Health insurance in Colorado
- Colorado utilizes at state-run marketplace.
- Open enrollment for 2019 coverage in Colorado continued through January 15, 2019; the November 1 – January 15 schedule will be used in future years as well.
- Seven insurers are offering 2019 plans through the Colorado exchange.
- The average rate increase for 2019 was 5.6 percent.
- More than 170,000 Colorado residents enrolled in 2019 coverage through the exchange.
- Colorado’s CO-OP, Colorado HealthOP, ceased operation at the end of 2015.
- Colorado terminated all grandmothered health plans at the end of 2015.
- Colorado adopted the ACA’s Medicaid expansion. Enrollment growth is fourth highest in the nation.
- Colorado’s uninsured rate dropped by 47% from 2013 to 2016.
- Colorado has been generally supportive of the ACA and coverage expansion, and was a leader in health reform pre-ACA.
- Colorado limits short-term health insurance plan duration to six months, but strict new state rules that took effect in April 2019 resulted in all of Colorado’s short-term insurers leaving the market.
- Nearly 879,000 Colorado residents were enrolled in Medicare in 2018.
- Colorado’s high-risk pool closed in 2014, once individual market plans became guaranteed issue.
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).
The Colorado health marketplace
Colorado utilizes 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 2019, as was the case the year before.
The counties with the most options, Denver, Jefferson, and Arapahoe, have six carrier options each in 2019. Colorado Choice/Friday Health has been expanding their coverage area in the state, and is offering plans in all nine rating areas for 2019 (the plans are only available in select counties in three of those rating areas).
Colorado implemented a special enrollment period that extended the length of the state’s enrollment period for 2019 coverage to 2½ months. The state’s insurance division has implemented regulations that make the extension permanent, so open enrollment will run for 2.5 months in future years as well.
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 enrollment in qualified health plans
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. That year, 90 percent of enrollees selected nonprofit health plans from Colorado HealthOP, Kaiser Permanente and Rocky Mountain Health Plans.
Since then, Colorado HealthOP has closed (details below) and Rocky Mountain Health Plans has reduced its coverage area for individual market plans to only Mesa County (Grand Junction). But Kaiser continues to be a key player in the state’s individual market.
Read more about the Colorado health insurance marketplace.
Colorado CO-OP ceases operation
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 2019, only four were still operational, offering plans in five states.
Grandmothered plans terminated
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.
Colorado and Medicaid expansion
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.
Read more about Medicaid expansion in Colorado.
Short-term health insurance in Colorado
Colorado has extensive state regulations pertaining to short-term health insurance plans. Under longstanding regulations, short-term health plan terms are limited to six months in the state, and cannot be renewable.
In addition, short-term policies cannot be purchased by anyone who has had coverage under more than one short-term plan in the prior 12 months. That means a Colorado resident could buy a short-term plan with a six-month term, and then buy one more short-term plan after the first ends. But after that, they’d have to wait at least six months before being able to purchase a third short-term plan.
Those rules predate the Obama and Trump Administrations, but Colorado drastically tightened its regulations for short-term plans as of 2019. Starting in April 2019, there are no longer any short-term plans for sale in the state. That’s because Colorado now requires short-term plans to be guaranteed-issue, cover the ACA’s essential health benefits, and cap premiums for older enrollees at no more than three times the premiums for younger enrollees.
Read more about short-term health insurance in Colorado.
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.
Colorado’s 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 coverage in 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 paid about $8,419 per Colorado enrollee in 2017. The national average was $9533 per enrollee.
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 650,000 Coloradans with Medicare were enrolled in Medicare Part D plans in 2018 – 344,288 in stand-alone prescription drug coverage and 306,062 in Part D coverage integrated with their Medicare Advantage coverage.
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
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 House has a Democratic majority, while the Senate has a Republican majority.
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.