States seeking to reduce their uninsured populations must beware a Catch-22

By David M. Anderson, Charles Gaba, Louise Norris and Andrew Sprung State policymakers have been prolific and creative in putting forward measures to strengthen their ACA marketplaces. Measures enacted since 2017 or in progress now include reinsurance programs, which reduced base premiums by an average of 20% in their first year in the first seven […]

AHCA: The Aye or Nay? Edition of the Health Wonk Review

Seven years ago today, President Obama signed the Affordable Care Act into law, ushering in a host of reforms for the U.S. health care system. And today, House Republicans are planning to vote on the American Health Care Act (AHCA), which would repeal many of the ACA’s spending-related provisions and implement replacements for some aspects of […]

What do the proposed HHS regulations mean for Colorado’s individual market?

HHS Secretary Tom Price was confirmed by the Senate last week, and the agency wasted no time in drafting new proposed regulations under his leadership. The new regulations are intended to stabilize the individual and small group health insurance markets. The comment period is only three weeks (it closes on March 7, 2017), which is […]

Connect for Health Colorado and the OIG Audit Report

On December 27, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) released an audit report (the full report is here) regarding Connect for Health Colorado’s use of federal start-up funding. This funding was provided for state-run exchanges to get their operations up and running in 2013 and 2014. To make a […]

PEAK Issues

As of now, it appears that PEAK has various errors. If you’ve had coverage through PEAK in the past, submitting a financial determination for 2017 also re-determines your 2016 financial eligibility. This can cause major problems with your 1095-A, your billing, and your insurance plan. **NO Confirmed Fix Yet** I will update this page when there […]

Don’t Get Caught By The ACA Individual Mandate Penalty – It’s much higher than it used to be

This post was originally written in March 2014, but was updated in November 2015 to reflect the changes in the penalty calculation for 2016, and again in November 2016 to address the penalty for 2017. The penalty in 2017 will remain unchanged from 2016, but it’s considerably higher than it was in 2014 or 2015, […]

You’re eligible for cost-sharing subsidies. Does that mean you should always pick a silver plan?

A recent article published by the Colorado Center on Law and Policy (CCLP) caught my attention on Twitter today. One part of the article stood out, and I wanted to address it here. The article states that “Anyone who purchases insurance on Connect for Health Colorado would be wise to check eligibility for assistance and, […]

New Benefits in Colorado for 2017 – Bariatric Surgery, Infertility, Chiro?

Open enrollment is just around the corner, and you may have started receiving information from your health insurer regarding changes to your premium and coverage for 2017. I maintain a detailed overview of Colorado’s exchange at, so if you have questions, you might find answers there. But after receiving our own family’s renewal packet […]

The “We’re Ten!” Edition of the Health Wonk Review

Welcome to the Health Wonk Review! The ten-year anniversary of our first blog post here at the Colorado Health Insurance Insider was earlier this month. I didn’t notice it at the time, but as I read through the entries for this edition of the Health Wonk Review, I was struck by how many changes we’ve witnessed […]

Pregnancy and Special Enrollment Periods

A year ago, I wrote an article about a petition in Colorado that was trying to get pregnancy added to the list of things that make people eligible for a special enrollment period during which they can enroll in a health insurance plan. Nothing has changed in Colorado on this issue since then, but I wanted […]

Prescription Drug Coverage: Terms and Concepts You Need to Know

What is a drug formulary? How do prescription tiers work? If you’re shopping for health insurance and take prescription drugs, you likely have questions about the prescription coverage offered by the various plans. The good news is that all of the plans available today have to cover your pre-existing conditions. They can’t deny your application […]

HR 5447 – Should employers be allowed to reimburse individual health insurance premiums?

