Tips: Colorado open enrollment for Medicare

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HMO, PPO, EPO, and POS are just a few of the specialist terms an insurance buyer should get to know as they dive into Colorado’s open enrollment season. Source: Getty Images.

It’s the season, but not necessarily to be cheerful – unless you’re genuinely interested in analyzing the pros and cons of health plans during Colorado Open Registration.

Yes, Medicare open enrollment season is upon us in Colorado. For those benefiting from an employer-sponsored health insurance plan, this is an opportunity to re-evaluate the costs and benefits of your current workplace offerings. Those enrolled in the state’s Connect for Health Colorado health insurance exchange have even more choices to browse during Colorado’s open enrollment period from Nov. 1 to Jan. 15. Even if you like your current coverage, be sure to re-register. .

Before I share some tips on choosing the right plan, a quick note: if you’re looking for coverage through State Exchange and want a plan that includes UCHealth, CU Medicine, and other affiliates in the network, you’ll have two options for the 2022 plan year: Anthem Pathway and the new Oscar Colorado Partners Choice, which are available in the Denver metro area. For more information on selecting a plan through Connect for Health Colorado, click here.

How to choose health insurance

Now, on to choosing the right plan for you and your family. Generally speaking, it is a process that involves balancing the amount of care you think you need with what you are willing or able to spend on that care. The “amount of care” is defined by the size of the network of health care providers from which to choose; the flexibility to go directly to a specialist without a primary care referral; the extent of drug coverage; and the frequency, extent and duration of the care covered by the insurance.

How to decide on health care needs when choosing a plan

First, understand your own health care needs. Are you using expensive drugs? Do you need a lot of care? Are you expecting a baby? Do you need surgery? Do you have a chronic illness? Has there been a diagnosis of cancer? Do you have young children who just might end up with some sort of gross injury or on the playground? Are you traveling abroad (and would you like to be covered if something happens there)?

Understanding health plan providers and networks

Second, determine if you have any preferred vendors – the ones who know you well and trust you – and if those vendors are part of the networks you’re considering. This includes your primary care physician and all your specialists, as well as your preferred hospitals, ancillary sites, and clinics. If these providers are off-grid, your insurance plan may not cover them.

How to choose the right health insurance

Third, with the above in mind, think about which category of health insurance plan you are interested in. This step will include price tags and allow you to start comparing costs. Health maintenance organizations (HMOs) require you to stay networked for everything except emergencies and typically require referrals for specialist care, but tend to be less expensive. Preferred Provider Organizations (PPOs) have larger provider networks, do not need referrals for specialist care, and allow you to exit the network for care (although this is more expensive than network care) . Point of Service (POS) plans that combine aspects of HMOs and PPOs are less common.

Compare health insurance plans

Fourth, once you’ve figured out your own likely medical needs and an approximate range of costs you’re willing to shoulder, it’s time to start targeting specific plans. This involves comparing what you are likely to spend on fixed monthly premiums with what you can or cannot spend on your care depending on how much care you actually need.

“Look at the total aggregate cost,” said Brandon Elliott, director of hospitalization and transplant contracts at UCHealth. “You have to compare the costs between the plans, including premiums, deductibles, co-payments and coinsurance. “

Finding a balance between costs and coverage

There is no one-size-fits-all formula here, although in general it’s safe to say that those who need consistent care, frequent specialist visits, or expensive drugs are probably better off spending more on premiums to minimize deductibles, co-payments and disbursements. maximum.

For the rest of us, the decision to buy health insurance is trickier and, assuming your budget can handle more than the most basic options (low premiums, high deductibles, and high caps), the right one. your plan will depend on your overall health, your habits, and your tolerance for risk.

A young, healthy person who may not need a doctor’s visit more than once a year could be seen as a lock in for a high-deductible, high-maximum diet. But that same person can also be an avid snowboarder. Take an advantage and this high deductible plan doesn’t sound like such a good deal anymore.

There is also the question of the level of care and the costs associated with the unexpected. If a snowboarding accident results in the need for a complex wrist reconstruction and the services of a bursary-trained orthopedic surgeon specializing in the procedure you need for a full recovery are out of the network, you may be forced to pay thousands of dollars out of pocket.

You might not be snowboarding, but you probably drive a car. Playing the odds can save you a bundle. If you’ve reasonably assessed your medical needs, budget, and lifestyle, you can position yourself to find a healthy balance between health insurance coverage and cost. If that’s not reason enough to be happy, it should at least bring peace of mind.


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