Division of Insurance releases preliminary 2019 health insurance information

Final approval of plans expected late summer / early fall.

DENVER (July 13, 2018) – The Colorado Division of Insurance, part of the Department of Regulatory Agencies (DORA), today released preliminary information for proposed health plans and premiums for 2019 for individuals and small groups. Colorado consumers can file formal comments on these plans through August 3.
2018 Companies Return for 2019
The same seven companies that offered on-exchange, individual plans are returning for 2019 - Anthem (as HMO Colorado), Bright Health, Cigna Health and Life, Denver Health Medical Plans, Friday Health Plans, Kaiser Foundation Health Plan of Colorado and Rocky Mountain HMO. And like in past years, this means that all counties in Colorado will have at least one on-exchange company selling individual health plans.
“I’m very pleased to see that we kept the same seven companies selling on-exchange plans,” said Interim Insurance Commissioner Michael Conway. “Last year we worked hard to keep them in Colorado and I think that work is reflected in their decisions for 2019.”
Smallest Increase in Years
For 2019 individual plans, the average premium increase request is 5.94 percent across all companies and metal levels. In the small group market, the average premium increase request is 7.15 percent. Remember, these are averages across all plans from all companies, across all areas of the state where a company offers plans, for all ages. These averages are not representative of how one individual’s premium could change.
Looking closer, the requested average premium increase for individual gold plans is 6.85 percent, and is 12.3 percent for silver plans. For bronze plans, the requested average premium increase is 0.9 percent.
In addition, for the first time in years, an insurance company is requesting a rate decrease for individual market plans for 2019. In fact, both companies under the Anthem umbrella, HMO Colorado and Rocky Mountain Hospital and Medical Service, requested average decreases:  -0.44 percent for HMO Colorado, and -2.64 percent for Rocky Mountain Hospital and Medical Service.
“Last year we worked to keep the companies participating in Colorado in the individual market,” continued Commissioner Conway. “Our efforts this year have concentrated on maintaining and furthering the stability we secured last year. Moving forward, we will be doubling down on our focus to address and attack the ever-increasing healthcare costs that drive premiums and push coverage out of reach for many. For too long Colorado consumers have been forced into the uncomfortable and oftentimes impossible position of paying for ever increasing healthcare costs.”
Challenges Continue
As in past years, challenges continue. Just last week, the Trump administration decided to freeze a key ACA program designed to discourage insurers from favoring healthy people over less healthy ones.
“Decisions at the federal level continue to make life interesting,” said Commissioner Conway. “But as we have in the past, we will find a solution to this most recent announcement. To that end, just this morning, I informed the insurance carriers that we will require that they account for their respective risk adjustment receivables or payables as they are reflected in the July 9, 2018 federal report. I will take any subsequent steps that are necessary to protect Coloradans and to maintain market stability.”
The Rate Review Process
The Division of Insurance will spend the summer reviewing these plans to make sure the requested premiums are neither too high nor too low, and ensuring that the plans comply with the Affordable Care Act (ACA) and state laws.

• The Division of Insurance does not set insurance premiums, but will review what the companies submitted to determine if the requested increases or decreases are justified.
• The Division of Insurance checks to make sure the premiums are sufficient for the company to continue to pay its members’ claims.
• The Division of Insurance verifies whether the plans meet the metal tier coverage levels:  bronze (an average of about 60 percent of medical expenses paid by the plan), silver (70 percent), gold (80 percent) and platinum (90 percent).  
• The Division of Insurance also reviews the benefits and the plans’ networks of healthcare providers to make sure that they meet state and federal requirements.   
• The Division will release the final approved plans and premiums for 2019 in late summer / early fall, along with summary information and analysis.

Preliminary 2019 Information
The information below on the number of plans and carriers and the requested premium changes for 2019 is preliminary. The information only reflects what the companies have requested, not the final approved plans for 2019. Any requested premium has to be justified by the insurance companies.
For 2019, a total of 16 insurance companies plan to offer 808 individual and small group plans in Colorado. The average requested premium change for individual plans across all companies is a 5.94 percent increase, while in the small group market, the average requested change across all companies is a 7.15 percent increase.

After the Division releases the final, approved plans and premiums for 2019 in late summer / early fall, it will host a public meeting to discuss health insurance for the coming year. The date and location for this forum will be determined later this summer.

Trump's latest move could push Obamacare premiums higher

By Tami Luhby

Updated 7:48 AM ET, Tue July 10, 2018

That is because the federal government won't distribute $10.4 billion it was expected to give insurers this fall under the Affordable Care Act's risk adjustment program. The administration said Saturday that it would temporarily suspend the payments because a federal judge earlier this year ruled the program's formula was flawed.

