Colorado Division Of Insurance Announces Significant Changes To The Individual Market

[LocalGrowGuy]

Effective January of 2017. Time to make sure your health insurance is in order to avoid paying the penalty of $695 or 2% of income, whichever is higher.

-Humana and UnitedHealthcare will no longer be offering Individual plans in Colorado in 2017.
-Rocky Mountain Health Plans will be exiting the individual market in all counties except Mesa.
-Anthem Blue Cross and Blue Shield is eliminating their individual PPO and will be offering HMO only statewide.
-Remaining carriers are requesting significant rate increases for their individual products, some as high as 40%.
-A new carrier, Bright Health Plans, will be offering Individual plans in Summit County and along the front range, it will likely use Centura providers, but nothing has been signed or publicly released.

DORA announcement-
https://www.colorado.gov/pacific/dora/node/140171

These changes will impact nearly 100,000 subscribers. This is for individual plans, not employer based group plans.

Grandfathered plans may see restrictions put on them as costs continue to increase, as most plans that are grandfathered have better benefits and thus higher utilization than obamacare or ACA-compliant plans. We were told from day one that we would be able to keep our grandfathered status as long as we don't make major changes to the policy like changing the deductible or adding ancillary lines of coverage. Those promises are now beginning to ring hollow, but time will tell.

For those who take prescriptions, it will be important to do your research to see which carriers treat certain conditions and medications. For a specific medication, some plans might have a $50 copay, some might have a $500 copay, some might require the patient to pay the cost outright and it would apply to the medical deductible. These benefits change from carrier to carrier even for the same medication.

 

[LocalGrowGuy]

I'm going to put this here as well to avoid cluttering the Colorado forum with boring (but important) insurance stuff.

In an effort to ensure transparency, I'll post up a quick summary of arguments for and against Amendment 69. For the record, I do not believe this legislation addresses the largest problem we see which is the rising costs of the delivery of healthcare.

For-http://www.coloradocare.org/ - Seth Meyers did a good job of pointing out how ludicrous our healthcare system is, in this state and others. It's a nine minute clip if you can stand it. Not exactly non-partisan but that's okay.

Against- http://cochamber.com/2015/11/13/god...ealth-care-measure-qualifies-for-2016-ballot/
-The Legislative Council, the research arm of the Colorado General Assembly, estimates that ColoradoCare will cost Colorado taxpayers $25 billion in its first year of operation. By contrast, Governor Hickenlooper proposed a $27 billion budget for the state’s 2016-2017 fiscal year. That means that taxes will effectively double for goods and services to fund this plan.
-Moreover, ColoradoCare would swallow up all State and Federal health-care programs, including four well-known, major programs:

1. Colorado’s workers’ compensation system;
2. Medicaid, the state-federal program that provides medical insurance for low-income citizens;
3. Children’s Basic Health program; and
4. Colorado Health Benefit Exchange.

-Amendment 69 states that “Colorado needs a health care delivery system that prioritizes value over volume and that encourages quality, efficient, and accessible health care.”
-Once fully implemented, ColoradoCare would impose a “premium tax” on employers (6.67 percent of total payroll income) and workers (3.33 percent of total payroll income). Wages, salaries and tips would be subject to the tax.

Anyone who has non-payroll income would be taxed at 10 percent. Such income includes, according to the Legislative Council:

• business proprietors’ income, including farm proprietors’ income;
• capital gains; and
• pensions, annuities, and social security benefits, to the extent taxed by the state under current law.

Taxes would not be collected on total personal income greater than $350,000 for a single-income filer or $450,000 for joint-income filers. These two limits would be indexed to calendar year 2017 but then adjusted annually according to the Denver-Boulder-Greeley Consumer Price Index (CPI) in later years.

The proponents of Amendment 69 are very generous in their concern for the financial impact of their measure on workers: “An employer may pay all or part of an employee’s share of the taxes levied . . . “

My apologies if I have ruined anyone's good mornin'.

 

[LocalGrowGuy]

Your number one is already law and in place so it's non-issue. Increases in premiums are more closely tied to utilization. What people don't seem to realize is that healthcare is expensive, which is reflected by these obscene rate hikes.

