The state of Colorado’s program for the sick and high risk is called CoverColorado. By being a high-risk applicant, you may still be accepted by insurers under the federal health reform law, but plans still aren’t designed to cover everything you may need if you have a condition. In this case, CoverColorado is a great alternative. Additionally, Coloradans who have lost their group coverage and exhausted COBRA or other continuation benefits (HIPAA-eligible) can apply for health insurance with CoverColorado. There is also another plan for those who are under age 65 and do not have access to Medicaid supplement plans apart from open enrollment periods.
CoverColorado plans are administered by the state’s regional insurer, Rocky Mountain Health Plans, who also offers private coverage, Medicare, and Medicaid plans. There are eight different plans to choose from, all of which provide the same level of coverage. Members are provided with a choice of deductibles, coinsurance and out of pocket limits to better fit their budgets. Those with medical conditions will not receive exclusions for any care they need related to that condition, though a six month waiting period applies. Those who are HIPAA eligible will not have a waiting period imposed on them. Overall, these plans are ideal for anyone who has not received the coverage they need from the individual market or lost coverage, keeping insurance affordable and within reach.
In order to qualify for CoverColorado, you must fit into one of the categories above, either having a medical condition, experienced a loss of coverage, or being Medicare-eligible. There are also several other ways to qualify. Firstly, you must be a resident of Colorado for at least six months, and legally present in the country or a U.S. citizen. Next, you must meet one of the following conditions:
After applying for a private individual health plan, you had one of the following experiences:
- Refused insurance due to a preexisting condition or health status. Include your notice of rejection with your application (must be dated within six months of applying for CoverColorado).
- Accepted for coverage through a private plan but rates were increased over the top amount charged by CoverColorado for a similar plan. Attach a copy of the premium bill (no more than 60 days old) to your application for CoverColorado.
- Coverage for certain types of care was excluded from your plan for at least six months after your application was approved. Include a copy of the insurer’s notice (not more than 60 days old from the day you apply for CoverColorado).
OR you have been diagnosed with one of the following medical conditions, and automatically qualify for a plan.
Loss of Individual Coverage
If you have recently had your coverage involuntarily canceled by an insurer for reasons other than not paying your premiums, you may qualify for CoverColorado. You must include a copy of the insurer’s termination letter from within 60 days before you apply for the high-risk pool. This applies to individual coverage only.
Those who are HIPAA eligible must meet each of these requirements:
- Most recent insurance was not canceled due to fraud or nonpayment of premiums.
- Can prove 18 months of creditable coverage, the most recent of which must be through an employer, government, or church policy.
- Have chosen to use COBRA or any other continuation coverage through the state, and exhausted those benefits.
- Not currently eligible for Medicare or Medicaid or have any other form of coverage – unless you are under age 65 and missed the Medicare supplemental open enrollment period.
Individuals can also qualify for CoverColorado if they are transferring from another state high risk pool, or if they qualify through the Trade Adjustment Assistance Act (TAA) Coverage/Health Coverage Tax Credit (HCTC). Those who have lost employment as a result of international trade and are Department of Labor Certified many also qualify.
Plans & Benefits
With eight comprehensive plans to choose from, all members receive the same benefits with different coinsurance after deductible, with the exceptions of 50 percent coverage for preexisting conditions. Plans also include a full range of prescriptions. Members may choose an HSA-qualified option with the $2,000 deductible plan, which can bring tax benefits and be a worthwhile investment. All plans cover preventive care at 100 percent, and you can receive care from any provider you like as there is no network. Primary care and specialist visits are covered for a copay, as are prenatal care and urgent care.
Lower deductible plans ($1,000, $1,500 and $2,000) have 80 percent coverage after deductible on most medical services like hospital care. Higher deductible plans ($3,000 to $10,000) cover 70 percent after deductible on a wide range of services. Both mail order and retail pharmacy options are available, with no additional deductible.
How to Apply
Make sure you have all necessary documents for your eligibility category prepared before you apply for CoverColorado. Also, decide which plan you want to apply for based on rates, affordability, and other considerations. Through the CoverColorado site, you can get a quote for various plans of theirs and find out which one suits you best. When applying online, you must print a copy to sign and date before submitting. You may also apply for GettingUSCovered, the state’s Pre-Existing Condition Insurance Plan, if you have been uninsured for six months and have a medical condition. GettingUSCovered has no waiting periods, as they already require you to be uninsured for six months.
Once you have completed your application, the hard copy with all required documents must be sent to CoverColorado by scan/email, fax, mail, or personal delivery.
Send your application to:
425 S. Cherry St..
Glendale, CO 80246
CoverColorado Customer Service: 888 770 1120
CoverColorado Enrollment Office: 866 787 9129