Frequently Asked Questions

What is the difference between group and individual health insurance?
What is an HSA?
What is an HMO?
What is a PPO?
What is a deductible?
Can there be more than one deductible in a year with an individual policy?
What is Coinsurance?
Are Prescription drugs covered under individual policies?
How long does it take to get an individual policy?
When can I contact someone at Colorado Affordable Health?
How much will you charge me for your help?
Will you meet with me in person?
What if I get declined after applying for an individual policy?
What is CoverColorado?
What is a pre-existing condition?

Question: What is the difference between group and individual health insurance?
Answer: In general Individual Health Insurance is less expensive than Group Health Insurance. The basic reason for this is that group insurers, due to Colorado State mandates, must, in most cases, insure all members of a group without regard to an individual’s health and personal history. As a group insurer knows that on average in any given group there will be members with heart disease, diabetes, cancer, etc, they have to charge premiums that will cover these eventualites.

When you apply for individual health insurance, most companies will look back 10 years into your personal and health history to make their decisions. If you have health or other issues, there is the possibility that the application could be “rated-up”, contain an “exclusion clause” or even be “declined”, due to what are called “pre-existing conditions.”

Think of it of like this: With individual health insurance, the insurance company gets to pick and choose to whom they will extend coverage. They select those who are healthy and present the lowest risk to the company; therefore the rates are much lower for an individual policy than for a group plan, where the company has to accept all comers.

Question: What is an HSA?
Answer: Operating similarly to IRA’s, HSA’s are tax-advantaged savings accounts for health care services.  A person must enroll in a qualified High-Deductible Health Plan (HDHP) before they can establish an HSA.

Question: What is an HMO?
Answer: This acronym stands for Health Maintenance Organization. HMO’s are prepaid, health benefit programs in which you’ll pay monthly premiums in return for managed coverage for your checkups, hospital stays, doctors' visits, surgery, emergency care, preventive care, lab tests, and X-rays. If you join an HMO, you will have to select what’s called a “primary-care physician” who will be responsible for coordinating your healthcare and making any referrals to specialists that you require. You’ll also have to use doctors, hospitals and clinics who are members of your HMO plan's network.

Question: What is a PPO?
Answer: A healthcare benefit arrangement designed to supply services at a discounted cost by providing incentives for members to use designated healthcare providers (who contract with the PPO at a discount), but which also provides coverage for services rendered by healthcare providers who are not part of the PPO network.

Question: What is a deductible?
Answer: A flat amount an insured must pay before the insurer will make any benefit payments. Usually, the higher the deductible, the lower the premium. Typical choices for deductibles on individual health insurance policies are $500, $1000, $2500, $5000 and $10,000.

Question: Can there be more than one deductible in a year with an individual policy?
Answer: It depends on which type of policy. Most standard individual health insurance policies will apply the deductible to each family member with a “stop loss” maximum two or three in any given year. HSA deductibles are usually cumulative, in that all family members’ expenses count towards the deductible total.

Question: What is co-insurance?
Answer: The percentage of each claim above the deductible paid by the policyholder. For a 20 percent health insurance coinsurance clause, the policyholder pays for the deductible plus 20 percent of his covered losses. After paying 80 percent of losses up to a specified ceiling, the insurer starts paying 100 percent of losses.

Question: Are prescription drugs covered under individual policies?
Answer: Many available individual health insurance offer prescription drug coverage with co-pays, but not all! Beware of purchasing a plan that does not offer this protection, as these costs, in the event of a catastrophic disease, can be excessive.

Question: How long does it take to get individual health insurance?
Answer: It all depends, if your family is relatively healthy and the insurance company doesn’t feel the need to look at your medical records, a decision on coverage can often be made in a day or two of the submission of an application. However, if the answers on your application cause the insurance underwriters to seek more information in the form of doctors’ or other types of records, it may take several weeks.

Question: When can we contact you at Colorado Affordable Health?
Answer: Our usual business hours are from 8:00 am to 6:00 pm, Monday through Friday. You are welcome to call (303-541-9533) or e-mail us charley@coloradoaffordablehealth.com. Or you can start the process yourself with a free online quote anytime by clicking this. Quote me now!

Question: How much will you charge me for your help?
Answer: Not a red cent! The insurance company pays our fee. It cost you no more to work through us.

Question: Will you meet with us in person?
Answer: You bet, we look for opportunities to get away from the desk and computer, meeting with people is the best part of the job! E-mail us at charley@coloradoaffordablehealth.com to request an appointment, or just give us call at 303-541-9533

Question: What if I get declined after applying for an individual health insurance plan?
Answer: Unfortunately this can happen. We often anonymously pre-screen pre-existing conditions with prospective health insurers to avoid this. However, should one of our clients get declined, we have often had success applying to other carriers who work with different guidelines.

Question: What is CoverColorado?
Answer: CoverColorado is a non-profit entity created by the Colorado Legislature to provide medical insurance for eligible Colorado residents who, because of a pre-existing condition, are unable to obtain coverage from private insurers. www.covercolorado.org.

Question: What is a pre-existing condition?
Answer: This refers to any healthcare issues you had prior to your insurance plans effective date. Many policies will refuse to cover the more serious pre-existing conditions, while others do so with a rate-up