[edit- Tying premiums to GDP isn't the answer, because it doesn't address the biggest cost of healthcare which is the cost of delivery, the cost of claims incurred. If people still over-utilize their insurance policies, we still have cost over runs that won't be made up or paid for by tying it to growth. Premiums should be a function of utilization, and I don't understand why people are against that idea in this instance. I don't meet people who are upset that their car insurance won't cover oil changes and headlights, but people expect (rightfully imo) to get a benefit when they pay hundreds of dollars per month for their insurance premium.

You don't see a solution because I don't think there is one that is feasible.]

I remember Pelosi saying that, and now we are dealing with those consequences, but nothing that is going on now is a surprise, this has been coming. It is designed to fail, designed to spread costs instead of lowering them. It is impossible to 'reform' an industry this complicated with a single piece of legislation.

The very reason insurance companies are pulling out is because the only people who have signed up are high utilizers, which largely negates the requirement to carry insurance. The only way obamacare or single payor or any other system that is guarantee issue is to ensure that everyone has insurance, not just the ones who are sick. Unless and until every single person signs up, there is no possiblity of this solution working. Again, I believe this was the intent of the law, for the very reason you mention. There should be two paragraphs and nothing more, but your two part solution doesn't address some very important issues. If the penalty for not having insurance was fifty grand, then everyone would have insurance, and we wouldn't need additional subsidies, again, in my opinoin. If a young healthy person has two choices, paying a year of premium at $2500, or paying the penalty of $695, what is that healthy individual going to do? The majority will pay the penalty and roll the dice, and considering half of bankruptcies are due to medical costs incurred, a lot of those who rolled the dice got bit. When they finally need it they can't get it because we can only sign up during open enrollment.

One example I use is what we refer to as defensive medicine. Doctors are providing more care than they ever have before, and most of it isn't needed. However, the policyholder determines what care is provided, and if the patient wants an MRI, they will likely get it, regardless of necessity. Doctors practice defensive medicine, which is costly, and the largest reason is that they are afraid of getting sued if they 'miss' a diagnosis. Doctors are now paying more for malpractice insurance then ever before, for this reason. An example is a facility that does MRI's. A new MRI machine costs between $500k and 3 million to purchase, and a million dollars a year to run and maintain. I don't think it takes a genius to see that there is a much higher chance that this facility will recommend MRI's, to you know, pay for the machine in the back. Note that this does nothing to reduce the cost of care, it doesn't save anyone any money. Reform is needed at every level, and that is impossible to accomplish as it stands now.

Colorado will be the first state to attempt single payer with Amendment 69, but that would double our budget. How do we pay for that? Increased taxes. The whole way. Effectively doubled. Every single item that is taxed now would be taxed at a higher rate, likely double or close to, that would 'pay' for this plan. I'd rather not pay twice the gas tax etc.

People who are healthy will say thanks but no thanks to these atrociously high rates, and the folks who have needs will enjoy the benefit of paying more via premium, and I haven't seen any plans getting more robust or richer in benefit that justifies the costs associated, so everyone still loses. Game, set, match.

 

[xavier7995]

Are shamans covered? .....that's all I use.

The cost is rather crazy....just got done signing up for some medium to good insurance and my contribution plus my employer is 2k a month. That's for the privilege of maybe not having to fight for every damn thing to be challenged and denied the first time.

Edit I really wish I knew what the level of care would be like for the single payer system. A tax increase to not have to shell out a ton of money each month in premiums looks good from where I am sitting...tax increase depending I guess.

 

[LocalGrowGuy]

Are shamans covered? .....that's all I use.

The cost is rather crazy....just got done signing up for some medium to good insurance and my contribution plus my employer is 2k a month. That's for the privilege of maybe not having to fight for every damn thing to be challenged and denied the first time.

Edit I really wish I knew what the level of care would be like for the single payer system. A tax increase to not have to shell out a ton of money each month in premiums looks good from where I am sitting...tax increase depending I guess.

I don't think people will be unhappy at their level of care, but you are lucky in that you are mostly healthy, except for those open sores on your junk. That's no longer considered a pre-existing condition.

