pay for a broken bone or surgery for a torn ACL?  Accident coverage is inexpensive and helps pay your deductible with the high deductibles on these new health insurance plans.  We have plans that cost around $1/day and can cover those big bills.  A broken bone and minor surgery can easily set you back $7500-$12,000 (dedutible/coinsurance)
  • Do you have adequate life insurance in place?   A good rule of thumb is to have a minimum of ten times your salary and if you plan on sending kids to college and your spouse does not have nearby help should something happen to you, I like to use the rule of $500,000 to $1 million for each child you have to fund care and the income lost over the many years you are gone to take care of that college funding.  (ASK STACEY her personal story of a friend in Texas and how $1 million gave one of her closest friend's the ability to grieve and take care of two bright girls (that are on a path to Hollywood today with one in an ABC Family movie this fall) when she was unable to find a job after a lay off and her ex died in a tragic DUI hitting him).
  • Do you have disability coverage?  SSDI does not kick in unless you are almost a vegetable and can take 2 years to qualify for usually a $800-$1000 amount.  Can you live on this?
  • Does cancer, heart disease or diabetes run in your family?   Critical Illness coverage is a popular option to help cover high deductibles and cover the cost of non medical items, travel for treatment and the peace of mind to have extra cash on top of your (60%) short term disability payment to pay your mortgage and utilities while you recover.   For a low cost you can cover you and your family and if you die of other causes, one of our plans PAYS BACK ALL PREMIUMS…so you never lose.
  • Are you over 50 and have you experienced the cost of and extended care facility with a parent or grandparent?  It's over $70,000 a year today.  There are some great options that you can lock into with hybrid products that combine life insurance and long term care and help protect your nest egg.
  • Do you have a health condition and know you can't qualify for life insurance or long term care coverage?   We have excellent short term care policies that are under $1 a day in cost that pay a daily benefit for home health care only for one year and the app doesn't ask a lot of questions.  Your health insurance has limited home health care, nursing and rehab that is usually to 15 days.  What will you do when that runs out?

Small Business SHOP Group Plans For 2-50 Employees:

How much is the tax subsidy for health insurance coverage for small businesses?

Employers with 25 or fewer employees who make an average of $50,000 or less per employee can receive up to a 50 percent tax subsidy for their contributions to an employee health plan. Employers with the fewest employees and the lowest average salaries will benefit the most from the federal tax subsidies. A  Small Business Tax Credit Calculator to help you get a better idea of how it will work. Please call 303-471-9424 for a copy.

I have a Small Group with Less than 25 employees and qualify with most of our employees making an average wage under $50,000.  How do we benefit with a group plan through the SHOP vs. letting our employees purchase with a subsidy?That's where a picking a broker who understands employee benefits is crucial.  The broker can do a comparison and look at how individual coverage with subsidy compares with small group coverage inside the exchange. Although it may look better for some employers with extremely low wage earners to have their employees purchase with a subsidy through the individual exchange, take a look at both sides.

Before you decide to "dump" your current small group insurance plan or if you are a start up that was thinking of adding small group health insurance think about a couple of items:

     1. A group plan is more benefit rich and compared with individual plans on the exchange offers more options to your employees.  Currently, there is only ONE PPO option on the individual exchange, all other plans are HMO only.   The individual exchange offers a "thinner" network of doctors and hospitals compared with group insurance plans and plans outside of the exchange so will limit coverage and care to employees.

     2.  A small group health plan will help you to attract and retain quality employees and compete with larger businesses for these employees.   A small group health plan shows current and new employees that you care about them.

How does the SHOP tax deduction work and do we have to purchase through Connect For Health Colorado?   The credit is available only for plans purchased through SHOP exchange. Businesses will qualify for the tax credit based on their annual wage base and number of employees.  Businesses still can deduct the rest of premium costs not covered by the tax credit from its annual tax bill.   With that said, if your group does not qualify for tax credits, make sure you purchase direct through a broker.   There are numerous issues with purchasing through Connect For Health Colorado if you don't need to purchase through them.

