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

Colorado health plan changes for 2017

Changes to our family’s plan for 2017

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 healthinsurance.org, so if you have questions, you might find answers there.

But after receiving our own family’s renewal packet in the mail today, I wanted to take a few minutes to address some questions that I’m guessing some of you have if you’ve looked at your renewal info.

Yes, rates are going up. The average rate increase in Colorado’s individual market will be about 24 percent for people who aren’t currently eligible for subsidies. For the entire state’s entire individual market, the average rate increase is 20.4 percent. But if you’re receiving subsidies, your rate hike will be partially or fully mitigated by a corresponding increase in the subsidy amounts.

And you may have noticed some additional benefits that will apply to your health insurance plan in 2017, specifically with regards to chiropractic care, bariatric surgery, and infertility treatment.

That’s because Colorado — along with the rest of the states — will have a new benchmark plan (see definition 2) in 2017. The initial benchmark plans that states selected were valid for 2014-2016, but are being replaced with new plans for 2017 and beyond. CMS has links to each state’s benchmark plan details, so it’s easy to compare Colorado’s current benchmark plan with the one that will apply beginning in 2017.

All three of those services — chiropractic care, bariatric surgery, and infertility treatment — were not covered on the Colorado benchmark plan that applied in 2014-2016. But they are all covered under the new benchmark plan that will take effect in 2017. Since the other plans in the individual and small group markets have to provide benefits at least as good as the benefits in the benchmark plan (with a few exceptions, detailed on the CMS page under “excluded benefits”), coverage for those three areas of treatment will be included in your plan for 2017.

But you’ll want to check the fine print to see the level of coverage your plan is offering, particularly with regard to infertility services. The benchmark plan’s details state the following:

NOT COVERED: “Services to reverse voluntary, surgically induced infertility. b. All Services and supplies (other than artificial insemination) related to conception by artificial means. This means prescription drugs related to such Services, and donor semen and donor eggs used for such Services, such as, but not limited to in vitro fertilization, ovum transplants, gamete intra fallopian transfer and zygote intra fallopian transfer are not covered. These exclusions apply to fertile as well as infertile individuals or couples.

THE FOLLOWING SERVICES ARE COVERED (including x-ray and lab work): “(a) Services for diagnosis and treatment of involuntary infertility; and (b) artificial insemination, except for donor semen, donor eggs and Services related to their procurement and storage.

So the minimum in terms of infertility treatment coverage will be to cover artificial insemination using the couple’s own eggs and sperm. But the big ticket items — IVT, GIFT, ZIFT, etc. — are not covered under the benchmark plan, and so do not have to be covered under other plans in the state in 2017.

As always, there’s no substitute for reading the fine print on your own plan, since the details vary considerably from one plan to another. We can help you sort through the specifics so that you can pick the plan that best suits your needs during open enrollment. You can also use our Rx formulary comparison tool to see which carriers cover specific prescription drugs.

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP. Follow on twitter and facebook.

Comments

  1. Unless I’m mistaken, as of 2017 there are no more individual PPO plans available in Colorado – on or off exchange.

    This is a huge change in the marketplace, surprised it hasn’t gotten more mention.

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