by Matt Valeta, Health Policy Fellow

While Obamacare was passed in 2010 many of the biggest pieces of the law are still being implemented. It is not even the 7th inning stretch and we have yet to sing ‘Take Me Out to the Ball Game.’ As implementation of Obamacare continues these new regulations give even more clarity to what Obamacare will look like for us the consumers. The regulations released this November provided a lot of clarity about how Obamacare will help you get access to affordable health insurance that gets you the care you need when you need it.

Fair Health Insurance Premiums

  • You are guaranteed issue of health insurance regardless of your health status or pre-existing conditions.
  • You are guaranteed to be able to renew your plan.
  • You cannot be charged a higher rate if you have a pre-existing condition.
  • You cannot be charged a higher rate because of your gender. Your premium will no longer be higher because you are a woman. (Colorado had already made gender rating illegal since 2010)
  • Rating based on age is limited to 3 times the rate of a 21 year old. This means that costs will not be shifted to older Americans who are not yet covered by Medicare.
  • Insurers are now required to put all customers in to a single risk pool. This prevents insurers from shifting costs to a certain populations.
  • Your health care premiums can only be increases based on your age, where you live, your family size, and whether you are tobacco user.
  • Colorado conducts rate reviews to approve all rate increases in the individual and small group markets. The federal government can provide additional review of any rate increase to evaluate its reasonableness.

These new regulations are designed to make sure that you have health insurance and that you can afford it. Guaranteed issue will ensure that they can find coverage so that consumers meet the individual mandate. The new regulations outlining rating factors and the rate review program will help make sure that your premiums are not excessively increased. 

Essential Health Benefits

Obamacare also ensures that the health plans you purchase are quality health plans and includes essential health benefits The Essential Health Benefits (EHB) package provides a baseline for coverage in 10 essential categories. In Colorado our EHB package is based of a Kaiser small group plan. 

With the new regulations, Colorado now has the opportunity to define what is included in the habilitative services category- services that create skills and functions- as it is not currently defined in Colorado.

Wellness Programs

Obamacare provides funding for wellness programs in employer-sponsored health plans. The regulations only allow incentives for a wellness program to 30% of the overall costs. If someone does not meet a health outcome, there has to be a reasonable alternative to reach the bonus.

Reinsurance and Risk Adjustment

Finally, the new regulations outline the reinsurance and risk adjustment program that will help keep your premiums affordable in the Exchange. The Reinsurance program will provide funding to insurers to help them cover costs if they get a lot of customers with high health needs. The risk adjustment program will give insurers with too many expensive patients payments from insurers that have a healthier client base. Together, these programs work to help insurers transition into the Exchange, helping keep your premiums low and giving you meaningful choice in the Exchange.

Getting the care you need when you need it isn’t too much to ask. As Obamacare is implemented these new details will help make affordable care a reality for Coloradans.

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