Why work with a broker?  A group must work through a certified broker on the exchange for coverage beginning on Jan. 1, 2014.  All Colorado brokers work through one of two managing general agencies that have a slick software program (that have been creating these group quotes for many years) that will take your census data and provide a quick spreadsheet of plans designs and premiums with links to brochures embedded in the spreadsheet to make it easy for you to choose.  The two MGA's have been certified by the Colorado Healthcare Exchange (along with their brokers) and have been assigned this task to take the load off of the staff at the exchange as they are experienced and provide an excellent experience for small groups. Connect For Health Colorado will ask all employer groups to pick a broker (please pick us!) to get a group quote.

The broker will listen to what you want to offer (PPO vs. HMO, your past experience with insurance companies, etc) and narrow this down before sending it to you because there are over 100 options and it can get confusing. Starting in 2014, only small businesses with 50 or fewer full-time employees are eligible, but in 2016, businesses with 100 FTEs can apply for insurance through SHOP.   If you do not qualify for the Colorado Health Care Exchange the broker will find you other small group options through their MGA.  This would be a wage base of over $50,000 a year (example: group of mostly doctors or IT professionals).

Coverage must be offered to every employee who works full-time, under the federal rules, which considers full-time as anyone working 30 hours or more a week.

How do I know if the business will receive a tax credit?    Small businesses with fewer than 25 full-time employees who earn about $50,000 a year or less are eligible for the credit. Businesses must pay at least 50 percent of premium costs, but are not required to offer coverage to part-time workers or any family members.    Nonprofit organizations receive a 35 percent tax credit and only businesses purchasing through the SHOP marketplace are eligible.   Tax credits are highest for companies with fewer than 10 employees who earn an average of $25,000 or less. The smaller the business, the bigger the credit.

Which companies are writing Small Group Health Insurance in Colorado?   

In the Denver Region: (1) Humana’s HMO-new!, (2) Kaiser Permanente HMO, (3) CO Choice-new!, (4) Humana’s PPO, (5) Anthem Blue Cross HMO/PPO, (6) COOP-new!, (7)  Rocky Mountain Health PPO and HMO(8)) United Healthcare PPO and HMO.

In the Boulder Region: (1) Kaiser Permanente, (2) Anthem Blue Cross, (3) COOP-new!,  (4)Humana, 5) Rocky Mountain Health, (6) United Healthcare.

In Summit County   (1) Rocky Mountain Health Plan (2) Anthem Blue Cross   (3) Colorado HealthOP New

Which Insurance Companies will offer a PPO Option on the Colorado Health Care Exchange SHOP for Small Groups?   At this time, See Change is the only PPO and they utilize the Cigna network.  All other plans on the SHOP are HMO or HMO Hybrid plans.

What other options are available to provide corporate benefits to help me retain and attract employees?  When an employer installs a small group health insurance plan, dental, vision and group life are easier to add and there are less pre-existing limitations for some coverage's in a group environment.

I have a young, active and healthy group of employees with no major health conditions.  We have had group health insurance for a few years but find the rate increases to be outrageous.  What can we do to minimize our costs?   We have creative products for healthy groups who are able to "medically qualify" for a partially self-funded health insurance plan.  Premiums can be 10-30% less than the guarantee issue plans on the fully insured market and if you have a year with few claims, you may qualify for a "participation in the claims fund" in the form of a refund of some of the claims part of the premium or a premium holiday for employees.  This option is only useful for HEALTHY groups who can make it through medical underwriting and have over 10 employees.

How do businesses receive tax subsidies? Business tax credits related to health insurance coverage already went into effect in 2010 and were up to 35% for qualifying small businesses with employees who make less than $50,000 a year and less than 25 employees.  For 2014, the tax credit is 50%. Business owners apply for those tax credits when they file their annual tax returns.

What if my business already offers health insurance to employees?   Businesses that already offer health insurance can keep the coverage they currently offer. However, those with 50 or fewer full-time workers can offer a plan via the marketplace instead. Tax credits are only available to businesses who receive coverage through SHOP.   Employees can buy health insurance through the marketplace, but if their business coverage is considered both affordable and meets minimum value, they will not be eligible for federal subsidies, and the business will not have to pay the Employer Shared Responsibility Payment.

What should businesses tell employees about the marketplace?  Companies covered by the Fair Labor Standards Act must provide a written notice to employees before Oct. 1. The notice should include information about the marketplace. If employees might be able to get lower costs on insurance by using the SHOP marketplace and if they buy insurance through the marketplace, they’ll lose the employer contribution to their health benefits.

