Individual Health Insurance

As a reminder, the 2025 Open Enrollment Period for the Affordable Care Act (ACA) Health Insurance Marketplace is November 1 through December 15, 2024 for a January 1 effective date, and from December 16 to January 15 for a February 1 effective date. Anyone looking to enroll, re-enroll, or opt out of private health, vision, and dental insurance plans for 2024 must do so during this time period. After the Open Enrollment period closes, changes can only be made by those who experience a qualifying life event such as marriage, birth of a child, or job loss.

What is the marketplace? The Affordable Care Act of 2010 mandated that all Americans be enrolled in health insurance. The marketplace platform was created to allow individuals, families, and small businesses to acquire affordable health insurance. Until 2019, anyone without coverage was forced to pay an Individual Shared Responsibility Payment. This fee has since been abolished, allowing Americans to opt out of health insurance without being penalized.

 Eligibility - Many get health insurance through an employer’s group health insurance plan, Medicare or Medicaid. If you don’t qualify for insurance through these three methods, you can buy private insurance through the marketplace or, if you are not eligible for subsidies, we can assist with getting you individual coverage outside the marketplace. Anyone who has recently retired, turned 26, become unemployed or self-employed, started working part-time, or started a business with employees is more likely to want or need private coverage.

Connect for Health Colorado® ( https://planfinder.connectforhealthco.com/home ) is Colorado’s official health insurance marketplace, and the only place to apply for financial help to reduce your monthly health insurance costs. The financial help you can get through Connect for Health Colorado to lower your monthly payment is called a Premium Tax Credit. Coloradans that qualify for financial help may also qualify for healthcare discounts, called cost-sharing reductions, that lower the amount you pay when you use your plan. Healthcare discounts are available on silver level plans sold through Connect for Health Colorado.

Aspen Financial & Insurance Services (https://www.afiscolorado.net) is a Connect for Health Colorado Enrollment Center in the Airport Business Center in Aspen with certified brokers to recommend a health insurance plan based on your specific needs, help you apply for financial help, and help you sign up for that plan. All health insurance plans sold through Connect or Health Colorado cover essential health benefits and you cannot be charged more or prevented from getting the care you need because of a pre-existing condition. 

Connect for Health Colorado offers health insurance plans from the following companies depending on where you live:

• Anthem
• Cigna (not available in the Roaring Fork Valley)
• Denver Health Medical Plan (not available in the Roaring Fork Valley)
• Kaiser Permanente (not available in the Roaring Fork Valley)
• Rocky Mountain Health Plans/United HealthCare
   

Re-enrollment - If you’re enrolled in private insurance through the marketplace, some people will be eligible for automatic re-enrollment. However, you might not be eligible to automatically renew, or your current plan is not being offered in 2025. Be aware that some of the coverage options provided and their costs vary year-to-year. Be sure to examine the types of coverage available for 2025 to choose one that offers the features you need at the best price.

 Opting Out - Though the Affordable Care Act no longer requires Americans to have health insurance coverage, consider the potential cost-savings an insurance plan can have before opting out. Medical bills from illness and accidents can be catastrophic to finances. Also, you can take advantage of routine preventative care, which helps to uncover problems early before they get more expensive. These are important to consider if you weigh the pros and cons of going without coverage.

Medicare

Medicare can be complicated to sort through, there are many options and choices available to suit different needs. To make it simpler, the program has been broken down into four basic parts. As you think about how Medicare will cover your health care needs, one of the major decisions will be whether to enroll in federally run Original Medicare or select a Medicare Advantage plan, the private insurance alternative.

For most individuals, knowing which parts to enroll in can be difficult to determine so here is an overview of each plan:

Part A – Hospital Coverage: This covers inpatient hospital stays, hospice care, and qualified nursing care that individuals may need after suffering a serious health issue or injury that requires rehabilitation or short-term nursing care.

Part B – Doctor and Outpatient Services: Includes routine doctor visits, lab tests, preventive medicine, medical equipment, ambulance transportation, x-rays, and some outpatient prescription drugs.

Part C – Medicare Advantage: Medical Health Plans for purchase through private insurers that contracts with Medicare to provide at least all of the services provided in Part A and B with additional offerings such as dental, vision, hearing, or prescription drug coverage. The coverage and cost vary from plan to plan.

Part D – Prescription Drug Plan: Drug insurance plans purchased through private insurers designed to help cover the cost of prescription medications. What types of medications are covered are determined by a formulary published by the federal government that is subject to change every year. Part D plans cover both generic and name-brand medications, with limitations. Some medications aren’t covered, in that event, an exception can be filed but there is no guarantee it will be granted.

The key to Medicare is to determine the Medicare coverage choices that work for your health care needs and budget. If you have questions on planning for your retirement health care costs, please don’t hesitate to reach out. We’re always here to answer your questions or address your concerns.