Like all states, existing Colorado insurance regulations will be affected by changes mandated under the 2010 Patient Protection and Affordable Care Act. Initially, those have involved the formation of temporary high-risk insurance pools, and key decisions about the creation of health care exchanges. Since 2010, insurers have been forbidden to exclude children on the basis of pre-existing conditions, and the same protection will be extended to adults by 2014. Additionally, children must now be covered by their parents work-related insurance benefits up to age 26 regardless of marital or educational status.
Health Care Exchange
The progress of forming the required health care exchange in Colorado illustrates the mixed bag of politics in the state. Currently Colorado is one of six states that have joined in a lawsuit seeking to overturn the 2010 Patient Protection and Affordable Care Act. There have, however, been significant strides in adopting the usage of electronic health records and organizing the efficient exchange of health information required under the law. In addition Colorado has established an insurance exchange on the clearing house model.
Pre-Existing Condition Insurance
The high-risk insurance pool in Colorado, known as the Pre-Existing Condition Insurance Plan, is run by Rocky Mountain Health Plans and Cover Colorado. Premiums average $139 to $763 a month with a medical deductible of $2,500; and a brand name drug deductible of $500. Out-of-pocket expenses are limited to $5,950.
Basic Insurance Regulations
Insurers in Colorado have wide latitude to deny coverage, and to base premium rates on individual and family medical history. Age, gender, and voluntary behaviors like smoking and alcohol consumption can all affect premium pricing. If an applicant who has a pre-existing condition is accepted for coverage, the company can attach a rider to the policy to exclude any benefit payments relative to the treatment of that issue.
Health insurance restrictions in Colorado are some of the most stringent in the nation, but on the whole residents are more healthy than their counterparts in other regions. This fact alone lessens the risk profile with which insurers are dealing. Once a health policy is in place in Colorado and all aspects of the contract including payment are honored, the insurer may not cancel the coverage. Premiums may be raised, however, in response to health complications, increasing age, and other factors.
Small businesses who employ 2-50 workers are guaranteed coverage under any group plan that is offered. The pricing is not restricted though and there may be a minimum level of participation for a group policy.
All Medicaid benefits are decided on income as a percentage of the Federal Poverty Level. In Colorado, infants under the age of 5 are eligible for Medicaid assistance at 133% FPL, with those 6 to 19 at 100%. Pregnant women can seek assistance with a qualifying 225% FPL, parents at 60%, and the non-elderly disabled on Social Security at 74 percent.
Medicare benefits in Colorado are supplemented by 48 approved prescription drug plans, some with zero deductibles and others with premiums as low as $16.90. For more information see www.coloradomedicare.us.