The cost is crazy because your employer's contribution to your premium isn't usually considered by the employee. That cost becomes transparent if you leave and have the option to keep the plan under COBRA or state continuation. You will be disappointed in what you don't get with your monthly premium. Some good things that came out of the ACA are that your non-travel immmunizations are free, no cost, deductible, or copay, and most if not all of your preventive care is also covered at no cost, no copay, nothing out of pocket.

Group Insurance is guaranteed-issue in Colorado, that's why group insurance has typically been more robust and more expensive.

Individual insurance premiums were able to be kept reasonably low by requiring medical underwriting, which went away with the ACA. Now, individual insurance policies are starting to require the same things as employer-based health insurance, which negates the savings that healthy people enjoyed. My book of business goes both ways, healthy people don't like the idea of having to help support higher utilization, unhealthy people and people with health conditions they didn't ask for like the idea of not having underwriting. Personally, I have a lead foot and I am okay with paying more for my car insurance. I am healthy, young, and male, so I don't like having to pay for maternity, prescription contraceptives, or other 'stuff' that doesn't apply to me. The ACA is an attempt to fix everything in one fell swoop, and that shit ain't happening.

Everything that is taxed would go up, likely double. I thought our state already couldn't make our 2017, 27 billion dollar budget, and I don't understand how adding startup costs of 25 billion MORE dollars we don't have will fix anything in any way.

 

[LocalGrowGuy]

The problem I have is that the ACA purports to cover everyone, that it is fulfilling a need that exists.

In fact, every single person in this state already has, or had guarantee issue access to care. Low income folks had Medicaid, disabled and elderly have Medicare, those with health conditions already had access to our state's safety net program called Cover Colorado, which went away. Colorado was one of few states that recognized those who are self employed as having a business and therefore access to group insurance as a self employed person. Now, there is no group insurance for self employed, and even two person groups are illegal unless the two employees are not related. No more mom and pop shops being able to purchase group insurance.

The biggest issue was and will continue to be cost. Unless and until we can or are able to reign in the extremely high costs of the delivery of healthcare, premiums will continue to rise, carriers will continue to exit the market since they have to answer to stockholders, and whichever administration gets into the white house can tell us how bad and evil those insurance carriers are for increasing premiums to affordable levels.

If you think people are pissed now, just wait for November and open enrollment, or the end of January when people try and use their policies.

 

[xavier7995]

My shaman promised sore free junk in 3 weeks if I paid 420 bucks and delivered him a unicycle in 73 days precisely.

The individual market sounds like a bag of suck.

 

[gravekat303]

Argggh my poor young brain is hurting I tried to keep up but I gave up I actually will start paying for insurance. 7/1 buck 50 a month good? Bad?

 

[xavier7995]

Depends on the level of care you get for 71.

 

[gravekat303]

No clue what that means in such a chump my wife takes care of all that jazz I just pay

 

[LocalGrowGuy]

I am 34 and healthy, I have an old cadillac plan with Anthem, I overpay at almost three hundred bucks, but my deductible is a grand.

These days I would consider anything under 250 for young bucks. We are talking about upper weight limits for girls, right? No? As long as you take advantage of all of the free shit you pay for, a buck fifty is fantastic. In my opinion, for ballers like yall.

edit- 7/1 was probably the effective date of the insurance, 71 is the over/under on how many fat joints that CM can roll in ten minutes. Buck fifty is premium after employer contribution?

 

[gravekat303]

I am 34 and healthy, I have an old cadillac plan with Anthem, I overpay at almost three hundred bucks, but my deductible is a grand.

These days I would consider anything under 250 for young bucks. We are talking about upper weight limits for girls, right? No? As long as you take advantage of all of the free shit you pay for, a buck fifty is fantastic. In my opinion, for ballers like yall.

edit- 7/1 was probably the effective date of the insurance, 71 is the over/under on how many fat joints that CM can roll in ten minutes.

Haha ice gone tobthe Dr 3times in 4 yrs one was the Er and another was a follow up from the Er fuck doctors

 

[LocalGrowGuy]

Haha ice gone tobthe Dr 3times in 4 yrs one was the Er and another was a follow up from the Er fuck doctors

Did she break your boner?