How do employees sign up for SHOP?   Once an employer chooses SHOP coverage through their Colorado Healthcare Exchange broker, employees can sign up for it online through the marketplace. There are tools to help create an employee roster and set up an email distribution list notifying employees about the coverage.    Employees must verify personal information and review the plan. Employees can see how much they will pay every month, their deductible and their out-of-pocket costs.    .

What if I’m self-employed?   People who are self-employed with no employees can use the individual marketplace for insurance coverage.   Business group of "one" is no longer available after 1/1/14 because of the availability on the exchange.    The federal government considers a person self-employed if he or she runs an income-generating business but has no other employees. Independent contractors do not count as employees, under federal guidelines. And there are new options under the ACA. Starting Oct. 1, people who are self-employed can go to Connect for Health Colorado to compare features of plans, determine premiums, deductibles and out- of-pocket costs before enrolling. No one is denied coverage based on pre-existing health conditions.   People with individual insurance policies might be able to switch to a marketplace plan. Based on annual income, the monthly premiums could be lower

If a small employer reports that their business has grown since they created their Small Business account, which now makes them ineligible, will they be kicked out of Marketplace?  

As long as employers meet the criteria for eligibility when they join the Marketplace, they will still be eligible regardless of subsequent growth. How much must an employer contribute to get the tax credit for starting or moving a small group to the SHOP?   In the Small Group employers are required to contribute at least 50% of the premium cost or $125.00 minimum, whichever is less.   An employer may also pay up to 100% of the premium for the employee and they may qualify for up to a 50% tax credit based on the number of Full Time Equivalent Employees and average wage base. Can we offer our group coverage to 1099 employees?   Only Anthem and Humana allow this on a group plan and you must have W2 employees to start.  

Individual/Family Tax Subsidy Chart Based on Your 2013 Earned Income (Modified Adjusted Gross Income)  Please note the figures below are averages that are not exact premium amounts and differ based on deductibles, co-insurance, age, smoking status and county.

  FPL 2013
  100%* 133% * 150% 200% 250% 300% 350% 400%
2013 Household Income  $11,490 $15,282 $17,235 $22,980 $28,725 $34,470 $40,215 $45,960
% of Income Premium Capped at: 0% – 2.0% 0% – 3.0% 4.00% 6.30% 8.10% 9.50% 9.50% 9.50%
Max Amount of Monthly Premium $0 – $19 $0 – $38 $57 $121 $193 $273 $318 $364
Average Silver Monthly Premium  $321 $321 $321 $321 $321 $321 $321 $321
Average Silver Annual Premium $3,852 $3,852 $3,852 $3,852 $3,852 $3,852 $3,852 $3,852
Federal Tax Subsidy (Monthly) up to $302 up to $283 $264 $201 $129 $49 $3 $0
Monthly Premium Cost $0 – $19 $0 – $38 $57 $121 $193 $273 $318 $321
Annual Premium Cost $0 – $228 $0 – $456 $684 $1,452 $2,316 $3,276 $3,816 $3,852
Penalty for Individuals Not Covered
Annual Penalty 2014 $115 $153 $172 $230 $287 $345 $402 $460
Annual Penalty 2015 $325 $325 $345 $460 $575 $689 $804 $919
Annual Penalty 2016 $695 $695 $695 $695 $695 $862 $1,005 $1,149

* This amount will depend on whether your state participates in Medicaid expansion.  

Health Insurance Tax Subsidy Chart: Family of Four

This chart provides tax subsidy and premium estimates for a family of four with two 40-year olds, and two children ages 21 or under. (Note: These are estimates only, and the premium amounts will vary by state. See sources below.)