Insurers rely on the funding, which serves as a backstop for those who wind up with a high share of costly enrollees. Under the risk adjustment program, insurers with healthier policyholders contribute money, which is then divvied up among carriers with sicker ones. It's the only remaining risk mitigation program in Obamacare. The other two, which were designed to last only three years, ended after 2016.

The administration's latest effort to undermine the Affordable Care Act comes at a particularly sensitive time for insurers. They are now deciding which exchanges they will participate in next year and what premiums they'll charge. Having a risk adjustment program factors into these calculations.

Silver Loading Impact on the Affordable Care Act

Is silver-loading the silver bullet? Actuaries wary of long-term impact of CSR cutoff

By Susannah Luthi  | April 5, 2018

Insurers dealing with the death of the Affordable Care Act's cost-sharing reduction payments may hit a stumbling block: the law's method for dealing with risk adjustment.

The calculation is supposed to help carriers that bear a higher share of risk in the individual market by having those that shoulder less risk make payments to offset costs. It is a formula that has been problematic since the start for smaller plans in particular, but actuaries are on the alert that it could cause more headaches to come.

Take an exchange insurer like Security Health Plan, an independent company in mostly rural Wisconsin where 60% of the people who buy their insurance from the Obamacare exchange qualify for financial help with co-pays—cost-sharing reduction payments—because their income falls below 250% of the federal poverty level.

For Security Health Plan, President Donald Trump's sudden elimination of CSRs last October changed the makeup of its exchange market substantially. The cost of CSRs for about 60% of the people who enroll in the company's exchange plans is now funneled entirely into the middle-tier silver plans. This work-around is known as "silver-loading."

Because silver-plan premiums are the benchmark for calculating tax credits used to subsidize lower-income enrollees' premiums, silver-loading has protected people with low incomes from bearing the brunt of the hikes. In fact, they have seen higher subsidies. In some cases, silver-loading has meant free or very cheap bronze plans and sharply reduced the premiums for gold plans as well.

Because it has appeared to work so well, Democrats have largely lost interest in restoring the CSRs. An effort led by GOP Sens. Lamar Alexander of Tennessee and Susan Collins of Maine to fund CSRs and a $30 billion reinsurance pool as part of last month's $1.3 trillion spending omnibus failed, and any federal stabilization effort is now unlikely to happen.

Silver-loading has accounted for about 20% of the Security Health Plan's silver-tier premium increases on the exchange. John Holahan of the Washington, D.C.-based Urban Institute said the nationwide average increase for silver premiums was more than 30% for 2018.

Ultimately, silver-loading reshaped the use of the individual market even though the needs of the insured remains the same.

"It's a forced reaction to a reaction," Michael Sautebin, actuary for Security Health Plan, said. "It was an artificial change, and we had to react."

While silver-loading appears to be working for now—many left-leaning policy analysts now support leaving CSRs out of the picture because restoring them would bring premium subsidies down to their previous levels. Sautebin said carriers likely face a day of reckoning when the time for risk-adjustment payment transfers comes around.

Stan Dorn of Families USA, a Washington, D.C., advocacy group, said risk adjustment will play out differently across the country, since risk adjustment is a "zero-sum game within each state."

However, he noted, a different level of risk has now become associated with different plans as former silver-plan enrollees shift to higher-value gold or lower-value bronze.

"If told that enrollees are now lower-risk than in the past, which is now the case, plans with a higher number of gold members may get too much compensation under risk adjustment," Dorn said.

If higher-risk enrollees opt for bronze because they have free or very cheap premiums thanks to the increased subsidies, the carriers insuring those plans could lose money in the risk-adjustment payments. This could impact companies like Security Health Plan, which has seen a shift to bronze plans even though its population, which skews older, does need to use their coverage.

And risk adjustment isn't the only thing actuaries are watching. They are also keeping an eye on how many low-income people now in cheaper or free bronze plans will actually be able to pay for care.

The CMS released its 2018 open enrollment numbers on Tuesday. A breakdown by Andrew Sprung, who writes a blog called xpostfactoid closely tracking ACA enrollment, showed that for this year there was a drop in people able to use CSRs. Nearly 460,000 fewer people enrolled in ACA plans, while more than 750,000 fewer choose plans that let them use CSRs.

The steepest drop in people who chose plans with CSRs came to the group of people between 200% and 250% of poverty—a 23% decline from last year even though total ACA enrollment in that group fell less than 3%.

