Colorado health insurance marketplace costs rise 10% next year

While the average monthly cost of health insurance on the marketplace is rising 10% in Colorado next year, some people will have lower-cost options.

Open enrollment on the state-run marketplace started Tuesday and will end Jan. 15. People who want their coverage to start at the beginning of 2023 need to sign up by Dec. 15, though.

Those who currently have a marketplace plan and don’t choose a new one by Dec. 15 will be reenrolled in the plan they have now.

Premiums increased an average of 10.4%, which is slightly lower than the 11.3% average increase insurers had sought. Prices vary considerably based on a person’s age and where they live, though.

“There’s some plans that increased their rates and some that decreased them,” said Mannat Singh, executive director of the Colorado Consumer Health Initiative.

People who qualify for tax credits may not see a significant difference in their premiums, though, since the subsidies also rise as prices go up. Connect for Health Colorado, which runs the state’s marketplace, estimated premiums would have been almost 20% higher without reinsurance — essentially a backstop limiting how much insurers have to pay out when customers have expensive medical needs.

The federal Inflation Reduction Act extended the American Rescue Plan’s enhanced tax credits through 2025, meaning that people who didn’t qualify before the pandemic because of their income may get some help now. Connect for Health Colorado estimated about three-quarters of people currently buying on the marketplace qualify for financial assistance.

A rule change at the federal level also fixed the “family glitch,” meaning more people whose workplaces offer unaffordable insurance plans will have the option of going to the marketplace. The Affordable Care Act allowed individuals whose employer-sponsored coverage took up too large a chunk of their paychecks to buy coverage on the marketplace, but didn’t have a provision for people who had access to affordable individual coverage, but not affordable coverage for their families. Now, families can go to the marketplace if employer-sponsored coverage would take up 9.12% of their income.

Colorado Option plans are available for the first time this fall, though they may not be the cheapest offering in all areas. The plans aren’t a true public option, but have a standardized design, meaning that all plans at the same level (silver, for example) have the same out-of-pocket costs. They don’t charge a copay or other out-of-pocket fees for mental health care or visits to your primary care doctor.

The Colorado Option plans are required to lower premiums 5% from their baseline in 2023, 2024 and 2025, for a 15% total reduction. An analysis of the rates that insurance companies had requested in July found about 87% of the Colorado Option plans would meet the mark for 2023, though it’s possible that more did if the Colorado Division of Insurance declined to give them the full rates they wanted.

This year, six companies are offering Colorado Option and other plans on the marketplace: Anthem, Cigna, Denver Health, Friday Health Plans, Kaiser Permanente and Rocky Mountain Health Plans. All Colorado counties except Jackson County have at least two companies offering competing plans.

Bright Health announced it would withdraw from the marketplace in Colorado and other states less than a month before open enrollment began. While the roughly 55,000 people who purchased plans from Bright Health are covered through the end of the year, they’ll need to chose a new insurance for 2023.

The state had fined Bright Health $1 million in April after receiving complaints from providers that it wasn’t paying for customers’ care in a timely fashion. It’s not clear if the company had similar struggles making payments in other states, but it said the retreat from the individual and small group markets is a way to become profitable.

Oscar Health also pulled out of the market in Colorado and Arkansas, saying its small share in those states made it not worthwhile to go through the effort to stay, according to Fierce Healthcare. The Colorado Division of Insurance estimated it had only 3,800 customers in the state.

While two insurers pulled out, patients haven’t had to deal with major network battles between health plans and hospitals this year.

In 2021, UCHealth went out-of-network with all of the marketplace plans in the Denver area, meaning that people who wanted to get nonemergency care faced higher out-of-pocket costs. This year, two plans offered by Anthem in the Denver area include UCHealth, though as with any plan, people considering them have to weigh costs and other factors.

Which plan is best depends on how often you expect to seek care; whether it’s important that certain medications be covered with low out-of-pocket costs; and if any doctors or facilities that you want to access are in the insurer’s network. It’s worth taking a particular look at plans on the silver level, because those can come with extra subsidies to reduce out-of-pocket costs for some people.

The state runs 77 enrollment centers for people who need help navigating the process and thinking through the options. Connect for Health Colorado’s website also includes a tool to search for insurance brokers and others who can help.

Singh said she was disappointed that insurers and hospitals hadn’t done more to contain the cost of health care, but that the rule changes and some plans’ success in bringing down costs will give people options.

“We’re encouraging people to shop,” she said.

Subscribe to bi-weekly newsletter to get health news sent straight to your inbox.

Source: Read Full Article