  FPL 2013
  100% * 133% * 150% 200% 250% 300% 350% 400%
2013 Household Income  $23,550 $31,322 $35,325 $47,100 $58,875 $70,650 $82,425 $94,200
% of Income Premium Capped at: 0% – 2.0% 0% – 3.0% 4.00% 6.30% 8.10% 9.50% 9.50% 9.50%
Max Amount of Monthly Premium $0 – $39 $0 – $78 $118 $247 $397 $559 $653 $746
Average Silver Monthly Premium  $962 $962 $962 $962 $962 $962 $962 $962
Average Silver Annual Premium $11,544 $11,544 $11,544 $11,544 $11,544 $11,544 $11,544 $11,544
Federal Tax Subsidy (Monthly) up to $923 up to $884 $844 $715 $565 $403 $309 $216
Employee's Monthly Premium Cost $0 – $39 $0 – $78 $118 $247 $397 $559 $653 $746
Employee's Annual Premium Cost $0 – $468 $0 – $936 $1,416 $2,964 $4,764 $6,708 $7,836 $8,952
Penalty for Individuals Not Covered
Employee's Annual Penalty 2014 $285 $313 $353 $471 $589 $707 $824 $942
Employee's Annual Penalty 2015 $975 $975 $975 $975 $1,178 $1,413 $1,649 $1,884
Employee's Annual Penalty 2016 $2,085 $2,085 $2,085 $2,085 $2,085 $2,085 $2,085 $2,355

Modified Adjusted Gross Income (MAGI) =  

Line 4 on a  Form 1040EZ
Line 21 on a Form 1040A

Line 37 on a Form 1040


  • Wages, salaries, tips, etc.
  • Taxable interest
  • Taxable amount of pension, annuity or IRA distributions and Social Security benefits
  • Business income, farm income, capital gain, other gains (or loss)
  • Unemployment compensation
  • Ordinary dividends
  • Alimony received
  • Rental real estate, royalties, partnerships, S corporations, trusts, etc.
  • Taxable refunds, credits, or offsets of state and local income taxes
  • Other income


  • Certain self-employed expenses
  • Student loan interest deduction
  • Tuition and fees
  • Educator expenses
  • IRA deduction
  • Moving expenses
  • Penalty on early withdrawal of savings
  • Health savings account deduction
  • Alimony paid
  • Domestic production activities deduction
  • Certain business expenses of reservists,performing artists, and fee-basis government officials
Note: Do NOT include Supplemental Security Income (SSI), Veterans’ disability payments, workers’ compensation or child
support received. Pre-tax contributions, such as those for child care, commuting, employer-sponsored health insurance,
flexible spending accounts and retirement plans such as 401(k) and 403(b), are not included in AGI but are not listed above

because they are already subtracted out of W-2 wages and salaries

Add back certain income:
  • Non-taxable Social Security benefits (Line 20a minus 20b on a Form 1040)
  • Tax-exempt interest (Line on 8b on a Form 1040)
  • Foreign earned income & housing expenses for Americans living abroad (calculated on a Form 2555)


  Health Insurance Companies with Approved Plans for 2014 in Colorado  
  Exchange Only:    Individual Exchange Only: Small Group Non-Exchange: Individual Non-Exchange: Small Group Both: Individual Both: Small Group
All Savers Insurance Company 9 plans          
Cigna Health and Life Insurance Company         11 plans  
Colorado Choice Health Plans       2 plans 12 plans 10 plans
Colorado Health Insurance Cooperative, Inc. Cigna Network GOLD Plans, Cofinity Network Silver and Bronze Plans 2 plans       6 both 6 plans
Denver Health Medical Plan, Inc. 4 plans          
HMO Colorado Inc. (Anthem) 14 plans 3 plans 15 plans 22 plans    
Humana Health Plan Inc. 7 plans   12 plans      
Humana Insurance Company     10 plans      
Kaiser Foundation Health Plan of Colorado 27 plans 24 plans 27 plans 42 plans    
Kaiser Permanente IC        1 plan    
New Health Ventures, Inc. 6 plans          
Rocky Mtn. Hospital & Medical Service Inc., DBA Anthem BCBS   2 plans    47 plans    
Rocky Mountain Health Maintenance Organization 18 plans       34 plans 30 plans
Rocky Mountain HealthCare Options, Inc.           14 plans
Time Insurance Company (Assurant) Cigna and Aetna PPO Network     32 plans      
SeeChange Health Insurance Company, Inc. Cigna PPO Network       6 plans   3 plans
UnitedHealthcare Insurance Company        65 plans    
UnitedHealthcare of Colorado        18 plans    
Golden Rule (United Healthcare Network)     4 plans      
Note:  Coverage by insurance company for individual or small group may not be available in every county due to network availability and insurance company decision to write coverage in that county.  The chart above represents most of the Front Range counties..