- Colorado has been generally supportive of the ACA and coverage expansion, and was a leader in health reform pre-ACA.
- Colorado’s Congressional delegation and state legislature are split between Democrats and Republicans, with opposing views on the ACA.
- Colorado’s uninsured rate dropped by 47% from 2013 to 2016.
- Colorado has one of just 12 fully state-run exchanges.
- Seven carriers are offering coverage in Colorado’s exchange for 2019.
- Individual insurance rates grew by 33% for 2018, but are rising by less than 6% for 2019 (and net premiums are decreasing for most people who get subsidies).
- Colorado accepted Medicaid expansion; enrollment growth is the 4th highest in the country.
- More than 165,000 people are enrolled in private plans through Colorado’s exchange.
- Colorado had a CO-OP, but it ceased operation at the end of 2015.
- Colorado’s high-risk pool closed in 2014, once individual market plans became guaranteed issue.
- Colorado terminated all grandmothered health plans at the end of 2015.
- Colorado lawmakers have considered state-based legislation to stabilize the individual market, but it’s mostly fallen short.
- Nearly 879,000 Colorado residents have Medicare in 2018.
Colorado has long been a leader in health reform
Colorado has long been a leader in terms of health care reform. Before the ACA implemented reform on a federal level, Colorado had already made maternity coverage mandatory in the individual market, and had banned gender-based premiums.
Colorado became the second state in the nation to actively pursue single-payer health care, with Amendment 69 appearing on the 2016 ballot. However, voters rejected the push for single-payer by a wide margin (Vermont was the first state to implement a plan to achieve single-payer, but they abandoned that path in December 2014).
Colorado’s state-run exchange has robust insurer participation
Colorado has a state-run health insurance exchange. While there are seven insurers participating, which is relatively robust compared with much of the country, coverage tends to be localized and plan availability is concentrated in urban areas. In 14 of the state’s 64 counties, those who shop the state’s exchange have a single carrier option (Anthem Blue Cross/Blue Shield) in 2018, as will continue to be the case in 2019.
The counties with the most options, Denver, Jefferson, and Arapahoe, have six carrier options each in 2018 and 2019. Colorado Choice/Friday Health has been expanding their coverage area in the state, and will offer plans in all nine rating areas for 2019, although the plans will only be available in select counties in three of those rating areas.
Learn more about Colorado’s exchange with our analysis that includes current events as well as historical context.
Colorado exchange rates and plans for 2019
Seven individual market insurers are offering plans in the state’s exchange for 2019, with the following average rate increases:
- Anthem: A 0.2 percent decrease for HMO Colorado, and a 2.6 percent decrease for Rocky Mountain Hospital & Medical Service, Inc.
- Bright Health: 6.5 percent increase
- Cigna: 8.1 percent increase
- Denver Health Medical Plan: 21.6 percent (although this is the largest rate increase, Denver Health only has 1,398 members)
- Friday Health: 7.3 percent increase. Friday is expanding into every rating area of the state (but not every county) and expects their enrollment to grow to 10,000 people in 2019.
- Kaiser: 7.5 percent increase
- Rocky Mountain HMO: 5.7 percent increase
The average rate increase is 5.6 percent, which is far smaller than the nearly 33 percent average rate increase that applied for 2018. But because Colorado insurers are adding the cost of cost-sharing reductions to silver plan premiums for 2019, premium subsidies will be much larger than they were in 2018. The result is that most enrollees with premium subsidies will have smaller after-subsidy premiums in 2019 than they had in 2018.
Colorado legislators’ positions on the Affordable Care Act
In 2009, Colorado Sens. Mark Udall and Michael Bennet – both Democrats – voted yes on the Affordable Care Act. Colorado’s five Democratic House members also voted yes, while the other two representatives, both Republicans, voted no.