HR 5447 is the Small Business Health Care Relief Act of 2016. It passed the House earlier this month, and is with the Senate now. This bill would allow employers to contribute to their employees’ individual health insurance premiums, up to a maximum of $5,130 for a single employee, or $10,260 if the reimbursement also includes […]

2017 Rate Increases for Colorado Individual Health Insurance Market

EDIT, 9/25/2016: Rates were approved recently by the Colorado Division of Insurance. The following average rate changes (actual changes will vary by plan) will take effect January 1, 2017 for the seven carriers that will offer individual market coverage through the exchange. They will also apply off-exchange, as all of these carriers offer their plans both […]

Open enrollment for 2017 coverage, and HSA contribution and coverage limits

Open enrollment for 2017 coverage starts on November 1, 2016. The schedule for open enrollment will follow the same November 1 – January 31 dates that were used last year (that schedule will continue to be used for 2018 coverage as well, but it will shorted to just a six week window in November/December for […]

Simple Choice plans in the federally-facilitated exchange

Last month, I wrote about the standardized plans that will be optional for insurers to offer on this fall. I noted that standardized plans do not signal the end of HSA-qualified health insurance, and outlined the basic details surrounding standardized plans. The standardized plan designs that HHS finalized in the 2017 Benefit and Payment Parameters […]

SB2 passes Senate – but it’s still a waste of time

Last week, the Colorado Senate passed SB2, with a vote of 18 to 17. All of the Democrats in the Senate opposed the bill, and it’s doubtful that it will pass in the Democrat-controlled House (it’s currently with the State, Veterans, and Military Affairs Committee in the House). I wrote about SB2 in February, when […]

Commission cuts aren’t the same in states with state-run exchanges

EDIT, March 29, 2016: In addition to having state-run exchanges, there’s another factor involved here, which is much more likely to be the correct explanation. California, Colorado, Connecticut, and Kentucky are the four states that have taken regulatory action to prevent health insurance carriers from cutting commissions. Although my initial hypothesis wasn’t bad, direct action […]

Healthcare Reform: The Path Forward

Welcome to the Health Wonk Review! It’s been nearly six years since the ACA was signed into law. And although most aspects of the law have now been implemented, the debate over its merits have not let up. In this election year, healthcare reform continues to be a hot topic, even dividing Democrats in terms […]

Should we eliminate the penalty exemption for a short gap in coverage?

Over the last several weeks, much has been said about the need to tighten up enforcement of the ACA’s special enrollment period eligibility. And CMS has said they will conduct audits this year to ensure that people enrolling through for the remainder of this year have a valid qualifying event. There is concern that people […]

Senate Bill 2 and Connect for Health Colorado’s Administrative Fee

Last month, Colorado Senator Kevin Lundberg (R, Berthoud) introduced Senate Bill 2. In a nutshell, the bill calls out Connect for Health Colorado’s administrative fee as a violation of TABOR, since the fee is technically paid by people who aren’t enrolled through the exchange, could be considered a tax, and wasn’t voted upon by Colorado residents. Connect […]

Should open enrollment end by December 31 to prevent adverse selection?

A year ago, I wrote a post in which I expressed the opinion that open enrollment should continue into January every year. At that point, the proposed guidelines from HHS had called for the 2016 open enrollment period to end on December 15, 2015 (ie, next week), and I noted that this would mean people […]

Standardized plan designs, proposed 2017 max oop, open enrollment, and more

On Friday, HHS published their proposed benefit and payment parameters for 2017. It’s a good read, if you’re into HHS regulations. They’ll accept comments on the proposals through December 21, and final regulations will likely be published in February or March 2016. open enrollment schedule for 2017 HHS has proposed that open enrollment for 2017 […]

Lesson from CO-OP failures: low premiums aren’t sustainable unless we reduce healthcare costs

Healthcare accounts for 17.4% of the US GDP. And yet most of us can’t or won’t include a healthcare line-item in our budget that accounts for 17.4% of our annual spending. Whenever health insurance carriers raise their rates – particularly if it’s a significant increase – there tends to be a public outcry, with the carriers […]

Why is Colorado Health OP shutting down?

UPDATE, 10/20/15: On October 19, Colorado Health OP filed a lawsuit in Denver District Court, seeking an injunction and temporary restraining order to allow the carrier to continue to sell policies – and participate in the 2016 open enrollment period – while working for the next few weeks to secure funding from one of the […]

Proposed rate increases in Colorado: CO-OP up 21%, Kaiser up 2%

The back-story Last September, when we wrote about the fact that the average individual rates increase in Colorado was less than one percent for 2015, we noted that the overall rate increase was astoundingly low – far lower than anything we’d seen during our time in this industry. And although it will be several more weeks […]