 

[gravekat303]

Nah 2 fat dudes in a mosh pit tore my minicus and a few other tendons and ligaments on a sat night so I was forced to the er

 

[chickenman]

We are low income and I got medicade..Free.wonder how good that is.
At least it covers accidents right??Take me to Hosp. will be paid in case of accident correct???​

Hard to find a provider for a knee issue luckily it healed itself...

 

[chickenman]

And I am no mooch/ I paid into system all my life never once had any benefits..
Have not needed any medical attention for many years..

 

[gravekat303]

I'm about to hop on a plane and go skydiving a if I die I bequeath my seed stash to lgg to spread to the masses seriously gravekat

 

[scoop]

Yikes. Such a scam. There should be a way to self-insure (just pay the bills if something happens) if you can afford such a thing. (like we do with "dental" services...we pay as we go/no insurance)

As it is now we pay $1400 a month for "medical" through Anthem (The PPO is gone in 2017? Fuck that) for 2 olders and a youngun with a 5K deductible and 2 office visit per year...

Thing is...I've paid in for 2 years and have never used the fuckin thing. 30K or so paid in....FOR NOTHING....that could have been put in a health related savings account for when I need it.

just let me show i can afford X amount of risk and get the fuck out of my way.... this shit is ridiculous.

 

[motz]

This is all due to Obama care plan.
Ins companies aren't digging his scene.
Wife works in ins industry expect more surprises, stay tuned

 

[LocalGrowGuy]

And I am no mooch/ I paid into system all my life never once had any benefits..
Have not needed any medical attention for many years..

You should enroll in Medicare when eligible if that's the right decision for you. Don't forget to sign up for part D and a supplement. They have zero premium options to help when you hit the donut hole.

Scoop, I feel you. You could have paid the penalty, for 2015, and rolled the dice. I have many clients who rightfully (imo) paid the penalty, as paying thousands of dollars out of pocket just on premium before claims and the penalty limits your immediate liability, but the risk is pretty big. That's the fact that outside of open enrollment now, you can't sign up whenever you want (or when you need a claim paid for) until the next years' open enrollment. I agree that this stuff is bullshit, and it is frustrating to put it mildly because it was easy to see coming. Anthem will still continue to allow PPO policyholders to keep them unless they make major changes per ACA regs. You should be able to keep your plan. Sound familiar? These happenings with carriers leaving the market won't likely affect current members, but I am also hearing ramblings that one of the major concessions might go away, and that's the ability for people to keep their grandfathered plans, like what was promised. This legislation is full of nothing. 50% of bankruptcies are related to health expenses. I promise it is easier to write that premium check and not have to go through the nightmare of being uncovered and sick.

Colorado might be the first state to try a single payer system, Amendment 69 would set up a giant body with no regulatory oversight and nobody to answer to. They say that there is too much unnecessary costs and claims, and they aim to address that. Insert radical conservative comment about death panels, followed by a sense of entitlement, that we should get X and Y for free, cost be damned, because money. Just like the national debate on healthcare reform, we were told there would be fraud and abuse that would be addressed, which would help cut costs, but I don't see anything remotely close to that, it's just lip service. Every tax you pay now would likely double. We don't have enough money to cover our current state budget but this amendment would double the budget that we can't cover now. It is troubling to me that this isn't a bigger issue.

This is all due to Obama care plan.
Ins companies aren't digging his scene.
Wife works in ins industry expect more surprises, stay tuned

This is no longer a partisan issue, it affects everyone. Insurance companies aren't the only ones negatively impacted by this, one fifth of our economy is related to healthcare, I don't think that is only L's and R's, and it's unfair to punish or blame obama. That's lazy. We should find fault at the local level such as the division of insurance or dora. Our insurance commissioner is not very well-liked, but at least she's somewhat transparent. Our legislators are also responsible, but they remain silent.

I haven't met many people who are happy with their ACA-compliant plans. Reimbursements are lower so doctors are having their patients sign documents stating that they will pay anything that their medical plan doesn't cover. If you sign on that dotted line, you are signing a contract that does not apply to your insurance plan. I see this often with pregnancies and what we call the PEAR providers. Pathologists, ER techs, Anesthesiologists, and Radiologist typically don't sign contracts and can charge whatever they want.