People in that range have an annual income of roughly $24,000 to just over $30,000 for an individual, or about $49,000 to $61,000 for a family of four.

Actuaries and insurance officials noted that it is too early in the plan year to draw trends for how this is working out for enrollees, but an analysis pulled from HealthCare.gov and obtained by Modern Healthcare looks at how out-of-pocket costs should change for consumers. A 45-year-old at 140% of the poverty level who lives in Nashville could, for example, see out-of-pocket costs for Type 2 diabetes climb from $869 net cost per year (including a premium) with the lowest-cost CSR plan to $7,110 with a $0 premium bronze plan.

Some in the insurance industry also worry about the continued impact on unsubsidized enrollees, particularly as the 2019 market brings other unknowns such as expansion of short-term, limited-duration plans and association health plans.

Wisconsin's Security Health Plan couldn't protect the unsubsidized silver enrollees from the CSR bump, and so even the off-exchange silver group saw about a 20% attrition—double the attrition they have seen in previous years.

Because most of the individual market in the plan's region is low-income, this wasn't a significant amount of people. But Sautebin noted that it poses a troubling trend, since Security Health Plan is the lowest-price option in the market, and it's unlikely those enrollees went to a competitor.

"We are going to pay for these people one way or the other, either through insurance, or, if they are uninsured, through uncompensated care costs," said Marty Anderson of Security Health Plan. "When you've got such a small population, no insurer has enough market share to guarantee less volatility."

To some extent, these concerns appear to be nascent. A spokesperson for the National Association of Insurance Commissioners said so far the group has "heard nothing that would make us concerned about silver-loading."

Dorn, who opposed restoration of CSRs because it would lower the tax credits for people who qualify for subsidies, said that he would like to see more state efforts on off-exchange silver plans to help the unsubsidized and noted the complexity of the issue.

"The story is not unequivocal," Dorn said.

Can we fix America broken health care system?

Can we fix America’s broken health care system?

May 14, 2018

---

The fee-for-service way to pay doctors and other health care professionals has driven up health care costs in this country for many years, according to an article published by The New England Journal of Medicine. To improve the quality of care and reduce costs, the current design of America's health care system needs a makeover.

Enhanced Personal Health Care (EPHC) is our approach to moving away from the fee-for-service model to one that's value-based. EPHC holds doctors accountable for delivering better coordinated care, improved quality and lower costs. Instead of simply treating symptoms, EPHC focuses on keeping people healthy.

EPHC gives doctors the personal support, data, resources and incentives they need to change the way they practice health care. It's this change in behavior that results in more coordinated care, fewer unnecessary tests and better chronic disease management. The end results are improved health outcomes for members and lower costs for employers.

Watch this video and see several health care professionals tell their personal stories of how EPHC helped transform their practices over the years.

New Health Insurance Broker Fees 2018

Broker Fees

Beginning August 8, 2018, brokers in Colorado will be permitted to charge a fee for advising customers on the choice of a health plan if the broker:

• Will not receive a commission on the plan from the health insurance company
• Provides a written disclosure to the customer

Brokers have played an important role in assisting our customers throughout our history and we expect that to continue.

Some points to be aware of:

• The Colorado Division of Insurance will develop rules to implement the new law
• No fee can be charged in connection with an enrollment in Medicaid or CHP+
• Connect for Health Colorado will continue to inform our customers on the full cost of their coverage and we will incorporate this change in future communications
• This change applies to health plans sold in or outside the Connect for Health Colorado Marketplace for brokers who choose to charge a fee

More information on the legislation, including the text of the bill, can be found here.

Frequent Headaches & Feeling Tired

Frequent headaches and feeling tired can be caused by a variety of common conditions. Some of the common conditions that can cause frequent headaches and feeling tired include dehydration, hypoglycemia--low blood sugar--and chronic fatigue syndrome. 

Pizza has a bad reputation, read on

Pizza has a bad reputation in the health industry because it is considered as the easy snack that we can grab all the time, especially at nights. But let’s be honest for a second; any meal consumed at night is not healthy. Plus, pizza is life, and we are here to prove that it is healthy for us!

According to Health Sciences Institutes in Baltimore, pizzas in Italy are completely different than the ones we make in the United States. Our pizzas have a thinner crust which means less empty calories.

In addition to that, both pizzas have a secret ingredient that helps our bodies fight diseases. Which means, my friend, that it is time to walk around guilt-free after binge eating it all night (maybe a little guilty, though!).