The current Colorado congressional delegation includes Senators Michael Bennett (Democrat) and Cory Gardner (Republican). Bennett supports the ACA, while Gardner opposes it. As of 2018, Colorado has seven representatives in the U.S. House: three Democrats, and four Republicans. Support for the ACA is split along party lines in the state’s House delegation.
At the state level, Colorado was one of the only states that moved in a bipartisan manner to establish a state-run health insurance marketplace. Gov. John Hickenlooper, a Democrat, signed legislation authorizing the marketplace in 2011. The state marketplace is called Connect for Health Colorado. The state also adopted Medicaid expansion under the Affordable Care Act. By 2018, more than 400,000 people in Colorado had gained coverage as a result of Medicaid expansion.
Lawmakers in Colorado tried in 2017 and again in 2018 to tackle the problem of unaffordable health insurance premiums for people who don’t qualify for ACA premium subsidies. H.B.1235, a bipartisan bill, passed in the House in April 2017. But it failed in Committee in the Senate the following week. In 2018, H.B.1205 met a similar fate. In both cases, the legislation would have provided state-based premium assistance to people with income between 400 percent and 500 percent of the poverty level (ie, a little too high for ACA subsidies) who live in the three most expensive health insurance rating areas in the state (the mountains, including Grand Junction, and the eastern plains) and pay more than 15 percent of their income for health insurance purchased through the exchange (the bill in 2018 would have set the threshold at 20 percent). For the time being, however, there is no assistance available to these residents, as the state-based program was not enacted.
Colorado lawmakers also considered a bill to implement a reinsurance program in 2018, and although it passed in the House, it failed in the Senate. Several other states have implemented, or will soon implement, reinsurance programs to stabilize their individual markets and reduce premiums. Colorado may do so in a future legislative session, but funding for the state’s portion of the cost was a stumbling block in 2018.
Colorado’s uninsured rate has dropped by nearly half since 2013
Colorado enrollment in qualified health plans
More than 165,000 people bought private plans in Colorado’s exchange during open enrollment for 2018 coverage, which was similar to the prior year’s enrollment, despite the fact that open enrollment was shorter for 2018 than it had been for 2017. By May of 2018, effectuated enrollment stood at about 142,000 people (effectuated enrollment is always lower than the number of people who initially enroll). Among unsubsidized enrollees, however, enrollment in Colorado’s individual market, including off-exchange plans, dropped by 19 percent from 2016 to 2017 (a drop in unsubsidized enrollment was the norm nationwide, as premium increases were substantial for people who don’t qualify for subsidies to offset some of the cost).
For comparison, 125,402 Colorado residents signed up for coverage during the first open enrollment period, for 2014 coverage. During the 2015 open enrollment period, 140,327 Coloradans enrolled in QHPs – 28 percent were new consumers. By the end of July, a few had dropped coverage or failed to make initial premium payments, and effectuated enrollment for exchange-based health plans was 137,372. That year, 90 percent of enrollees selected nonprofit health plans from Colorado HealthOP, Kaiser Permanente and Rocky Mountain Health Plans.
However, Colorado HealthOP is no longer offering coverage. The nonprofit was a Consumer Operated and Oriented Plan (CO-OP) founded through a $72.3 million federal loan. The CO-OPs formed under the Affordable Care Act were intended to increase competition in the individual and small-group insurance markets while providing consumers with affordable, high-quality options. Colorado was one of 22 states that were home to an ACA CO-OP. However, 12 of these CO-OPs, including Colorado HealthOP had announced their closure by early November 2015. And by 2018, only four were still operational, offering plans in five states.
New Health Ventures and Time Insurance Company also left the state’s individual market at the end of 2015—Time exited the market nationwide. Three carriers entered Colorado’s individual market for 2016, selling off-exchange plans: Golden Rule in the individual market, and Aetna Health and Aetna Life in the small group market.
Colorado required all grandmothered (transitional) plans to terminate by the end of 2015. There are still grandfathered plans in the state, but all other individual and small group plans are now ACA-compliant.
