Healthcare Plan Comparison & Cost Estimator
Understanding your healthcare costs should not require a degree in actuarial science. Use our free interactive tools below to compare plan types and estimate your out-of-pocket expenses based on your specific situation. These tools are designed for educational planning purposes and reflect Colorado marketplace averages.
Understanding Health Insurance Plan Types
Before using the comparison tool, here is a quick primer on the four major plan architectures you will encounter in the Colorado marketplace and through most employer-sponsored options.
HMO (Health Maintenance Organization)
HMO plans require you to select a primary care physician (PCP) who coordinates all your care and provides referrals to specialists within the plan's provider network. Out-of-network care is generally not covered except in true emergencies. HMOs typically offer the lowest premiums and most predictable copay structures, making them a strong choice for individuals and families who prefer straightforward cost expectations and do not anticipate needing frequent specialist care outside a defined provider network. Colorado's largest HMO network is Kaiser Permanente, which operates an integrated delivery system across the Front Range.
PPO (Preferred Provider Organization)
PPO plans offer the most flexibility in choosing healthcare providers. You can see any doctor or specialist without a referral, and the plan covers a portion of out-of-network care, though at a higher cost-sharing rate. PPOs carry higher monthly premiums but provide greater freedom, making them ideal for individuals who travel frequently, need to see multiple specialists, or prefer the ability to self-refer to any provider. In Colorado, Anthem Blue Cross Blue Shield and Cigna offer some of the broadest PPO networks across the state.
EPO (Exclusive Provider Organization)
EPO plans blend elements of both HMOs and PPOs. Like a PPO, you typically do not need a referral to see a specialist. However, like an HMO, out-of-network care is not covered except in emergencies. EPO premiums fall between HMO and PPO rates, making them a practical middle-ground option. These plans work well for individuals who want specialist access freedom but are comfortable staying within a defined provider network for routine and planned care.
HDHP (High Deductible Health Plan)
HDHPs feature the lowest monthly premiums but require you to meet a significantly higher deductible before insurance begins covering costs. The key advantage is eligibility for a Health Savings Account (HSA), which provides triple tax benefits: contributions are tax-deductible, growth is tax-free, and withdrawals for qualified medical expenses are tax-free. HDHPs are best suited for healthy individuals with adequate emergency savings who want to maximize tax-advantaged savings potential and minimize monthly premium obligations.
Healthcare Plan Comparison Calculator
Select your plan type, expected usage level, and prescription needs to see an estimated annual cost breakdown. These estimates are based on 2024 Colorado marketplace averages and are for educational purposes only.
Medical Procedure Cost Estimator
Get an approximate out-of-pocket cost range for common medical procedures based on your insurance status. These figures use Colorado fair-market pricing data and national averages.
Key Insurance Terms Explained
Understanding these fundamental terms will help you make more informed decisions about your healthcare coverage.
Premium
The monthly amount you pay to maintain your health insurance coverage, regardless of whether you use any medical services. Premiums are typically paid through payroll deduction for employer-sponsored plans or directly to the insurance carrier for marketplace plans.
Deductible
The amount you must pay out of pocket for covered healthcare services before your insurance plan begins to pay its share. Preventive services are typically covered at 100% before the deductible under ACA-compliant plans. Family plans often have both individual and family deductibles.
Out-of-Pocket Maximum
The most you will have to pay for covered services in a plan year. After you reach this amount, your insurance plan covers 100% of covered services for the remainder of the year. For 2024, the ACA maximum is $9,450 for individual plans and $18,900 for family plans.
Copay vs. Coinsurance
A copay is a fixed dollar amount you pay for a covered service (e.g., $30 for a doctor visit). Coinsurance is a percentage of the cost you pay after meeting your deductible (e.g., 20% of a hospital stay). Both count toward your out-of-pocket maximum.
Need Personalized Guidance?
These tools provide general estimates for educational purposes. For personalized plan comparison and enrollment assistance tailored to your medical needs, income, and family situation, schedule a free session with one of our certified navigators.
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