Colorado’s Department of Regulatory Affairs (DORA) will open the first of 3 stakeholder meetings on Wednesday aimed at establishing rates for the Colorado Option after the plan was approved by CMS last month.
The first of these hearings will be held this Wednesday and will discuss the the progress of stakeholder sessions thus far and outline the next steps in the rate setting process.
DORA will hold 2 additional hearings on July 27th and August 17th, engaging a range of stakeholders from payers, consumer advocacy groups, community organizations, and local care providers. The department will gather input on proposed standardized plan rates—submitted by carriers in April—from these stakeholder groups before publicly releasing its standardized plan rates for all carriers in September.
DORA has designed a Standardized Plan that allows consumers and businesses to easily compare tiered plans and choose the plan that is right for them. The plan covers all essential health benefits required by the Affordable Care Act, provides free primary care and mental health visits, and is designed to reduce racial health disparities and improve equity.
The standardized plan will have the same benefits and cost-sharing structure for all carriers, though specific cost-sharing rates will differ among carriers. Consumers will be able to make “apples to apples” comparisons across carriers.
Differences in quality, provider network, and pricing among carriers will be reflected through various premiums and provider networks.
Under Colorado law, private insurers are required to offer the standardized plan to individuals and small businesses on the state’s health insurance exchange and reduce the plan’s premium rates by 15% over 3 years.
After 2025, premiums may only increase in proportion to national medical inflation. The state projects to save $1.6 billion in federal savings, including significant savings in premium tax credits, over the 5-year Section 1332 waiver period.
The Colorado Division of Insurance (DOI) will use a part of those savings to subsidize the Option and the state’s claims-based reinsurance program, which will operate in conjunction with each other. DOI has the regulatory authority to support carriers and providers in reaching their premium reduction targets.
Such regulations include amendments to filed plans and providers contracts, levying fines on hospitals, and requiring additional public rate hearings.
Scheduled to become available in 2023, the Colorado Option is expected to lower premiums by an average of $132 per person per month, or 22%. By 2027, the state projects 32,000 Coloradans to gain coverage.