Health Care Affordability

Health care affordability is a shared responsibility. Understanding the cost of health care starts with understanding both the cost of insurance and what you may pay when you need care.

The cost of health care involves more than a monthly insurance premium. Patients may face out-of-pocket expenses, and the cost of providing care reflects the people, resources, technology, and services needed to treat patients. Deductibles, copayments, coinsurance, prescription drug costs, and other expenses can add up.
 
Colorado’s hospitals and health systems work with patients to help them access the care they need, understand their financial responsibilities, and navigate available financial assistance.

Understanding Your Health Care Costs

Understanding your insurance benefits, potential out-of-pocket costs, and available financial assistance can help you make informed decisions about your health care.

What Goes Into the Cost of Health Care Delivery?

The cost of providing hospital care reflects the many people, services, and resources required to care for patients. Hospitals must maintain skilled teams of physicians, nurses, technicians, and other health care professionals; purchase medications and medical supplies; operate and maintain specialized equipment; and support essential services such as laboratories, imaging, emergency care, and technology. Hospitals also maintain facilities, equipment, and staff around the clock so they are ready to care for patients whenever and wherever they need help.
 
The cost of care can vary based on a patient’s condition, the services and treatments needed, the complexity of care, and the resources required. Hospitals must also account for the cost of maintaining the infrastructure and workforce necessary to provide care to their communities.

How Does My Health Insurance Work?

Health insurance helps pay for covered medical services, but understanding what your plan pays for and what you are responsible for can be challenging. Most plans require you to pay a monthly premium to maintain coverage, along with potential out-of-pocket costs when you receive care. These costs may include a deductible, copayments, and coinsurance. Your plan also sets an out-of-pocket maximum, which limits how much you pay for covered services during a plan year, subject to your plan’s terms.
 
Understanding these terms, what services your plan covers, and how your benefits work can help you anticipate health care expenses and make informed decisions about your coverage.

Why Can I Still Have Significant Costs When I Have Insurance?

Having health insurance does not mean all health care costs are covered. Depending on your plan, you may be responsible for a significant portion of the cost of care before your insurance begins sharing expenses or until you reach your out-of-pocket maximum. This can be particularly challenging for people with high-deductible health plans, which often have lower monthly premiums but require patients to pay more out of pocket before insurance coverage applies.
 
Your costs may also depend on whether you receive care from an in-network or out-of-network provider, the type of services you need, and your plan’s coverage requirements. Understanding these factors before receiving care, when possible, can help you prepare for potential expenses and avoid unexpected bills.

What If I Need Help Paying for Care?

If you are having difficulty paying for medical care, resources may be available to help. Colorado hospitals offer financial assistance programs, including Hospital Discounted Care for eligible patients, to help make care more affordable. Depending on your circumstances, you may qualify for reduced hospital charges, financial assistance, or payment plans.
 
You do not have to navigate these questions alone. Hospital financial counselors and billing representatives can help explain your bill, discuss available assistance, and answer questions about payment options. Patients can also learn about their rights and protections under Colorado law and where to turn for additional support.

Understand what you’ll pay with insurance

When you compare health plans, look at the monthly premium and what you’ll pay when you get care. Check whether your doctors and hospitals are in network and what the plan charges for the prescriptions you take.

  • Deductible — The amount you pay for certain covered services before your plan starts sharing those costs.
  • Copay — A set amount you pay for a covered service or prescription.
  • Coinsurance — A percentage of the cost you pay for a covered service.

Happening Now: Open Enrollment

Open enrollment offers a great opportunity for patients to explore their options and choose the health care coverage that works best for them and their families. CHA has compiled resources to help consumers better understand the coverage options available and what to consider before enrolling in a plan.

Commercial (individual/marketplace): Nov. 1, 2026 – Jan. 15, 2027*

Commercial health insurance coverage is provided by private insurance companies, including plans purchased individually or provided through an employer. Connect for Health Colorado is the state’s official health insurance marketplace.

*Your employer may have a different open enrollment window.

Medicaid: Year-round

Health First Colorado is Colorado’s Medicaid program, providing free or low-cost health coverage to eligible individuals and families based on income and other eligibility requirements.

  • Note: As H.R. 1 is implemented, federal changes are being made to the Medicaid program. This may include new work requirements (i.e., community engagement requirements) and renewal checks every six months for certain beneficiaries, among other changes. Learn more about changes to Colorado Medicaid.
  • Resources:

Medicare: Oct. 15 – Dec. 7, 2026

Medicare is a federal health insurance program primarily for adults age 65 and older, as well as some younger people with disabilities or certain medical conditions.

Before You Choose a Plan

    • Check whether your preferred hospitals, physicians, and specialists are in-network.
    • Review monthly premiums, deductibles, co-pays/co-insurance, and out-of-pocket maximums.
    • Confirm that your prescription medications are covered.

Further reading and additional resources:

Where for Care
Understanding Your Care Options

Knowing where to seek care is one part of understanding health care costs. Primary care offices, urgent care centers, and hospital emergency departments serve different needs. For nonemergency care, understanding those options—and your insurance coverage—can help you make informed decisions about where to go and what you may pay.

CHA’s Where for Care resource helps Coloradans explore care settings and better understand their options before a health concern arises.

Explore Where for Care

FAQ

There are a lot of factors to assess when considering the total cost of health care. These include the costs of insurance premiums, deductibles, co-pays and co-insurance, provider and specialist visits, hospital visits, prescription drugs, and much more. Every part of the health care system has a role to play in making health care both affordable and accessible.

Like other sectors of the health care system, hospitals are part of the affordability equation. That's why hospitals around the state have robust programs to help uninsured and underinsured patients get care, low-income patients manage costs, and communities access preventive care before it becomes an emergency. But unlike other sectors of the health care system, hospitals operate under unique circumstances and stand ready to treat any patient 24/7, 365.

Hospitals have obligations that other parts of the system don't. They maintain emergency departments, trauma capabilities, intensive care, operating rooms, pharmacies, labs, imaging, infection control, specialized staff, emergency preparedness, extra capacity, and more. Some services provided by hospitals are critical, but not sustainable by the market alone. Behavioral health, obstetrics, trauma, burn care, neonatal care, rural emergency services, and others are essential even if they don't generate revenue. Hospitals need to offer these services to their communities in a sustainable way that ordinary business models usually cannot address.

The first step is understanding how costs are generated and how different parts of the health care system influence those costs. On an individual level, this allows patients to make more informed decisions about their health care coverage and services they need. On a larger scale, knowledgeable advocates can help explain the complex health care system and ask that each sector do its part to maintain an affordable, accessible network of high-quality patient services and specialty care.