Division of Insurance approves 2015 health insurance rates

By Vincent Plymell
Special to The SUN

The Colorado Division of Insurance (DOI), a division of the Department of Regulatory Agencies (DORA), reviewed and approved 1,072 health insurance plans from 20 carriers that are offering health coverage to consumers and small businesses for 2015. Consumers will have a wide range of plans to choose from, with many variations across plan types and premiums.

“We are pleased to see that our health insurance market is so competitive, especially compared to the other states that have released their 2015 rate information,” said Colorado Insurance Commissioner Marguerite Salazar. “With so many options, people in Colorado will need to spend time shopping to find the plan that best fits their needs, as well as consider that it’s not just about what you pay, it’s about what you get for your money.”

What the new rates mean

On average statewide, plan premiums will increase 1.18 percent over 2014, although premiums vary by carrier, age and geographic area. Premiums also vary by plan type — known as bronze, silver, gold or platinum plan types. For individual plans, the statewide average increase is 0.71 percent, and for small group plans, the average increase is 2.54 percent. It is important to note, however, that these are averages and consumers should look carefully at the specific details for plans available in their area.

For 2015, DOI realigned the geographic areas in the state, consolidating the higher health cost regions into larger rating areas. Geographic rating areas are used by insurance carriers to price premiums. This realignment reduced the number of areas from 11 to nine. For 2015, individual plans in the West rating area, which includes the mountain areas, but not Mesa County, will see average premium decrease of 7.44 percent. In the East rating area, comprising southern and eastern parts of the state, the average individual premium will decrease 5.01 percent.

“This past year, the premiums in the mountain areas of Colorado have been a concern for many,” said Salazar. “We are encouraged to see carriers such as Anthem and the Colorado Health-Op working with healthcare providers in the mountain areas to develop more affordable insurance options for 2015.”

It’s important to note that, under the Affordable Care Act (ACA), consumers cannot be denied coverage because of their health, nor can they be charged higher premiums due to a health condition. In addition, coverage has expanded and improved under the ACA. People get access to coverage for 10 essential health benefits, including recommended preventive care at no cost. This adds up to consumers getting more for the dollar.

How DOI reviews plans

Over the summer, DOI reviewed plans submitted by insurance carriers to make sure they meet federal requirements for coverage. DOI also reviewed the rates to ensure they are not excessive or inadequate. DOI verified whether the plans meet the federally defined metal tier coverage levels: bronze (60 percent of medical expenses paid by the plan), silver (70 percent), gold (80 percent) and platinum (90 percent). These percentages are referred to as “actuarial value.”

Financial assistance

These premiums do not account for those who may qualify for federal tax credits, known as Advance Premium Tax Credits (APTC), which help to make premiums more affordable. APTC and other federal financial assistance are only available for coverage purchased through Connect for Health Colorado. Eligibility for the APTC depends on a consumer’s household income in relation to the federal poverty level. The tax credit itself is calculated based on income, age and the cost of insurance in a community. For more information about APTC, contact Connect for Health Colorado at www.connectforhealthco.com or (855) 752-6749.

Tips when shopping for health insurance

Having many options is good news for Coloradans, but with so many choices, it is important for consumers to comparison shop and look at more than just the premiums before making their decision. For example:

• Is your doctor or hospital of choice included in the plan’s provider network? Seeing an out-of-network doctor typically is more expensive.

• Lower premiums often mean higher costs when receiving care. Find out if there is a deductible and how much it is, as well as the out-of-pocket maximum. Determine what you would have to pay for a doctor’s visit.

• Find out about prescription coverage, especially if you need specific medications.

• Does the plan cover procedures you may need some day, such as back surgery, ambulance service, MRI scans or knee replacement?

• Consumers who have questions about their current plans should contact their insurance carrier, Connect for Health Colorado, their insurance broker or their employer.

More information about the approved 2015 plans is available online at www.dora.colorado.gov/healthinsurance.

This story was posted on October 2, 2014.