Coloradans will soon be able to purchase ‘Colorado Option’ plans on marketplace for the first time

Coloradans will soon be able to enroll in the state’s standardized health insurance plan also known as the Colorado Option, which was designed to address accessibility, affordability, and equity. 

 

 

The Colorado Division of Insurance (DOI) introduced its individual and small group health insurance plans and their finalized rates for 2023 on Tuesday ahead of the health insurance open enrollment period, which is set to begin next week. 

The Option’s 3 plans (Gold, Silver, and Bronze) are tiered by their premiums. The Gold and Bronze plans will be available in 63 out of the state’s 64 counties while Silver will be available in all counties. Each plan offers the standard benefits required for individual and small group health insurance plans under the ACA, in addition to free primary care and mental health visits. Premium rates for each tier of the Colorado Option will be less than or equal to the average premium for each tier in each county.

DOI estimates the Option could provide up to $14.7 million in consumer savings for the state.

“Saving Coloradans money on health care has been a priority of the Polis-Primavera administration and I’m excited that we can make more savings a reality for our neighbors as we work to provide affordable, accessible, and equitable health care to all Coloradans,” said Lieutenant Governor Dianne Primavera and Director of the Office of Saving People Money on Healthcare.

“The Colorado Option, which is being offered for the first time, allows participants to better understand what they are paying for and prioritizes mental and physical well-being intended to better support total wellness.”

Colorado Insurance Commissioner Michael Conway praised the Polis administration and state legislators for their work on healthcare affordability. The department has outlined the importance for consumers to take advantage of the financial assistance available and compare the various offerings for savings when shopping for health plans this fall. 

“But I also want to emphasize how much people can save by using the assistance continued under the federal Inflation Reduction Act,” Conway said. “Continuing this help means more than 80% of Coloradans that shop for coverage on Connect for Health Colorado will be eligible for subsidies next year. I encourage everyone to visit Connect for Health Colorado to determine what financial help they could receive, and shop for the plans that fit their needs.”

In June, CMS authorized the continuation of Colorado’s Reinsurance Program through 2027 for individual health insurance plans. DOI said the program, set to enter its fourth year, will save Coloradans $294 million on their 2023 individual plan premiums, an average reduction of 32%.

The recently passed Inflation Reduction Act extended the federal financial assistance for health insurance originally provided through the 2021 American Rescue Plan Act, which DOI affirms will further help reduce costs for Coloradans purchasing health insurance.

Financial assistance is available through Connect for Health Colorado, where consumers can check eligibility, find plans, and calculate costs through an online portal. Coloradans can also access the “We Can Help” site, a robust network of certified insurance brokers, and in-person enrollment assistants, or call 855-752-6749 for assistance.

Residents of Summit County in western Colorado who are eligible for assistance, for example, could see a premium reduction of up to 53% if they choose to enroll in a lower-cost plan, compared to the 34% they’d save by renewing their current plan.

Rocky Mountain Health Plans (RMHP), which provides Medicaid coverage for Summit County and Western Colorado, says the state’s Reinsurance Program has had a positive impact by covering high-cost cases in the individual and family market. 

Patrick Gordon, CEO of RMHP, said the program helped stabilize carrier participation and has driven lower premiums and out-of-pocket expenses. But he emphasized that healthcare costs for residents in some rural parts of Colorado remain some of the “highest on the planet.” 

“But there’s still a lot of work to do on affordability,” Gordon said. “The Colorado Option is implemented effective for 2023 in the small-group and the individual market. Carriers, providers, and other stakeholders are struggling to hit the targets set by the state.

There’s a fair amount of additional work on public policy to make sure that we continue to make progress towards meaningful improvements and affordability, but don’t implement policies that have the effect of disrupting the market.”

Gordon, who led reform efforts in the market involving practice transformation, payment reform, and technology adoption, says the approach must be to work from the ground up.

“We know from years of experience that affordability is produced over time through a commitment to the development of clinically integrated provider networks, increased accountability for quality and access, heavy focus on high-performing Comprehensive Primary Care, and then supporting payment models …

In our case, in places like the individual market, where we’ve had those types of partnerships with community providers in place for years, they’re producing sustained results. We’ve been able to deliver significantly lower premiums than the rest of the market.

The same is true on the Front Range and our partnership with the Colorado Doctors Plan, which was spearheaded by the Centura system, and now has been joined by the HCA system. That model rests on a highly curated foundation of primary care providers, which are really the cornerstone of sustained improvement and performance.”

The Colorado Association of Health Plans (CAHP)―which has been staunchly opposed to the Colorado Option since its inception―said the newly announced rates for the Option will drive costs up, not down. The association argues that the lowest prices available during this year’s open enrollment will come from commercial providers―not the Colorado Option.

“The decisions made by the Polis Administration regarding the Colorado Option were fundamentally contradictory to the stated goal of saving people money on healthcare,” CAHP Executive Director Amanda Massey said in a statement following the rate announcements.

“The outcome of those decisions are fewer carriers offering individual and small group products to consumers across the state, less competition, and higher premiums. We fully support market-based policies that actually drive down costs, but the result of Colorado’s first-in-the-nation policy shows the Administration chose politics over math.”

Open enrollment for individual plans will start on November 1st and run until January 15th, 2023.