Division of Insurance approves health insurance plans for 2017
DENVER (Sept. 20, 2016) – The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has approved the individual and small group health insurance plans for 2017 for the state. In Colorado, the individual market (plans not from an employer) makes up about 7.7 percent of the population who have health insurance (around 450,000 people), while at least 51 percent of Coloradans get their insurance through an employer (small and large employers).
DOI reviews health insurance premiums to make sure they are neither too high nor too low, and makes sure that the plans meet state and federal regulations -- it does not have the regulatory authority to set the insurance premiums.
The Division of Insurance will be hosting a public forum on Tuesday, Sept. 27, from 3 p.m. to 5 p.m., to discuss the plans and premiums for 2017. Representatives from the insurance companies will be in attendance. The forum will be held at:
Legislative Services Building
Room A (LSB - A)
200 E. 14th Avenue (SE corner of 14th and Sherman)
Denver, CO 80202
2017 - Approved Plans
DOI approved 277 plans for the individual market and 667 plans for the small group market.
Premium decreases for tax credit recipients
Colorado consumers who receive tax credits for their insurance may see their premiums decrease. A person who currently receives a tax credit for their 2016 insurance, and who will enroll in the same plan for 2017, will see an average decrease of 11 percent for their subsidized premium, despite actual premium increases for plans. If those consumers shop for a lower cost plan, they can reduce their subsidized premium even more, up to 29 percent on average.
Premium increases in the individual and small group market
On average in Colorado, premiums for individual plans (not from an employer) will be increasing by 20.4 percent. An individual’s age and residential location will impact that their respective premium, making it higher or lower from the average.
In the small group market (health plans for small employers), increases are much more moderate, averaging 2.1 percent. Insurers in this market have more experience working with this market and better understand how to price their products.
Carriers leaving / entering the market
As noted when the DOI shared preliminary information in June, there are fewer carriers offering fewer plans on the individual market for the coming year. UnitedHealthcare and Humana Insurance are not offering individual plans, while Anthem Blue Cross and Blue Shield is not offering its PPO (Preferred Provider Organization) individual plans, and Rocky Mountain Health Plans is pulling back all of its individual plans aside from offerings in Mesa County. All told, this impacts 92,000 people.
New for 2017 will be Bright Health Plans, which will sell individual plans. Here is how the plans break across the individual and small group markets, both on and off-exchange.
Individual Market (plans not from an employer)
- 277 plans available (413 in 2016): 132 on-exchange; 145 off-exchange
- 11 insurance carriers total, including 7 selling on-exchange plans (in 2016: 15 carriers total, with 10 selling on-exchange plans)
Small Group Market (plans for small employers)
- 667 plans available (660 in 2016) - 141 on-exchange; 526 off-exchange
- 13 insurance carriers total including 5 selling on-exchange plans (in 2016: 13 carriers total, with 5 selling on-exchange plans)
Addressing the cost of healthcare
Premiums reflect the costs of healthcare -- what doctors and hospitals and other providers charge for medical services. However, the Division of Insurance does not regulate doctors, hospitals or other healthcare providers and their associated healthcare costs.
The Division of Insurance is engaging a workgroup of representatives from Colorado hospitals, physicians and insurance companies to address increasing healthcare costs. This group will release its recommendations in December.
“Health care costs are increasing across the country and those costs push up premiums,” said Colorado Insurance Commissioner Marguerite Salazar. “The recent EpiPen scandal is a prime example. The drug maker raised prices stating it did not expect consumers to pay the increases but rather their health insurance plans. However, when insurance plans must pay those increased costs, it will show up in consumers’ health insurance premiums.”
The premiums released today do not take into account the federal tax credits, known as Advance Premium Tax Credits (APTC), which help to make premiums more affordable. APTC and other federal financial assistance are only available for plans purchased through the state’s health insurance exchange, Connect for Health Colorado. Eligibility for the APTC depends on a consumer’s household income in relation to the federal poverty level. The tax credit itself is calculated based on income, age and the cost of insurance in a community. For more information about APTC, contact Connect for Health Colorado at connectforhealthco.com or 855-752-6749.
When shopping for insurance, look at more than premiums
Shopping for an appropriate plan is crucial for Colorado consumers. The average increase in premiums assumes a person stays with their current plan, but people can often reduce their rate increase by shopping. For example, consumers who bought individual plans through Connect for Health Colorado, but who did notqualify for tax credits, can bring down their average increase in premium to around 13 percent if they switch to the lowest cost plan in the same metal tier. This is significantly less than the average increase of 24 percent they would experience by automatically renewing the same plan for 2017.
It is important for people to look at more than the premiums when shopping for insurance. Consumers should consider the following as they work to make an informed decision about a health plan.
- Find out if a doctor or preferred hospital is in the plan’s provider network. Seeing an out-of-network doctor will be more expensive.
- Be aware of any deductible amounts and out-of-pocket maximums in the plans. The tradeoff for lower premiums will likely be higher deductibles and out-of-pocket costs. Understand what will be paid for a doctor’s visit and other co-pay or coinsurance amounts.
- If specific medications are needed, find out how those drugs are covered.
- If major procedures are expected to be done in the coming year, look for how those would be covered by the plans.
Consumers who have questions about their current plans should contact their insurance carrier, Connect for Health Colorado, their insurance broker, or their employer.
The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA) regulates the insurance industry and assists consumers and other stakeholders with insurance issues. Visit dora.colorado.gov/insurance for more information or call 303-894-7499 / toll free 800-930-3745.