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RBC I The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), on Monday released the preliminary information for proposed health plans and premiums for 2017, including several agencies dropping plans for next year.
The DOI confirmed that four insurance companies either will not offer or will significantly cut back individual plans (non-employer) next year. A new entrant into the Colorado market will sell plans in the individual market, and a number of companies currently offering individual plans are seeking significant premium increases for their 2017 individual plans.
“As we prepare for the fourth open enrollment of the Affordable Care Act, it’s worth noting that we’re still in the stabilization phase,” said Colorado Insurance Commissioner Marguerite Salazar. “Companies are still figuring it out where to sell, how to sell, how to price, which is why we’re seeing some companies pull back on individual plans or requesting significant increases while still other companies are coming into the market.
Some companies have done a better job of figuring out how to operate in this new environment and compete for people’s business, while others must step back and re-evaluate their approach.”
Rocky Mountain Health Plans / Anthem PPO : As noted in a May 13 release, UnitedHealthcare and Humana Insurance will not offer individual plans in 2017, which impacts approximately 20,000 consumers in Colorado (UnitedHealthcare–10,549; Humana–9,914).
In addition, Rocky Mountain Health Plans (RMHP) determined that it will reduce individual plan offerings for 2017, offering individual plans only in Mesa County, only via its Monument Health affiliate. Approximately 10,000 people currently enrolled in an individual RMHP plan will have to find another plan for 2017.
In addition, Anthem Blue Cross and Blue Shield decided it will not offer its PPO (Preferred Provider Organization) individual plans for 2017, which impacts 62,310 people. However, Anthem will continue to offer HMO (Health Maintenance Organization) individual plans statewide, and these plans will be available to all consumers affected by the PPO decision.
All of these companies will continue to offer their small and large group plans for employers.
Rocky Mountain Health Plans has been a key player in the mountain areas and Western Slope, and its departure from the individual market will leave many areas with only one on-exchange insurance company—Anthem Blue Cross and Blue Shield’s HMO division—for individual plans.
“I’d rather these companies continued in the individual market,” Salazar said. “But in the larger picture, what’s taking place is a market correction; the free market is at work. And it is important to recognize that this is a market correction taking place on a national scale, not just in Colorado. While it was good initially to have so many companies offering so many individual plans, this could be an indication that there were too many options for the market to support.”
“It’s also important to highlight that we are not seeing this market correction in the small group market,” she said. “In many ways, that market seems to be stable.”
Around 92,000 people with individual plans from UnitedHealthcare, Humana Insurance, RMHP and Anthem will need to find other coverage for 2017 during open enrollment, which runs Nov. 1 through Jan. 31, 2017. This represents approximately 20 percent of the 450,000 Coloradans who get their insurance through the individual market, either through the state exchange, Connect for Health Colorado, or off the exchange. Those 450,000 consumers with plans in the individual market represents approximately 7.7 percent of Coloradans.
At least 51 percent of people in Colorado, around 2.8 million, continue to get their health insurance through an employer.
As other companies work to readjust, a new entrant into the Colorado market, Bright Health Plans, will sell individual plans both on and off the exchange.
“Where others have experienced challenges, Bright sees opportunity with what they believe is an innovative approach,” Salazar said. “They are focusing on efficient delivery of quality care through a healthcare partner. This echoes what RMHP is doing through its Monument Health program and what UnitedHealthcare is doing in other states with its subsidiary, Harken Health. It seems that what the market needs is innovation rather than the old operating model.”
For the individual market in 2017, many companies have requested significant premium increases. The companies review what they paid out for health claims to doctors, hospitals and other providers this year in order to set appropriate premiums for next year that will allow them to pay claims and remain in business.
“In general, the companies have indicated that the people enrolled in individual plans have used more healthcare services and with greater frequency than anticipated,” Salazar said. “While the DOI will evaluate information provided by the companies to determine if their requested premium increases are correct, all of us in the industry must tackle the more pressing question of what is driving the increased health costs in the individual market that lead to higher premiums.”
In the small group market, companies are requesting single-digit increases or even decreases.
“We should not lose site of the positive news in the small group market, even while we work to gain an understanding of what’s happening in the individual market,” Salazar said.
The DOI recognizes there are forces at work in Colorado, and particularly in the individual market in certain areas of the state, that make it challenging for insurance companies to offer individual plans, as well as for many consumers to afford them. The DOI has started a study that looks at the underlying costs of healthcare. The DOI is also available as a resource for consumers.
House Bill 1336, passed this past legislative session, directs the DOI to study the feasibility of moving the state to a single geographic rating area. The bill also directs the DOI to study how healthcare costs impact premiums, which will provide greater insight into how the Colorado individual market functions.
Throughout this process, the Division of Insurance is ready and available to help answer consumer questions regarding their health insurance plans or their future options. Contact the Division of Insurance at 303-894-7490 or 800-930-3745 (outside the Denver metro area) or via email at DORA_insurance@state.co.us.
During the summer, DOI staff will examine each plan to make sure it complies with the Affordable Care Act (ACA) and state laws.
The DOI does not set insurance premiums, but will review what the companies submitted to determine if requested increases or decreases are justified.
The DOI checks to make sure the premiums are sufficient for the company to continue to pay its members’ claims.
The DOI verifies whether the plans meet the metal tier coverage levels: bronze (an average of 60 percent of medical expenses paid by the plan), silver (70 percent), gold (80 percent) and platinum (90 percent).
The DOI also reviews the benefits and the plans’ networks of healthcare providers to make sure that they meet state and federal requirements.
The filings from the companies are available for review on DOI’s Health Insurance Filings page. During the review period, Colorado consumers can submit public comments on the filings, which will be reviewed and considered by the DOI. The DOI encourages consumers to submit comments no later than July 6 so they can be included as part of the review of the filings.
Tips on filing an online comment: When viewing the filings online, there will be a section for comments within each filing. Click on the “Add” link in the “Comments” column of the filing of interest. The user will be prompted to enter his/her name, city and state of residence, email address, and the comment.
After DOI completes its review and analysis in late September / early October, it will notify carriers and Connect for Health Colorado of the approved plans for 2017. At that time, the DOI will also provide summary information and analysis regarding the carriers and plans for 2017.