At the end of 2016, United and Humana exited the individual market in Colorado, but Bright Health joined in 2017. There were seven carriers offering individual health plans through Connect for Health Colorado in 2017, and all of them are continuing to offer coverage for 2019.
Colorado and Medicaid expansion: Enrollment has grown by 71 percent since 2013
Colorado is among the 31 states and the District of Columbia that have expanded Medicaid under the ACA. The expansion extends Medicaid eligibility to most nonelderly adults at or below 138 percent of the federal poverty level.
By mid-2018, more than 400,000 people had gained coverage under Colorado’s expanded Medicaid. From late 2013 to July 2018, enrollment in Colorado Medicaid and CHP+ increased by 71 percent to about 1.34 million. From late 2013 to July 2018, Colorado was tied with Alaska for the nation’s fourth-largest percentage increase in Medicaid enrollment. Only Kentucky, Nevada, and Montana had larger percentage increases in their Medicaid/CHIP populations.
Note that individuals can sign up for Medicaid, or lose coverage, if their eligibility changes, anytime throughout the year, so enrollment totals fluctuate each month.
Learn about Colorado’s Medicaid and Child Health Plan Plus (CHP+) programs at the Colorado Department of Health Care Policy & Financing website, and learn about Colorado’s Medicaid expansion in our overview.
Does Colorado have a high-risk pool?
Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including Colorado. People with pre-existing conditions were often unable to purchase coverage in the private market, or were only eligible for policies that excluded their pre-existing conditions or charged them premiums that were significantly higher than the base rate.
CoverColorado was created in 1991 to provide an alternative for people who were not able to get comprehensive coverage in the private market because of their medical history.
One of the primary reforms ushered in by the ACA was guaranteed issue coverage in the individual market. An applicant’s medical history is no longer a factor in eligibility, which means that high-risk pools are no longer necessary the way they once were.
CoverColorado stopped enrolling new applicants at the end of 2013, and encouraged all existing members to transition to a new plan by December 23, 2013, in order to have private coverage (or Medicaid, if eligible under the expanded guidelines in Colorado) by January 1, 2014. For those who were unable to secure new coverage by the beginning of 2014, CoverColorado plans remained in force until the end of March, at which point the program ceased operations.
Any members who were still covered by the plan at the end of March were eligible for a 60-day special enrollment period at that point, allowing them to select a new plan, on or off-exchange. For a while, the CoverColorado website included a touching Wordle comprised of compliments submitted by members during the final months the plan was operational.
Medicare enrollment in the state of Colorado
By August 2018, Colorado Medicare enrollment reached 878,937 people, which is about 15.4 percent of the state’s population. Nationally, about 18 percent of the population is enrolled in Medicare. As of 2015, 87 percent of Colorado’s Medicare recipients qualified based on age alone, while the other 13 percent were on Medicare as the result of a disability.
Medicare pays about $8,727 per Colorado enrollee each year and ranks 28th in overall spending with $5.3 billion annually.
Coloradans who want additional benefits beyond what original Medicare offers can select a Medicare Advantage plan instead. 37 percent of Colorado Medicare beneficiaries had Medicare Advantage plans instead of traditional Medicare plans in 2017, compared with 33 percent of Medicare beneficiaries nationwide.
About 36 percent of Coloradans with Medicare are enrolled in Medicare Part D plans, which provide stand-alone prescription drug coverage. Of all U.S. Medicare recipients, 43 percent have stand-alone Rx plans.
Colorado health insurance resources
- Colorado Child Health Plan Plus (CHP+)
- Colorado Department of Health Care Policy and Financing
Colorado health reform at the state level
Colorado lawmakers considered measures to implement reinsurance, state-based premium subsidies, and a Medicaid buy-in study in 2018, but none of them passed the GOP-controlled Colorado Senate.
See the bottom of this page for a summary of other state-level health reform legislation.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.